Inspection on 20/06/06 for Leeza Court - Welcome House

This inspection was carried out on 20th June 2006.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 19 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Leeza Court - Welcome House 29/01/07

Leeza Court - Welcome House 15/02/06

Leeza Court - Welcome House 21/09/05

Leeza Court - Welcome House 29/12/04

Leeza Court - Welcome House 01/04/04

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

CARE HOME ADULTS 18-65 Leeza Court - Welcome House Leeza Court 9 London Road Rainham Kent ME8 7RG Lead Inspector Mary Cochrane Unannounced Inspection 20th June 2006 10:00 Leeza Court - Welcome House DS0000031629.V299839.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 Leeza Court - Welcome House DS0000031629.V299839.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. Leeza Court - Welcome House DS0000031629.V299839.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Leeza Court - Welcome House Address Leeza Court 9 London Road Rainham Kent ME8 7RG 01634 377667 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) Welcome House Residential Care Homes Post Vacant Care Home 16 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (16) of places Leeza Court - Welcome House DS0000031629.V299839.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th February 2006 Brief Description of the Service: Leeza Court is a large detached property with accommodation on two floors, offering fourteen single and one double bedroom. The home is registered for 16 service users. Communal areas include a large lounge, a dining room, kitchen and conservatory. The home is located on the main road in Rainham, Kent. It is close to good transport links to the main Medway Towns and has pubs, local shops and facilities nearby. The home benefits from a large rear garden. The current fees for the service range from £540.00 - £865 per week. Information on the Home and the CSCI reports for prospective service users will be detailed in the Statement of Purpose and Service User Guide. Leeza Court - Welcome House DS0000031629.V299839.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 key inspection, which took place over one day. Two inspectors undertook the site visit to the home. All the key standards were looked at during the visit and the inspectors gave special attention to the requirements and recommendation identified in the previous report. One inspector spent the majority of time with service users and staff whilst the other looked through records and spent time speaking with the acting manager of the home. The acting manager returned a pre-inspection questionnaire. Questionnaires were sent to service users and other visiting professionals but none of these were returned. The acting manager has only been in post since March ’06 and she realises that she has a lot of work to do to meet the National Minimum Standards. She requires the support and assistance from the company to identify, implement and develop systems to ensure the home improves and all the needs of the service users are met. 2 of the 3 care staff working at the home have only been there a very short time and are only just getting to know the service users. During the inspection the atmosphere in the home was calm and the service users seemed settled and content. The majority of the service users spoken to said that they liked living at the home, some said that they were waiting to move on from the home into more independent living. The service users were very supportive towards each other. Their main collective issue with the home was the attitude of the acting manager, which they find abrasive and disrespectful at times. This was discussed with the manager and the registered provider at the time of the inspection and both reported that this issue had been identified the previous week and that steps are being taken to address it. The following methods of inspection and information gathering were used: one-to-one discussion with staff, communicating with service users, observing interactions, care interventions and activities, reading and discussing individual support plans, risk assessments, selected policies, medication charts, training matrix and training programmes. Leeza Court - Welcome House DS0000031629.V299839.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The service users need to have information available to them in a format that they understand explaining what the home offers and how the home plans to meet their needs. Service users do not have adequate assessments prior to being admitted to the home. The acting manager needs to ensure that all assessments are done. The monitoring, planning and implementing of care, needs to be undertaken for all service users and systems improved. The home needs to ensure that all risks are kept to a minimum. The systems and tools that have been put in place should be fully used to attain this. Leeza Court - Welcome House DS0000031629.V299839.R01.S.doc Version 5.2 Page 7 All the service users need to have access to a variety of activities and leisure pursuits. They need to be given every opportunity and support to reach their full potential and have a fulfilling life both in the home and in the community. The home needs to ensure that all the health of the service users is promoted and monitored. The service users need access to all health care facilities and also receive any specialist input that they require. The number of staff working in the home is minimal and should be reviewed with a mind to increasing numbers on duty. The arrangements for residents to contact staff during the night should be improved. Staffing hours are insufficient to meet the needs of service users. The home needs to have registered manager in post. The service users need to be treated with respect and dignity at all times. All staff need to receive the necessary training to enable them to develop the skills and knowledge required to look after all the service users. The staff need to receive the necessary support and guidance from their seniors to make sure they are doing their jobs effectively and properly. The company needs to ensure that all staff employed are fully vetted before starting work at the home. Effective quality assurances needs to be implemented to measure the homes success in achieving aims and objectives outcomes and identifying shortfalls so they can be acted on. The home needs to develop a maintenance and renewal programme to ensure that Leeza Court is a pleasant and homely place for the service users. 