Inspection on 02/09/08 for Katherine House

This inspection was carried out on 2nd September 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Katherine House 10/03/09

Katherine House 17/05/07

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOME ADULTS 18-65 Katherine House 91-93 Sutton Road Erdington Birmingham West Midlands B23 5XA Lead Inspector Alison Ridge Key Unannounced Inspection 2nd September 2008 08:50 Katherine House DS0000068481.V371130.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 Katherine House DS0000068481.V371130.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. Katherine House DS0000068481.V371130.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Katherine House Address 91-93 Sutton Road Erdington Birmingham West Midlands B23 5XA 07834977180 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) Pharus Care Limited Ms Sheila Claybur Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Katherine House DS0000068481.V371130.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of care only Care Home only to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning Disability 10 The maximum number of service users to be accommodated is 10. Date of last inspection 17th May 2007 Brief Description of the Service: Katherine House is a large detached house and provides twenty-four hour care and support for ten people with Learning Disabilities, Autism and Challenging Behaviour. The home is situated on Sutton Road in Erdington. It is close to the centre of Erdington where there are a variety of shops, restaurants, transport links and leisure facilities. There are eight single bedrooms, each one with an en-suite bathroom with either a bath or shower. One of the bedrooms is on the ground floor and is accessible to a person with limited mobility. All other bedrooms are on the first floor. On the second floor there are two semi-independent flats, with separate lounge and bathroom. There are two large lounges on the ground floor a large dining room and a domestic kitchen and a separate laundry. The office and staff sleep-in facilities are located on the second floor. To the rear of the Home is a large garden with lawned area and patio, and to the front of the Home there is off street parking. A copy of the last inspection report, a Service User Guide and Statement of Purpose were available at the home. The range of fees were included in the Service Users Guide. Katherine House DS0000068481.V371130.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 people who use this service experience poor quality outcomes. The main inspection took place over one day, followed up on the following day by a pharmacy inspection. The home did not know we were coming. We met briefly all of the people living at the Home, looked at shared parts of the home, and one persons bedroom, looked at care records and health care records and medication management. Health and safety records and staffing records were also assessed. All information looked at was used to determine whether peoples varied needs were being effectively met. On this occasion very limited time was spent with the people who live at Katherine House. The feedback we received with the exception of one person was positive. The manager completed an AQAA (annual quality assurance assessment), which tells CSCI about how well the home thinks they are performing and achieving outcomes for the people who live in the Home. It also provides some factual information about the home. Information from the AQAA was used to help inform the inspection process. We didn’t meet any relatives or professionals during the visit, but some comments from family members of people living at Katherine House were noted in the compliments book, and these have been considered as part of this inspection. What the service does well: People who live at Katherine House have good, fresh food and they have opportunities to choose dishes they like, so people can eat a healthy, well balanced diet that meets their needs. Everyone has their own bedroom, staff don’t enter these without permission, so people can be assured their privacy will be maintained. People can put things important to them in their rooms, to make them feel comfortable and homely. There are lots of opportunities to go out of the home for activities. There are two cars to help people get to places they would like to go, so people can do things they enjoy. Family can visit people at Katherine House, and are made to feel welcome. Katherine House DS0000068481.V371130.R02.S.doc Version 5.2 Page 6 People get the chance to feedback about the things they like and dislike at Katherine House. People are asked and things that are important to them are written down in their care files and in meeting minutes. What has improved since the last inspection? What they could do better: Recruitment for new staff needs to continue so that a stable staff team is in place, this will help people feel confident the staff know them, what they like and need and how their needs should be met. When new staff are found the records to show they have been checked need to be better and must be kept at the home, to ensure only people who are safe to work with vulnerable people are employed. The managements knowledge about what to do in the event of people being abused or placed at risk of abuse must improve so that people living at Katherine House are safeguarded from abuse and harm. The running of the home needs to get better to ensure that each person has their needs met, and the negative impact of one person on another is minimised. The care needs people have need to be assessed and recorded in a clear and accessible way. Staff need to be sure of what these are, and need to have the relevant training and where needs be, to have signed to say they have understood. Medicine management must improve to ensure that the health and safety of the residents is maintained at all times The owner of the home needs to make regular, at least monthly recorded visits to the home, to show he is aware of how the home is running and to ensure he knows how people living at Katherine House are and feel about the home. Some of the things we identified last year, which needed improvement, have not been fully addressed, and these must be sorted out urgently, so that the home is a safe place to live. Katherine House DS0000068481.V371130.R02.S.doc Version 5.2 Page 7 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. Katherine House DS0000068481.V371130.R02.S.doc Version 5.2 Page 8 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 Katherine House DS0000068481.V371130.R02.S.doc Version 5.2 Page 9 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 Quality in this outcome area is adequate. People have a chance to visit the home and try it before making a decision about moving in, this helps them to feel confident they will like the home they have chosen. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In the care files sampled, it was evident that people had been assessed by staff from the home prior to being offered a place and moving in. Assessments were lengthy but it became apparent during the visit that they were not comprehensive as needs outside those known and assessed became apparent, for which no assessment or plan of support was available. It was positive that records showed that people had been offered the opportunity to visit the home and stay over night if they wished before deciding whether to move in. At this visit we did not find out directly from people living at Katherine House if they were happy with this process. A Statement of Purpose was provided. This was very full, and generally informative. It had not however been amended as identified at the last inspection with details regards emergency admissions. Katherine House DS0000068481.V371130.R02.S.doc Version 5.2 Page 10 A Service User Guide was provided. This was written in an easy read format, it contained the necessary information, and gave the reader a feel of the opportunities available in the home. It included details about fees and exclusions. Katherine House DS0000068481.V371130.R02.S.doc Version 5.2 Page 11 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): 6,7,8,9 Quality in this outcome area is adequate. Many of peoples wishes and risks are known and recorded, however some of these are not, which could result in needs going unmet, or not met in the way people wish. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care documents of one person were looked at in full, and the care documents of a further three people were sampled. It was pleasing to find that much effort had been made to find out about each persons strengths and information such as “Things that are great about me” had been recorded. The people who live at Katherine House all have multiple and complex needs and the documents available did not fully recognise these. This does not ensure staff have all the information required to consistently and safely meet assessed needs and wishes. Katherine House DS0000068481.V371130.R02.S.doc Version 5.2 Page 12 We identified that some of the people living at Katherine House will have rapidly changing needs and wishes as they have just moved from children to adult services. The majority of documents reviewed stated “No change” and it was not evident that the information collected in the past month from care notes, incident or activity records for example had formed part of the review. Staff at the home arrange for “Talk time “ to be held. This is a meeting in which people can feedback their experiences of the home, and any hopes or changes they would like to see occur. Written notes showed that three of these meetings had been held in 2008, and that generally the same people attended each one. Staff need to look at how to engage and canvass the views of people who would not be able to, or wish to partake in a joint meeting. Lots of very positive ideas had been put forward by people regards activities they would like to do, however we could not see how this information was being built into each persons activity/lifestyle plan. We therefore could not be certain that the views of people living at Katherine House were being listened to and acted on. Each of the care files sampled had a range of risk assessments. These had been kept under review, but as previously mentioned it was not evident that information collected during the month had been used to inform these reviews. We did not find that the information in the care files was linked. In some cases people had risk assessments for medical conditions, but no mention of this in a care plan for example. We suggested that a significant piece of work regards care documents needs to be undertaken to consolidate and review them to ensure the documents available underpin people’s needs and provide staff with the guidance and support required. Katherine House DS0000068481.V371130.R02.S.doc Version 5.2 Page 13 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 adequate. People have opportunities to access leisure and learning both at home and in the community so people are supported to lead a busy meaningful life. A range of fresh and tasty food is provided which meets their individual needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The daily notes read did show that people undertake a wide range of activities in the community. At the time of inspection a large number of people were observed to be supported to access the community, and the home has two vehicles to support people with this. Two staff were interviewed as part of the inspection and one reported that, “This place offers a lot of opportunities unless people choose not to take them.” We looked at the cultural and religious needs of one person, and could evidence that some opportunities were provided by the home, but these could Katherine House DS0000068481.V371130.R02.S.doc Version 5.2 Page 14 be explored by the home much further. At this visit we did not find out if the people were happy with the opportunities offered to them in this area. It was pleasing to see that family members are welcomed into the home, and although no family were seen in person at the time of the visit, comments in the home from family included, “ We have been so happy with the care and attention given to x, staff are welcoming and attentive”, “ Staff are always willing to talk