Inspection on 29/01/07 for Leeza Court - Welcome House

This inspection was carried out on 29th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Leeza Court - Welcome House 20/06/06

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 Key Unannounced Inspection 29th January 2007 10:00 Leeza Court - Welcome House DS0000031629.V317615.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.V317615.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.V317615.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.V317615.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th June 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.V317615.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the 2nd unannounced key inspection to Leeza Court since April ‘06. Two inspectors did the site visit to the home. All the key standards were looked at. Focus was given to the areas identified at the previous visit, which required attention and improvement The following methods of inspection and information gathering were used: one-to-one discussion with and service users staff, observing interactions, care interventions and activities, reading and discussing individual support plans, risk assessments, selected policies, medication charts, training matrix and training programmes. Evidence was also gained from a pre inspection questionnaire completed by the home; comment cards from service users, and care managers; and a site visit to the home. Comment cards received from the service users and visiting professionals contained mixed comments. Some felt that the service was reasonable and others felt that there were areas that needed improvement. These will be further reflected throughout the report. Since the last inspection the company has employed a new manager to run the home. She realises that she has a lot of work to do to meet the National Minimum Standards. The manager needs to be given the resources, support and autonomy to develop and improve the service. At the time of the visit there were 12 service users living at he home. What the service does well: The service users at the home get on well together and are supportive of each other. Those who wish to maintain contact with their family and friends. The care staff on duty were observed interacting and engaging service users in a positive and caring manner. The staff on duty at the time of the visit were helpful and co-operative. Leeza Court - Welcome House DS0000031629.V317615.R01.S.doc Version 5.2 Page 6 The more independent and motivated residents live a fulfilling and active life. The bedrooms are individualised to reflect the personalities of the residents. The home is clean and tidy. A competent member of staff will assess prospective service users before they come to live at the home. The home provides contracts for all its service users, which explain the terms and conditions of residency. What has improved since the last inspection? The home has appointed a new manager who has the qualifications and skills to develop the service and meet the needs of the service users. They have also appointed another member of staff who has the necessary qualifications and skills to fulfil her role. The service users reported than the things have improved at the home since these appointments. All the service users spoken to said that they are now much happier at the home. The atmosphere is more friendly and relaxed. One service users said the new manager “knows what she is doing” One comment was ‘ I am now getting the help and support that I need’. The manager is aware of the shortfalls within the home and wants to improve the quality of the service offered to the residents. Service users also reported that since the arrival of the new manager they have more input into how the home is run and this is increasing. Residents now receive the support and guidance to ensure that remain healthy. Records are kept to make sure that service users attend clinics, G.P’s and other services when they are supposed to. Appointments are monitored and outcomes are recorded. Leeza Court - Welcome House DS0000031629.V317615.R01.S.doc Version 5.2 Page 7 What they could do better: The Statement of Purpose and Service Users Guide needs to give a more precise and accurate picture of the service offered to residents. Both documents need to be reviewed and distinguishable from each other and contain the information required by the National Minimum Standards. Care plans need further development to make sure that all needs have been identified and staff have the information on how to meet individual needs. Some information is repetitive and unnecessary for meeting the individual daily needs of the service users. The files do need to be streamlined so that the staff can easily access and use the information that they require to look after the service users and keep them safe. The care plans need to be used as daily working tool. Specific information about individual needs of the service users is difficult to find. There is little available that gives a full picture of what service users do on a day-to-day basis. The home needs to show how service users spend their time, what help support or assistance they have needed or what have they done independently. Aspirations and goals need to be attained. Risks to service users needs to be kept to a minimum. The service users need to have more input and involvement in the way the home is being run. Service users said that they would like to have more individual time with staff and often do not receive the personal support that they need as there is not enough staff available. Visiting professionals to the home also support this view. The management need to make sure that all areas of the home both in-side and out are kept safe and maintained to a good standard. Medication practises at the home need to be reviewed to ensure service users receive their medication as safely as possible. 