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. Leeza Court - Welcome House DS0000031629.V299839.R01.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 Leeza Court - Welcome House DS0000031629.V299839.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 5 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The prospective and existing service users at the home do not have all the information required to ensure that the home will be able to meet all their needs. Prospective service users cannot be sure that their individual aspirations and needs are assessed. Service users places at the home are protected. EVIDENCE: At the time of the visit the home was unable to provide an up-to-date statement of purpose or service users guide. The registered provider reported that he had just completed amending the homes new statement of purpose. He reported that this will be available and used for achieving the aims and objectives of the home as soon as he receives feedback from the link inspector. Leeza Court - Welcome House DS0000031629.V299839.R01.S.doc Version 5.2 Page 10 The inspector looked at the files of the three most recent service users who have come to live at the home. One service user was recently admitted from the south west of England and staff were unable to assess due to the distance. However there was evidence to show that contact and discussions had taken place between the registered provider and the care management team to show that some assessment of needs had taken place prior to the service user being transferred. On the other 2 files there was no evidence to show that any preassessment had taken place and there was very little information available to allow the development of a care plans and risk assessments. The manager is now backtracking and is going to assess all the service users at the home to ensure that all their needs are identified and the home is able to meet them. All of the service users had individual contracts in place which explains the terms and conditions of residency. Leeza Court - Welcome House DS0000031629.V299839.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users cannot be sure that their assessed and changing needs and personal goals are reflected in their individual plan. Service users are able to make decisions about their lives but their participation is limited in the way the home is run. Their views are not considered. The home cannot ensure the safety of the service users as risks are not identified, recorded and minimised. Leeza Court - Welcome House DS0000031629.V299839.R01.S.doc Version 5.2 Page 12 EVIDENCE: There are major shortfalls in the planning and implementing of the assessed and changing needs of all the service users. The acting manager has not yet transferred information of care needs on to the companies new system but has made a start. She reported that she needs to get to know the service users first, which will enable her develop individual care plans for each resident. There is a long way to go before this standard is met. The manager is working towards developing a key-worker system but this has not yet been implemented. The Inspector viewed one of the new plans and four old ones. All need further developing to ensure that all care needs are met. The plans need to contain precise and accurate information. For example one plan said that a service user suffered from anxiety and panic attacks, the action was to support and reassure. There was no information on how the attack would be recognised, what the trigger might be and in what way staff were to support and reassure. Most of the plans are inadequate. One service user who was admitted to the home in October ’05 did not have any care plan. The plans are difficult to follow and disorganised and information was not kept together. Staff are not able to use them as a working document. The manager needs to ensure that the service users and staff are actively involved in developing the new plans. The staff need to have all the information available to enable them to deliver the individuals care in the most effective and safest way. It was evidenced that newly identified needs are not incorporated into the care plans. One service user had recently visited the G.P and new needs had not been added to his care plan. Information identified at reviews had not been actioned. The service user plans generated by the home do not adequately address restrictions on choice or freedom and where restrictions are imposed there is no evidence of these being agreed with the individual service user. There is no clear guidance or individualised procedures to enable staff to manage any incidences of self-harm or aggression. Care plans need to be updated when necessary and used as a daily working document by all the staff. A requirement will be issued to the home that the new care plans are completed and implemented within four months. This will give the manager the necessary time to develop the plans and allow staff to be trained appropriately so they can produce a care plan that is of a high standard and ensure that all the needs of the service users have been identified and met. The staff do not complete daily records so the home are unable to track the daily activities of the service users. Information is lost and forgotten. The Leeza Court - Welcome House DS0000031629.V299839.R01.S.doc Version 5.2 Page 13 manager needs to ensure that this issue is addressed