with you, pleasant atmosphere in difficult circumstances, staff are caring and pleasant” It was reported by staff and evident in care notes that people are supported to maintain the relationships that are important to them. We were not able to see that people’s wishes in the area of sexuality and gender had been well explored or documented. This means staff may not support people in the way they wish. Entries were limited to “Displays no sexually inappropriate behaviour.” At this visit we did not find out how people feel about this area of their support but we have recommended this be reconsidered. We saw a copy of the planned menu, and records of food eaten. A large supermarket shop had been undertaken the day prior to the inspection, and a large and varied supply of food was available in the home. The menu was varied and did show with initials that people had been involved in choosing a meal. We were concerned not to be able to track the dietary intake in the record sampled. Two areas were of particular concern to us. One person was identified as being light/under weight, and another person we looked at had a specific cultural diet. The food record had large recording blanks, and it was not possible to establish if food had been offered and rejected, or offered and eaten but not recorded, or if food offered met with the persons cultural needs. This is an area that needs to improve. Katherine House DS0000068481.V371130.R02.S.doc Version 5.2 Page 15 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. People cannot be certain that all staff know or are able to meet their medical needs or manage their medication. This does not ensure they receive the required support or medication at the right time. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has some very detailed routines sheets detailing how each person likes to be supported with their personal care. These were all seen to be individual. For example we were pleased to see that times for rising and retiring to bed were not set, but individual to each person. We spoke briefly with four of the people living at Katherine House, and it was evident they had all been supported to undertake personal care to a good standard and to present themselves in a way they were happy with. We found that the range of needs of the people living at Katherine House were very complex and diverse. These included a range of challenging behaviours, autism, asperger’s, mental ill health and additional medical conditions. Katherine House DS0000068481.V371130.R02.S.doc Version 5.2 Page 16 It was not possible to establish from the records provided that all these needs had been assessed and planned for by the home, and our observations in the home did not show that staff were always confident or able to meet them. The manager was asked to produce all the records relevant to a specific selection of peoples needs. Three main records were provided for each person. We read and commented on these. We did not find that they had all the information required for each person. We were surprised that during feedback the manager produced further records that were not referenced in the main files or provided initially when requested. We determined that this number of files in so many locations would not support staff in meeting people’s needs. We asked the manager to provide us with a basic needs profile of each person and tracked the needs they stated against records held. Key issues such as sleep disturbance, challenging behaviour, self-harm and epilepsy for example were either not planned for at all or the records available did not reflect the intensity and severity of the need. We were concerned that this had not been undertaken and this combined with evidence from training and recruitment files did not evidence to us that the home had employed staff with the range of skills to meet the complex needs of the people accommodated. The specialist care needs of one person with Epilepsy were tracked. It was positive that a detailed care record had been established with a specialist epilepsy nurse. It was however very concerning not to be able to evidence that the majority of staff had read this, and were confident to deliver the care required. When questioned the manager reported that the pathway was quite new, however closer examination showed the first of the few people to have signed the document had done so two months previously. We were not confident that the staff could support this person safely or effectively in the event of a seizure occurring. The pharmacist inspection took place on the following day of the main inspection. It lasted just over three and a half hours. Four residents medicine charts were looked at together with their corresponding medication and supporting care plans. One senior care assistant was spoken with and all feedback was given to the manager present during the inspection. The medicines were all stored in a locked trolley and cabinets within a locked cupboard in the home. Key security was good and staff understood that the cabinets and trolley should remain locked at all times when not in use, so residents don’t have access to the medicines inside them. Two senior care assistants prepare the medication, one administers them. Both record the transaction on the medicine chart. Concern was raised that as both staff sign the medicine chart it was not possible to demonstrate who actually had administered the medication. We were told that one member of staff stayed with the trolley whilst the other took the open pot of medicines to Katherine House DS0000068481.V371130.R02.S.doc Version 5.2 Page 17 the resident in the home. There was nowhere to secure these medicines if an emergency occurred whilst travelling through the home. One open pot of medication was found in the trolley that the resident had refused to take but this had not been labelled so could easily be given to the incorrect resident. In addition they had been recorded as administered on the medicine chart, but an additional chart identified that this had not occurred. Staff should only be signing the medicine chart once the actual medication has been taken. The prescriptions were seen prior to dispensing