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, especially with regards to mental health and the specialist requirements of the service users. All staff need training in safe guarding the residents from abuse 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. Leeza Court - Welcome House DS0000031629.V317615.R01.S.doc Version 5.2 Page 8 The lack of adequate staffing levels throughout the day and night has an overall impact on the service offered and on this report. Many of the national minimum standards are not meet as there is not enough staff employed by the home to meet the needs of 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. The summary of this inspection report can be made available in other formats on request. Leeza Court - Welcome House DS0000031629.V317615.R01.S.doc Version 5.2 Page 9 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.V317615.R01.S.doc Version 5.2 Page 10 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 and 5. Quality in this outcome area is adequate. 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 can be sure that their individual needs will be assessed prior to coming to the home. Service users places at the home are protected. EVIDENCE: The home does have as Statement of Purpose and Service Users Guide in place, however they contain exactly the same information. There is no distinction between the 2 documents. The service users guide is not written for prospective service users and does not contain the required information detailed in the national minimum standards. The first paragraph of the guide states, “further information, which is too bulky to be stored in the guide can be Leeza Court - Welcome House DS0000031629.V317615.R01.S.doc Version 5.2 Page 11 found at the reception area of the home”. This information could not be found at the time of the inspection. The Statement of Purpose and Service User Guide stated ‘We hold a firm belief of user empowerment, and our service users take an active role in helping us shape the services that we provide and we are committed to ensuring that service users are fully consulted about matters which are significant in the running of the home or about matters which might affect their well being or quality of life. Managers and staff are available to listen to the views of service users at any time’. There was no evidence to demonstrate that this was happening. Service users confirmed this. There have been no recent admissions to the home. The home does have an assessment tool in place, which would be used to assess any prospective service users. This format needs to be expanded and developed so that it contains more relevant and pertinent information about the service users mental health condition. This was discussed with the new manager at the time of the inspection and she was aware of the shortfalls. All of the service users had individual contracts in place which explains the terms and conditions of residency and were signed. Leeza Court - Welcome House DS0000031629.V317615.R01.S.doc Version 5.2 Page 12 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 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 the information on how to meet their needs is used on a daily basis. There are shortfalls in implementing care for the assessed and changing needs of the service users. Service users are able to make decisions about their lives but their participation in the way the home is run is limited. The home cannot ensure the safety of the service users, as risks are not minimised. Leeza Court - Welcome House DS0000031629.V317615.R01.S.doc Version 5.2 Page 13 EVIDENCE: A sample of care plans were looked at. Some work has been done on the care plans since the last inspection. However there are still short falls. Generalised care needs have been identified but there is no clear guidance and direction for the staff on what action they have to take and how they are to meet the identified needs of the service users. The plans contain a lot of information some of which is duplicated and repeated. This makes them a very cumbersome document to use on a daily basis. The plans are difficult to navigate and are not being used as a working tool by the care staff. The care plans need to be streamlined and simplified to ensure that they are effective and serve the purpose they are intended for, which is to give staff the information they need to meet the individual and changing needs of the service users. The care plans had not been up-dated to reflect the changing needs of the service users. The service users do need to be involved in developing their own plans. Daily records kept by the home do not give picture of what service users are doing during the day. Important information is lost and not transferred into the care plans. Service users are able to make decisions about what they do and were they go on a daily basis. A number of service users have engaged in a range of activities in the local community. There is information available about local resources. Resident meetings are arranged to discuss issues affecting the home, however the last recorded meeting was in October 2006, where a range of issues were discussed including menus, complaints, smoking and other house issues. The minutes of that meeting demonstrated that a good range of topics were discussed and there was a healthy attendance. In discussion with the manager it was evident that she is intent on developing greater levels of participation within the home including into menu planning, shopping and other activities. One service user did say said, “Things are better here now, the staff are nicer and Roshan (the manager) has made a real difference.” Another resident said, “There’s a chores list so that everyone gets involved.” Others stated that they would like to have more say in the appointment of