and the practise improved. Service users are involved in the CPA process and have an awareness of the roles of CPNs, Consultant Psychiatrists and other professionals. Some of the service users reported that they are able to make decisions on how they live their lives and this was seen on the day of the visit. On the day of the inspection 3 service users had all gone fishing, which they had organised themselves. The home does need to evidence how decisions are made by service users which affect their daily lives and also how, why and when decisions have to be made by others. Service Users meetings are not taking place regularly. The manager needs to ensure that the service users are consulted and participate in all aspects of life at the home. They need to be involved in the daily running of the home and their choices and preferences need to be acted on. The home does have some risk assessments in place for some service users, but these do not address all current and potential risks as identified in the CPA risk management process. The individual risk assessments at the home do not give staff the necessary information on how to manage risks. The manager has started work on this area however there is a lot of work to do. All areas of risk need to be identified and robust risk assessments need to be developed to ensure that staff have all the necessary information and training to keep risks to a minimum while allowing service users to live a fulfilling and active life as possible. Leeza Court - Welcome House DS0000031629.V299839.R01.S.doc Version 5.2 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 14,15,16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service users cannot be sure that the home will provide them with the opportunities, facilities and support to enable them to develop and maintain an appropriate lifestyle in and out-side the home. Service users cannot be sure that they have sufficient input into choosing planning and preparing their meals. EVIDENCE: Some service users were seen to undertake activities and leisure pursuits using their own initiative and were busy getting on with their lives. Some of the service users spoken to were fine about the level of support provided but were not impressed with the manner in which it was sometimes provided (see later comments) but they had no complaints about getting help when it was needed. One service users was attending college regularly and achieving qualifications, another spoke about a variety of social / educational activities she was involved in for example music workshops, ice skating, drawing and visits to a Leeza Court - Welcome House DS0000031629.V299839.R01.S.doc Version 5.2 Page 15 resource centre in Gillingham. Another service user spoke about working in a charity shop three days a week. Service users are able to use public transport or walk to attend their pursuits. Three residents had been fishing together the morning of the site visit. One of the service users had arranged for the installation of SKY TV which he and other residents were very pleased about. They were paying for the service. The majority of the service users access activities and leisure pursuits without staff support. Evidence needs to be available to show that service users are able to do this safely with minimum risk. Other service users who are not so motivated would not receive the encouragement and support they need to participate in activities and leisure pursuits. There was no evidence provided to show that the home provides any in-house activities or leisure pursuits. Staff could not provide any evidence in to show how service users are supported and encouraged, or guided and assisted to reach their full potential and maintain or gain skills in independent living. Some service users access the local facilities in the area. One gentleman claimed that he regularly attended the local snooker hall and others said that they visit the local day centre. Service users receive their own mail and open it themselves. Some service users do have family contact and under their own volition and motivation maintain family links and go home regularly to visit relatives. Several service users spoke about there being restrictions on their access to the kitchen at varying times and that seemed at odds with the drive to have them contributing to the upkeep of the home and developing independent living skills. The residents appeared to all get on well together and were all quite supportive of one another and comfortable in each other’s company. Some reported that the best thing living in the home was the other residents. The inspectors were informed that service users can have keys to their rooms if they wish. The home operates a 4weekly menu rota, which indicates that nutritious healthy meals are provided and that choices of food are offered The residents said “that the food was OK” but none could say much about how menus are planned. The manager does all the shopping and goes out most days to pick things up. She explained that the arrangements to plan the menu were agreed at a service users meeting. The arrangements made for flexibility and choice are not clear. There was evidence that someone has developed a personal menu with one service user but there was no evidence to show that this was actually provided. Service spoke about preparing their breakfast and Leeza Court - Welcome House DS0000031629.V299839.R01.S.doc Version 5.2 Page 16 lunch. Staff prepared the evening meal with service users encouraged to help out with preparation and clearing up. The Kitchen was clean and adequately equipped. There was a fly zapper; it was turned on but just sat on top of the fridge rather than being properly attached to the wall. Leeza Court - Welcome House DS0000031629.V299839.