and a copy of them were taken for staff to check the dispensed medicines received into the home. Quantities of medicines received had been recorded but staff didn’t always carry over any balances of medicines from previous cycles so it was not possible to demonstrate if they had all been administered as prescribed. Audits indicated that the majority of medicines had been administered as prescribed and only a few errors were seen. Evidence of secondary dispensing was seen. Staff had put some dispensed medication into another pharmacist labelled container. This is considered poor practice as expiry dates may be different and staff may inadvertently put the incorrect medication in the container so the resident may receive the incorrect medicines. All medicines must be administered from the pharmacist dispensed and in a labelled container as received into the home. Some medicines had been purchased for use as homely remedies. These had not been recorded on the medicine chart to record administration and no protocols were seen to support their use. It could not be demonstrated if advice had been taken to confirm there were no potential drug interactions between the homely remedy and the prescribed medication. One supporting care plan-detailing guidelines for administering “when required” medication was seen for one resident. This was very good in content but the senior care assistant who administered medication had a very poor knowledge of its content, which may have a very serious consequence for the resident as the protocol was for a life threatening condition. Not all “when required” medication had supporting protocols for staff to follow. The senior care assistant spoken with had a very poor knowledge of the medicines he administered. Most were described as “for calming the resident down” which was not the case. Due to the complex needs of the residents’ who live in the home current accurate information about what the medicines do and their side effects is essential for staff to be able to fully support them. The care plans were lengthy and repetitive and had not been fully updated. Despite asking for the clinical information the manager did not produce these until the end of the inspection. Instead social care plans were offered. Files Katherine House DS0000068481.V371130.R02.S.doc Version 5.2 Page 18 were cumbersome and difficult to negotiate through and lacked specific details of doctor’s visits or plans to fully support the clinical needs of the residents. For example following the doctor’s visit, a prescribed medication was not named or any other information surrounding the outcome of the consultation. The manager had introduced a medicines quality assurance system. This was supposed to be undertaken weekly but due to the busy nature of the home it was difficult to do and three weeks had elapsed when it had not been done. It did not identify individual staff practice and was unnecessarily cumbersome. A medication competency test had been devised which was very good in content. However staff handled and administered medication before they had completed the assessment so the manager was unaware of actual staff competency, which may lead to medication errors. The home did not have a controlled drug cabinet that complied with the Misuse of Drugs (safe custody) Regulations 1973, but all controlled drug transactions were accurately recorded in the separate register. Katherine House DS0000068481.V371130.R02.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is adequate. People cannot be confident that arrangements in place protect them from harm or ensure their views are listened to and acted upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We found it positive that the staff make time, ”Talk time” to consult with people about how it is living at Katherine House. It was of concern that we could not see how these views and information were being fed back into the homes operation. The Commission received a complaint about Katherine House in June. This was referred to the provider, and a detailed response was provided. A record of the complaint was not evident in the complaints log. The home has provided information in formats as accessible as possible to the people living at Katherine House regards what to do if you wish to make a complaint, however at this visit we did not find out from people if they know how to make a complaint. We were informed that a Safeguarding matter had arisen on the day prior to inspection, and that some action to protect the people living in the home had been undertaken. The manager informed us of her plan of action following this, and we were concerned to find this was not consistent with the procedures laid out regards safeguarding vulnerable people. We were not confident that the manager Katherine House DS0000068481.V371130.R02.S.doc Version 5.2 Page 20 would have pursued the correct course, if the inspection and subsequent guidance had not taken place. We therefore could not be certain that people were protected or supported as is required. We did not find that the running of the home, or records available protected the people from abuse, neglect or self-harm. We observed and heard that often one persons experience would upset other people living at Katherine House causing a domino effect of challenging behaviour. It was not evident that the home was as pro-active as possible in meeting each person’s individual needs in a timely way, which possibly could prevent this escalation and subsequent harm or risk of harm. It was of concern to us that one of the staff interviewed believed a person was prescribed a medication, “In case she was abused”. This did not make us feel confident that all staff were aware of the reason medication was prescribed. Katherine House DS0000068481.V371130.R02.