staff and other things such as menu planning and the type of food that is bought. Leeza Court - Welcome House DS0000031629.V317615.R01.S.doc Version 5.2 Page 14 The frequency of resident meetings needs to increase. Service users feel that they do have some input into the home and this is an area that is steadily improving. Service users are supported to manage their own finances and restrictions are only made following discussion with care managers and the service user in question. Some residents stated that they are free to choose how they spend their days and that no restrictions are imposed. One staff member stated that the aim is to allow people to live their lives as they wish. If this has an impact on their health they liaise the mental health team. The individual risk assessments at the home do not give staff the necessary information on how to manage risks and keep them to a minimum. The manager is working on this area. 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. Leeza Court - Welcome House DS0000031629.V317615.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Leeza Court - Welcome House DS0000031629.V317615.R01.S.doc Version 5.2 Page 16 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 home does not provide all the service users with the support, opportunities and facilities that enable them to maintain an appropriate and fulfilling lifestyle in and outside the home. Service users are part of the local community. Service users do engage in leisure activities. Service users have opportunities to develop personal relationships though have limited support to do so. Service users’ basic rights are respected and responsibilities recognised in their daily lives. Service users are provided with a balanced diet although aspects of the planning process could be improved. EVIDENCE: Through discussion with a number of service users it was clear that some people are motivated and keen to develop their educational, occupational and social lives. One resident has recently completed a City and Guilds qualification in gardening and is currently looking for work. He stated that the staff in the home are supporting him in this and are available for advice. Another resident does voluntary work every week and finds that this is a fulfilling pastime. Some service users access local colleges and mental health resources, which run groups that help in developing daily living skills and personal strengths. It was reported that there are fairly good transport links from Rainham to both Sittingbourne and Gillingham. The activities available in the home are informal such as watching television, listening to music, etc. Some service users said that they like the relaxed atmosphere in the house and would not want too many activities organised in house. Others said that they would like to do more things in the house. Similarly, amongst the residents spoken to, it was felt that people like the opportunity to go out on their own or in small groups rather than on large group outings. It was also stated by one person that they would like it if the staff had the chance to spend more 1:1 time with residents instead Leeza Court - Welcome House DS0000031629.V317615.R01.S.doc Version 5.2 Page 17 of having to concentrate on household tasks such as cleaning and cooking. Some residents said that they needed more support from staff to undertake activities. Service users are able to pursue their own hobbies and interests; one person said he was going fishing for the weekend with some other residents. None of the service users had activity programmes. It was difficult to evidence and trail what service users actually did during the day. The staff need to make sure that they do record when activities have taken place and how service users are spending their time. Residents are able to maintain relationships with friends and family and there is an open policy to visitors, which is only reviewed if it has a negative impact on service users. The manager stated that she recognises the need for people to maintain intimate relationships. There is a relaxed atmosphere in the home and residents clearly stated that their personal space is respected by staff and that the routines in the house are flexible and not too rigid. Residents have unrestricted access throughout the house and garden, can choose when to spend time alone and take responsibility for some household chores. There are rules in place regarding smoking, alcohol and drugs, which are clearly communicated and understood. The home operates a 4-week rolling menu, The manager stated that she is reviewing this and a meeting is planned to support the service users to plan their own menus and take more responsibility for the purchase of food and weekly shopping. A number of complaints and concerns have been raised by residents about the quality of food, which the manager is intending to address in a positive fashion. The kitchen is domestic in size and adequate for the needs of the home. On inspection it was evident that there was reasonably well-stocked food cupboards, fridges and freezers with a selection of fresh fruit and vegetables. When asked about the planned changes in organising the menus and shopping the resident went on to say “We spoke about this with the manager and it will be good if we have more control and can choose the food we buy.” Leeza Court - Welcome House DS0000031629.V317615.