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users cannot be sure that they will receive the personal support they need or that their physical and emotional health needs will be met. Also they cannot be sure that they will receive the appropriate care and support regarding their medication. EVIDENCE: The inspector was informed that the service users in the home are able to self care and require little input from staff. However there was some indication at the inspection that at times service users do need guidance and support and staff need to be aware of these times and the implications of self neglect for some of the service users. At the present time staffing numbers and staffing skills at the home would limit the amount of support staff would be able to give. There is no evidence to support that the emotional needs of the service users are addressed. Care plans do not demonstrate how staff would offer emotional support. One service users had just lost her husband. It was not reflected in her care plan to show how her changing needs would be met. Leeza Court - Welcome House DS0000031629.V299839.R01.S.doc Version 5.2 Page 18 Service users are encouraged to be as independent as possible and the home does promote maximum independence for all its service users, however there remains the need to ensure that appointments are happening at regular intervals and that service users are reminded, prompted and supported if necessary. The staff at the home have little knowledge of the service users needs and conditions. They do not have the information available or the knowledge and skills to identify if the mental health of a service user was deteriorating. The service users do receive input from the local mental health team and regular reviews are undertaken. However new information obtained in reviews is not actioned and incorporated into the care plans. Service users reported that they go to visit their doctors when they need to. One service user reported that she had attended a G.P appointment the previous week as she had experienced some falls. The manager had no knowledge of the falls, the appointment or the out-come of the visit. It was also identified that several service users require regular blood tests to monitor drug levels. There was little or no information in their care plans or daily records to show the frequency of the blood tests, if the service users attended and the outcome following the results. Staff did not know the side effects they should be observing for to identify side effects of the drugs. This lack of planning and recording leaves service users at risk. The staff have little available time to spend with service users to meet their emotional, personal, physical and social needs. The service users do support each other. The service users have appointments and links with the specialist services and G.Ps with regards there medication. Medication is stored in Tupperware boxes in a filing cabinet draw in a locked room. The MAR sheet included the amount of medication coming in and going out of the home. A record was kept on medications admnistered. Instructions were transcribed by staff against the label on the package of medication. The transcription was in at least one instance inaccurate. This was checked with care staff and they confirmed that the actual dose given was as prescribed and agreed to amend the instructions to more clearly reflect what they actually were. Staff reported that there was very poor communication in relation to arranging appointments for clozaril checks. None of the residents were able to give a clear account for the arrangements regarding taking control of their own medication. It was noted that service users ‘queue up’ for their medications and this was the normal practise at the home. Dossette boxes are used for service users going out for the day / overnight. The risks involved with this practise are not considered. There were no risks assessments in place and no monitoring undertaken to ensure service users had taken their prescribed medication. Leeza Court - Welcome House DS0000031629.V299839.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users feel that their views are not listened to. Service users are not protected from self-harm, abuse and neglect due to staff being unaware of constitutes abuse. EVIDENCE: Service users spoken to said that knew how to complain within the home. Service users explained that they would report any concerns to the manager and then to the registered provider though were not sure where to go after this. A copy of the complaints procedure was displayed on the service users notice board. The home had received a complaint from a service user some months ago. The manager reported that the complaint had been taken seriously and was being dealt with by the registered provider. There was no evidence available to indicate that the complaint had been dealt with and that an out-come had been reached. The complaints procedure in the home has not been reviewed. Staff have not received Adult protection training and they do not have the knowledge or skills to identify or prevent abuse. The home have no involvement with the monies or finances of the service users. All the service users spoken to described a lack of confidence in the outcomes of complaints and meetings. The example was given about asking for more Leeza Court - Welcome House DS0000031629.V299839.R01.S.doc Version 5.2 Page 20 bins – it was apparently agreed that some should be purchased however these never appeared. Another example was in relation to staff using the washing machine for long periods therefore restricting their access to the facilities. Service Users said they had complained about this though felt that nothing much was done. There have been no recent reported adult protection issues at he home. Leeza Court - Welcome House DS0000031629.V299839.