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): 24,30 Quality in this outcome area is good. Katherine House has been furnished and maintained in way which provides a comfortable and homely place to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Katherine House is still a fairly new home, and it is furnished and decorated in a homely and comfortable way. We were pleased to find that although wear and tear is already evident this is being managed and ongoing work undertaken to ensure a good standard is maintained. Since the last inspection a conservatory and kitchen extension have been completed. The conservatory will provide additional communal space for people to pursue their interests and the larger kitchen enables people to safely access the equipment and food with staff support if required. One person kindly showed us their bedroom. This was very well presented and had lots of their personal items to help it feel homely. We identified some possible hazards of particular concern regards the needs of some of the people that live at Katherine House. These included a hearth in the Katherine House DS0000068481.V371130.R02.S.doc Version 5.2 Page 22 lounge, which could cause injury, or trip hazard in a challenging incident, trailing wires from a wall mounted TV and roller blind chords. These had not been risk assessed to find ways to reduce or remove the risk to people living and working at Katherine House. There is a large garden to the back of the home, and this was being used as a place to relax or to ride bikes. We found that standard of cleanliness was reasonable, and that the products and equipment required to maintain the home to this standard were available. Katherine House DS0000068481.V371130.R02.S.doc Version 5.2 Page 23 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 adequate. Not all staff records showed that the required recruitment checks, supervision or training had taken place, which does not ensure people are always supported by people able to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We undertook very limited observation of staff practice during this inspection. It was possible to hear that some good work was being undertaken with people to engage them and help them with their day. We also heard and saw some interactions were lacking and did not help the person with challenges or events they faced. The records sampled did not show that the majority of staff had experience of working with people who have this level and type of needs, and that while some training was being provided this was not to an advanced level. It was positive that most staff had undertaken training in physical intervention. One staff explained that this had been “Very good and helpful” as they had never worked in this type of service previously. It was of concern that risk assessments regards behaviour and possible physical intervention identified, “All staff NVCPI” trained. (This is the name of the physical intervention training) yet rotas showed that this was not the case. It was not evident that Katherine House DS0000068481.V371130.R02.S.doc Version 5.2 Page 24 staff profiles were being considered when planning each day’s activities and support. We were aware from the AQAA that a large number of agency staff are used by the home to fill vacancies. It is positive that the home tries to use the same agency staff where possible to promote continuity. At the last inspection we were concerned that recruitment practice was not safe. We were concerned at this visit to find that the home had no recruitment records for staff supplied by the agency, and as such could not have verified their experience, qualifications or suitability to work in the home. These were obtained during the inspection, but these staff had already had many weeks of access to the vulnerable people living at Katherine House. This practice does not ensure people are supported by staff who are qualified and safe to work with them. It was apparent that the home has an extensive training programme in mandatory areas and it is encouraging that staff can access the NVQ award, and some basic relevant training specific to the people at Katherine House. We could not establish that the home had enough staff with the very specialist knowledge and skills required to meet the needs of this group. Supervision had been undertaken with staff. Records showed this was to a good level, but that the frequency needs to be increased to ensure staff are adequately supported and that the target of at least six supervisions each year is met. This will ensure that staff are well able to support the people they work with. Katherine House DS0000068481.V371130.R02.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is adequate. The management of the home did not always ensure the people’s needs were well met, in the way they wish. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A new manager has been recruited and commenced in post since the last inspection. She was present during our visit and was supportive of the process. The visit did not establish how ever that the management was adequate or effective to ensure Katherine House is well run. Examples of this area included in the earlier sections of the report. We requested evidence of Quality Assurance at the time of inspection. This was not available in the home. A report was sent to us following the inspection, this Katherine House DS0000068481.V371130.R02.S.doc Version 5.2 Page 26 had been completed earlier in 2008. It was disappointing to find that shortfalls identified in this audit over five months previously remained evident at the time of inspection. No action plan regards how to address the shortfalls identified was included with the report, this did not evidence that the management had used this tool to develop or improve the service. The tool did not show that the views of people living at Katherine House had been sought during the audit. The AQAA document informed us that all the required tests of health and safety equipment had been undertaken. We saw audits by the service manager to confirm this, and we subsequently only sampled health and safety records. We found that water temperatures in bathrooms and showers are tested weekly, fire drills are undertaken, emergency lighting is tested monthly and food and fridge temperatures are tested and recorded. This ensures these appliances are safe to use. The home had fallen behind in testing the fire alarm weekly, and this had not been completed for over a month. It was not evident that the documents regards the fire