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home does not always provide the necessary personal care. The service users healthcare needs are now met. Medication issues are generally well managed, although assessments for service users who self-medicate need to be strengthened. The facility for storing medication does not meet the guidelines. EVIDENCE: Most of the service users at the home are able to self-care and require little input from staff. However there are times when service users do need support and guidance from staff. Staff need to be aware of these times and the Leeza Court - Welcome House DS0000031629.V317615.R01.S.doc Version 5.2 Page 19 implications of self-neglect for some of the service users. There needs to be information in the care plans on how staff are deal with these situations and what is required of them so they can meet the needs of the service users in the best possible way. As identified in the previous inspection staffing numbers would limit the amount of support staff would be able to give. This view was supported by the service users and visiting professional. The staffing skills have improved since the last visit. The manager of the home was able to demonstrate that the emotional needs of the service users are addressed. Care plans now need to explain how staff would offer emotional support. The home do not employ enough staff to give the service users the choice about who they would like to work with. Often there is only one member of staff on duty so service users do not have the option to see someone of their own gender if they so wish. Service users reported that they received appointments with dentists, opticians, and the homes records now support this. There are systems in to ensure that all the service users received the specialist support that they need. Contact and visits from care managers and CPN’s are recorded and monitored. The manager of the home encourages and supports service users to attend health care appointments and this was evidenced on the day of the inspection. Closer monitoring and observation is kept on those who attend independently. The service users now receive the support to attend appointments and the manager ensures that the health care needs of the service users are met. The medication processes within the home were thoroughly examined. There are adequate policies and procedures in place, which are located within the office. However, it was noted that there was an out of date version of the procedures in the medication room, which should be updated. Medication administration records are well managed and up to date. The recording of medications and evidence of administration is clear and complete. There is also evidence that the home has liaised with GPs/Psychiatrists to ensure that individual service user’s medications have been reviewed. 5 service users are self-medicating and procedures are in place to provide weekly blister packs to these individuals, which are dispensed by the pharmacy. However, there was no evidence that the home completes readiness assessments or risk assessments for service users who selfmedicate. This was discussed with the manager. It was stated the decision to enable self-medicating are discussed with the care manager and psychiatrist, but the evidence for this is not recorded. Periodic self-administration assessments should be completed with each service user. The medication storage facilities need to be in line with the recommendation made by the Royal Pharmaceutical Society. Efforts have been made to Leeza Court - Welcome House DS0000031629.V317615.R01.S.doc Version 5.2 Page 20 organise the storage cupboards. Temperature records are maintained, as are records of medication received, returned and destroyed. It was noted, through discussion with service users, that residents come to the medication room and “line up” for their medication, which is felt to be a rather institutional practice and should be reviewed. Leeza Court - Welcome House DS0000031629.V317615.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22and 23 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Service users feel that their views are listened to and acted upon. There is an adequate complaints process. Service users are not protected from self-harm, abuse and neglect due to staff not having received the necessary training. EVIDENCE: The home has an adequate complaints process in place that has been posted on the notice board. The policy states that formal complaints will aim to be resolved within 28 days, but where possible the aim is to deal with any issues on an informal basis. There is a complaints book in the lounge, which is used and contains a number of recent issues raised regarding the food in particular. The manager should review the process for demonstrating that these issues are addressed as the entries in this book and the actions taken were somewhat inconsistent. The format for making complaints also needs to be reviewed as all complaints are logged together in one book, which does not allow for confidentiality and protection of the complainant Leeza Court - Welcome House DS0000031629.V317615.R01.S.doc Version 5.2 Page 22 However, service users spoken to said that since the new manager arrived they now feel comfortable raising concerns in the house and that they were listened to. The feeling was that the manager and staff are open and approachable and act upon concerns wherever possible. The last residents meeting demonstrated that the complaints process had been discussed and that there were opportunities to raise issues with the organisation and home staff. There have been no adult protection issues at the home since the last inspection. The manager was able to explain what action she would take if any issues did arise and there are policies and procedures in place. Not all staff have received training in the protection of vulnerable adults. The service users in the home did say that they now felt protected, safe and supported by the staff. Leeza Court - Welcome House DS0000031629.V317615.R01.S.doc Version 5.2 Page 23 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 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 is comfortable and generally safe, although there are a number of issues that were highlighted through the course of the inspection. The home is clean