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 28 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s premises are suitable for its stated purpose and meet service users’ individual and collective needs in a comfortable and homely way. Some areas do need attention and maintenance. The home is clean and hygienic. EVIDENCE: The home’s standard of cleanliness and general repair has improved sine the last inspection. Overall the environmental standards were adequate. Space was proportionate. Three bedrooms were seen with the permission of the respective service users. The bedrooms were personalised to varying degrees. They were furnished and equipped in line with the national minimum standards. Residents and staff reported that some minor repairs have been required for a long time.for example the shower fitting in the blue bathroom, a Leeza Court - Welcome House DS0000031629.V299839.R01.S.doc Version 5.2 Page 22 missing shower curtain in the pink bathroom, curtains coming of the railings in a bedroom, a light taking two days to fix in another room. Service Users benefit from a back garden, which was proportionate to the size of the home. At the time of the site visit several service users and a visitor all used to garden to socialise and spend time. One of the service users spoke about the work he had enjoyed doing in the garden. The registered person should consider with service users privacy and security issues presented by there being no back fence in situ. Open windows protruding outwards at body level across a side alley past the house present a risk. There was no indication the risk had been considered i.e. warning signs / window restrictors / enclosures etc. There was a covered lean to designated for smokers looking out over the back garden – it was being well used. The inspectors could not detect any offensive odours throughout the premises. The service users at the home assist in keeping the premises clean and tidy and are supported by staff. A laundry room is available and the majority of the service users tend to their own laundry needs. Leeza Court - Welcome House DS0000031629.V299839.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The staff at the home do not have the required, qualifications, training and support to meet the stated purpose of the home and meet the assessed needs of the people who live there. The number of people working in the home is minimal and may be having a detrimental impact on outcomes for residents. The service users are not fully protected by the homes recruitment procedures. Service users do not benefit from a staff team that is supported and supervised. EVIDENCE: The home employs 3 care staff to cover 24-hour care for the service users. The manager also spends some time on the ‘floor’ but the development and improvement of the service restricts the amount of time spent with service users. The manager also completes all the administrative duties. Leeza Court - Welcome House DS0000031629.V299839.R01.S.doc Version 5.2 Page 24 Between 8-5 there are 2 care staff on duty then this reduces to 1 between 5pm and 10pm. There is a sleep-in member of staff throughout the night. At weekends there is only one member of staff. The numbers of staff on duty throughout the day and night do not adequately ensure that the individual and collective needs of service users are met. Care staff complete undertake the routine duties in the home including the cooking of meals and cleaning/housekeeping duties. There is little available time for uninterrupted work with service users. Only 1 member of staff is on duty from 6pm until 10am the following morning and the sleep-in duty runs from 10pm8am. It was reported that often service users do not come home until the early hours of the morning and there was a reported incident when a service user locked themselves out late at night and had a lot of difficulty waking the night staff to gain access. There were reports of service users smoking in the downstairs lounge late at night and then falling asleep. Many of the service users do keep late hours and there is the possibility risk of them allowing other people into the home who may present a risk. There was no risk assessment in place to deal with this. Staff frequently work alone with a mix of male and female service users, which affects the availability of support for service users from someone of their own gender. There was no evidence to demonstrate that the staffing levels in the home provide the necessary flexibility to ensure the changing needs of service users can be met. The new manager was aware of these issues and is presently looking at ways in which they can be addressed. 2 of the 3 members of care staff have only been at the home for a very short period of time. Induction programmes were in place but had not been completed. None of the staff had received all the necessary mandatory training and had received no specialist training relating to the specific needs and conditions of the service users in their care. The inspector was concerned that staff were left alone in the home unsupervised without the necessary skills and knowledge to undertake their role effectively and safely. This leaves service users and staff at high risk. These issues need to be addressed by the registered person as soon as possible. One staff member has NVQ training to level 3 and another has started level 3 training. The recruitment procedures at the home leave the service users at risk. Staff files do not meet the regulations. The 2 new members of staff did not have a full employment history on file. The reference requests sent out by the company do not ask sufficiently detailed questions, nor do they insist on formal letterheads or any other indication regarding authenticity of the reference. Leeza Court - Welcome House DS0000031629.V299839.R01.S.doc Version 5.2 Page 25 None of the care staff receive formal supervision from the manager. The care workers need this support and guidance from a senior member of staff to ensure that any problems are addressed and that their work is reviewed. Leeza Court - Welcome House DS0000031629.V299839.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39 and 42. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The present management approach is not benefiting or promoting the needs of the service users. Quality assurance and monitoring needs to be further developed to ensure the aims and objectives of the home are being met and the views of the service users/representative are acted on. The service users cannot be confident that their health, safety and welfare is promoted and protected Leeza Court - Welcome House DS0000031629.V299839.R01.S.doc Version 5.2 Page 27 EVIDENCE: The manager of the home has only held the position since March of this year and realises that she has a lot of work to do to bring Leeza Court in line with the national minimum standards. She has made a start but there is a long way to go. The manager has worked for Welcome Homes for the past 11years and is the registered manager of another home in the company. At the present time she is spending the majority of her time at Leeza Court. The registered provider needs to ensure that this situation is resolved as there is the possibility that resourses will be spread too thin and nothing achieved. The CSCI will be monitoring this situation over the following months. The manager did inform the inspector that she did plan to apply to become the registerd manager of Leeza Court. The manager is trying to move the home in the right direction and the inspectors recognised the amount of work and determination required to achieve this. However the service users did report that while they did understand the work needed to be done by the manager they did not think she was doing it in the correct manner. They did feel that the way it was being achieved was very authoritarian and abrasive. They reported that at times they felt that the manager was disrepectful and overbearing and they felt unheard. This was discussed with the manager and the registered provider at the time of the inspection and both reported that this issue had been identified the previous week and that steps are being taken to address it. The inspectors requested that it be discussed in the next service users/staff meeting and a copy of the minutes be sent to the CSCI. This was agreed. The home has been lacking in any coordinated quality assurance systems. The company have recently appointed a quality assurance manager who has begun to develop systems and strategies to monitor, review and develop the home. There is still along way to go before it can be evidence that the home is reaching its aims and objectives and is resulting in positive outcomes for the service users. The inspector had recently received a regulation 26 report that highlighted many of the issues identified in the report The inspectors noted that the water temperatures at the home are very hot. Staff reported that the water temperatures were not tested and no risk assessment had been completed in relation to negating the need to regulate or test temperatures. There was no thermometer in the home. It was also noted that the windows on the first floor were unrestricted and when opened the aperture was of a size that it is feasible for a person to go through the gap. This was discussed with the manager and the registered provider at the inspection and they are going to address these issues. Leeza Court - Welcome House DS0000031629.V299839.R01.S.doc Version 5.2 Page 28 The manager is in the process of developing environmental risk assessments. Gas and electric maintenance was up to date. PATS tests have been done. Fire checks are undertaken at the necessary intervals. The home needs to ensure that all staff receive the required mandatory training and that it is on going and up-dated as necessary. Leeza Court - Welcome House DS0000031629.V299839.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 1 2 1 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 2 28 2 29 X 30 3 STAFFING Standard No Score 31 X 32 1 33 1 34 1 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 X 1 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 1 X 2 1 1 X X 1 X Leeza Court - Welcome House DS0000031629.V299839.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 4 Requirement Timescale for action 31/08/06 2. YA2 14(1)(a)(b)(c)(d) 14(2) The registered person needs to produce an up-to date statement of purpose setting out the aims, objectives and philosophy of the home, its services and facilities and terms and conditions; and provides each service user with a service users guide to the home. The statement of purpose should clearly set out the physical environmental standards met by the home in relation to standards 24.2, 24.9, 25.3, 25.5, 27.2, 27.4 and 28.2; and a summary of this information should appear in the service users’ guide. New service users are 31/07/06 admitted only on the basis of a full assessment undertaken by people competent to do so, involving the prospective service user, using an appropriate communication method and with an Version 5.2 Page 31 Leeza Court - Welcome House DS0000031629.V299839.R01.S.doc 3. YA6 15(1)(2) independent advocate as appropriate. (Outstanding requirement. Time scale of 02/04/06 not met). The manager develops and 31/10/06 agrees with each service user an individual plan which may include treatment and rehabilitation, describing the services and facilities to be provided by the home, and how these services will meet current and changing needs and aspirations and achieve goals. The plan needs to be reviewed regularly. Daily records need to be completed. (Outstanding requirement. Time scale of the 02/04/06 not met). The registered person shall 31/10/06 ensure that (b) any activities in which service users participate are so far as reasonably practicable free from avoidable risks; and (c) unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. (Outstanding requirement. Time scale of the 19/03/06 not met). Service users rights are respected. The daily routines and house rules promote independence, individual choice and freedom of movement, subject to restrictions agreed in the individual DS0000031629.V299839.R01.S.doc 4. YA9 13(4)(b)13(4)(c) 5. YA16 12(4)(a) 31/08/06 