safety system had been reviewed and amended following the recent extension of the home. Doing this would ensure in the event of a fire the alarm would sound, and people would know what to do, and where to go. The home has to send us an AQAA document each year, when we ask for it. This tells us how the home thinks it is performing. This home did return an AQAA, but we found the information contained was basic, and poorly presented. There is a legal requirement that the owner must make at least monthly, recorded visits to the home. Records available show that only three visits have been undertaken in 2008, in January, February and May. Katherine House DS0000068481.V371130.R02.S.doc Version 5.2 Page 27 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 2 2 2 3 2 4 2 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 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 2 2 2 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 2 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 1 x 1 X 2 X X 2 X Katherine House DS0000068481.V371130.R02.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No 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 YA18 Regulation 12 Requirement Arrangements must be made to ensure to ensure all peoples health care needs are identified and staff have clear instructions on how to meet these to ensure their good health is promoted. The medicine chart must record the current drug regime as prescribed by the clinician including any homely remedies administered. Timescale for action 03/11/08 2. YA20 13(2) 03/10/08 3. YA20 13(2) It must be referred to before the preparation of the service users medicines and be signed directly after the transaction by the member of staff who administered the medicines. It must accurately record what has occurred. Staff must transport medicines 03/10/08 throughout the home in a safe manner and all medicines must be able to be securely held in a locked facility in the event of an emergency All secondary dispensing must cease. All medication must be administered from a labelled Katherine House DS0000068481.V371130.R02.S.doc Version 5.2 Page 29 4. YA20 13(2) container as dispensed by the pharmacist. The quantity of all medicines received and any balances carried over from previous cycles must be accurately recorded to enable audits to take place to demonstrate the medicines are administered as prescribed The right medicine must be administered to the right service user at the right time and at the right dose as prescribed and records must reflect practice. 03/10/08 5. YA20 13(2) 6. YA20 13(2) 7. YA20 13(2) 8. YA22 22 9. YA33 18(1)(a) A quality assurance system must be installed to assess staff competence in their handling of medicines. Appropriate action must be taken when these indicate that medicines are not administered as prescribed and records do not reflect practice, to ensure that all medicines are administered as prescribed and this can be demonstrated. All staff must be trained to understand the indications and side effects of the medicines they handle. The purchase and correct installation of a controlled drug cabinet that complies with the Misuse of Drugs (safe custody) 1973 is required to safely store all Controlled drugs kept in the home. Complaints must be logged with details of how they were investigated and their outcome to ensure that the procedures are followed and concerns are dealt with. A staff team with the required experience and qualifications must be recruited to ensure the DS0000068481.V371130.R02.S.doc 03/10/08 03/11/08 03/12/08 02/10/08 01/11/08 Katherine House Version 5.2 Page 30 10. YA34 Sch27, 9, 19 23(4)(c ) 11. YA42 12.. YA43 26 complex needs of service users can be met. The recruitment practices must be reviewed to ensure robust systems are in place to protect people. Suitable arrangements must be made to ensure fire detection systems work, and people will be alerted promptly in the event of a fire. Monthly owner (Regulation 26) visits must be undertaken to ,mxcensure the home is being managed appropriately. Evidence of these must be available at the home. 02/10/08 20/10/08 01/11/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. Refer to Standard YA1 YA1 YA6 YA8 YA9 YA15 YA17 Good Practice Recommendations The statement of purpose should be amended to include emergency admission procedure. The pre-admission assessment be reviewed to ensure this is comprehensive, and that findings are kept under review. Care plans should continue to be developed so that all people have a comprehensive care plan. Talk time should be reviewed to ensure all service users views are heard, and that information collected is used in the development of the service. Risk assessments should be reviewed utilising information collected on incident and daily reports to ensure risks are fully known and planned for. The home should further explore ways it can support service users in the areas of sexuality and gender. A full food diary should be maintained where service users are at nutritional risk or low body weight to ensure they are receiving the nutrition required to maintain a healthy weight. Health action plans should be further developed to ensure that a comprehensive and user-friendly plan is in place. DS0000068481.V371130.R02.S.doc Version 5.2 Page 31 8. YA19 Katherine House 9. YA23 10. YA24 11. YA39 Contact details of other agencies (Social services etc) and refresher training for staff on vulnerable adult issues should take place so that staff know what to do should an incident occur in the Home. Environmental risks noted to include the fire hearth, roller blind chords and trailing TV cable should be risk assessed and any identified action taken to ensure risks to people and staff are reduced or removed. Service users views should be sought and included in Quality Assurance. It is recommended that an implementation plan be developed following a quality assurance audit. Katherine House DS0000068481.V371130.R02.S.doc Version 5.2 Page 32 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Katherine House DS0000068481.V371130.R02.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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