Leeza Court - Welcome House Version 5.2 Page 32 6. YA18 12(4)(a) 7. YA19 12 Plan and Contract (subject to Standards 2 and 6 if necessary). Staff provide sensitive and flexible personal support maximise service users’ privacy, dignity, independence and control over their lives. The registered person ensures that the healthcare needs of service users are assessed and recognised and that procedures are in place to address them. (Outstanding requirement. Time scale of the 19/03/06 not met). The registered manager and staff encourage and support service users to retain, administer and control their own medication, within a risk management framework, and comply with the home’s policy and procedure for the receipt, recording, storage, handling, administration and disposal of medicines. The registered person needs to ensure that there is a clear and effective complaints procedure, which is acted on and outcomes recorded. The registered person ensures that service users are safeguarded from physical, financial or material, psychological or sexual abuse, neglect, discriminatory abuse or self-harm, or inhuman or degrading treatment, DS0000031629.V299839.R01.S.doc 30/09/06 30/09/06 8. YA20 13(2) 31/08/06 9. YA22 22 30/09/06 10. YA23 13(6)(7) 30/09/06 Leeza Court - Welcome House Version 5.2 Page 33 11. YA32 18(1)(a) 12(4)(b) through deliberate intent, negligence or ignorance, in accordance with written policy. Staff have the competencies and qualities required to meet service users’ needs and achieve Sector Skills Council workforce strategy targets within the required timescales. (Outstanding requirement. Time scale of the 19/03/06 not met). 31/10/06 12. YA33 18(1)(a) The registered person shall, 31/10/06 having regard to the size of the care home, the statement of purpose and the number and needs of service users (a) ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. (Outstanding requirement. Time scale of the 31/03/06 not met). 13. YA34 19(4)a19(4)b19(4)c The registered person shall 31/08/06 not allow a person to whom paragraph (2) applies to work at the care home in a position to which paragraph (3) applies, unless the person is fit to work at the care home; the employer has obtained in respect of that person the information and DS0000031629.V299839.R01.S.doc Version 5.2 Page 34 Leeza Court - Welcome House documents specified in paragraphs 1 to 7 of Schedule 2; and has confirmed in writing to the registered person that he has done so; and (c) the employer is satisfied on reasonable grounds as to the authenticity of the references referred to in paragraph 5 of Schedule 2 in respect of that person, and has confirmed in writing to the registered person that he is so satisfied. (Outstanding requirement. Time scale of the 17/03/06 not met). 14. YA35 18(1)c(i)(ii) The registered person shall, 30/09/06 having regard to the size of the care home, the statement of purpose and the number and needs of service users (c)ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform; and suitable assistance, including time off, for the purpose of obtaining further qualifications appropriate to such work. (Outstanding requirement. Time scale of the 21/04/06 not met). The registered person shall ensure that persons working at the care home are appropriately DS0000031629.V299839.R01.S.doc 15. YA36 18(2) 31/08/06 Leeza Court - Welcome House Version 5.2 Page 35 supervised. (Outstanding requirement. Time scale of the 21/04/06 not met). 16. YA38 12(5) The management approach 31/08/06 of the home creates an open, positive and inclusive atmosphere, which the service users respond positively to. The CSCI requires a copy of the minutes of the next service users meeting to demonstrate how this will be achieved. Effective quality assurance 31/10/06 and quality monitoring systems, based on seeking the views of service users/representatives, are in place to measure success in achieving the aims, objectives and statement of purpose of the home. The management of the 31/07/06 home needs ensure that water temperatures are checked and that action is taken to ensure the safety of the service users. That the amount of opening of the upstairs windows is assessed and risk assessments developed and action taken to ensure safety of all the service users. All staff need to receive the 30/09/06 required training to ensure they have the skills to meet the needs of the service users. 17. YA39 24(1)(a)(b) (2)(3) 18. YA42 23(2)(p) 12(1)(a) 19. YA42 13, Leeza Court - Welcome House DS0000031629.V299839.R01.S.doc Version 5.2 Page 36 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA7 Good Practice Recommendations Staff respect service users’ right to make decisions, and that right is limited only through the assessment process, involving the service user, and as recorded in the individual Service User Plan. Staff help service users to find and keep appropriate jobs, continue their education or training, and / or take part in valued and fulfilling activities. Staff ensure that service users have access to, and choose from a range of, appropriate leisure activities. Service users need to be involved in the purchasing planning and preparing of meals. There needs to be evidence of choice and flexibility. Menu plans for individuals need to be adhered to. Leeza Court needs to develop a home maintenance and renewal programme with time scales to ensure the fabric and decoration of the premises. Records of this need to be kept. Both bathrooms need to be fully functional and shower curtains provided to ensure privacy and comfort. The garden needs to be private and made as safe as possible. Leeza Court needs a registered manager in post who is dedicated, qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives 2 3 4 YA12 YA14 YA17 5 YA24 6 7 8 YA27 YA28 YA37 Leeza Court - Welcome House DS0000031629.V299839.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 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. 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