and hygienic. EVIDENCE: Service users live in a homely and comfortable environment with a good range of available communal space and bedrooms that meet individual requirements of the service users. A tour of the premises was undertaken and the opportunity for the inspector to be invited into a number of the service user’s bedrooms, all of which were of a good size with adequate furniture and fittings. Some rooms had en-suite facilities. One resident said, “I like my room. I’ve got a nice en-suite.” Leeza Court - Welcome House DS0000031629.V317615.R01.S.doc Version 5.2 Page 24 A number of issues were noted during the tour of the home. Some of the windows on the first floor do not have window restrictors in place, which is advisable. It was also noted that some work is required in the garden, parts of the garden should be tidied as there is a large rusty metal container in the side alley and no fencing to the rear of the garden, which backs on to a private property and offers no privacy and potentially represents a security risk. The management does need to develop and produce a programme for the renewal and maintenance fro the fabric and decoration of the premise. The home is clean and hygienic and appeared generally well cared for. Hazardous substances are appropriately stored and there are adequate domestic laundry facilities. It was noted that the chopping boards in the kitchen were well worn and would benefit from being replaced. Leeza Court - Welcome House DS0000031629.V317615.R01.S.doc Version 5.2 Page 25 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 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: In the past few months all the care staff at Leeza have changed. The team leader previously worked at one of the company’s other homes. The home Leeza Court - Welcome House DS0000031629.V317615.R01.S.doc Version 5.2 Page 26 employs 3 care staff to cover 24-hour care for the service users. The manager also spends some time on the ‘floor’ but the amount of development and improvement that is needed for the service restricts the amount of time spent with service users. The manager also completes all the administrative duties. Between 8-5 there are 2 care staff on duty then this reduces to 1 between 5pm and 10pm. There is only a sleep-in member of staff throughout the night. At weekends there is only one member of staff on duty. 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 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. Many of the service users do keep late hours and there is the possibility risk of them allowing other people into the home that 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. 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 inspectors were 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. It was evidenced from looking at the staff rota that one member of staff who had been employed by the home for 2 weeks was left alone at night in the evening and at weekends. He was also administering medication to service users. His induction had not been completed; he had received no mandatory training and had no training in the administration of medication. This was discussed with the manager and development Director who immediately took steps to rectify the situation. One staff member has NVQ training to level 2 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 Leeza Court - Welcome House DS0000031629.V317615.R01.S.doc Version 5.2 Page 27 full employment history on file. Gaps in employment history have not been explored. 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. Residents are never involved in the recruitment of staff 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. All these issues were highlighted at the previous inspection, but no steps have been taken by the company to address the requirements concerned with staffing. Feed-back from service users and other visiting professionals highlights concerns that there is not enough staff employed by the home to meet the needs of the service users. Leeza Court - Welcome House DS0000031629.V317615.R01.S.doc Version 5.2 Page 28 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): 37,38 39 and 42 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Considering the number of staff on duty the home is well run on a day-to-day basis. The manager needs to demonstrate her fitness by undertaking the necessary qualifications and becoming registered Quality assurance and monitoring has been developed to assist in ensuring the aims and objectives of the home are being met and the views of the service users/representative are acted on. Gaps in staff training and equipment checks potentially leave service users and staff at risk. Leeza Court - Welcome House DS0000031629.V317615.R01.S.doc Version 5.2 Page 29 EVIDENCE: Prior to the appointment of the new manager in November ’06 the Development Director of Welcome Homes had been acting manager of Leeza Court. He was still working at the home on the day of the inspection but plans to return to his original position within the company in the near future. The new manager of the home does have the skills and knowledge to move the service forward in the right direction and she is aware of the amount of work that is needed to achieve this. The company need to provide the resources, support and allow her the autonomy she needs to develop and improve the home. The manager of the home is keen to apply to the CSCI to become the registered manager of the home. She is committed to providing care and support to service users at the home and works beyond her duties to provide this. She is knowledgeable about their needs and has the skills to deliver care. The manager needs to evidence her competency and knowledge by under taking the necessary qualifications. It was reported by service users that since the appointment of the new manager the atmosphere at the home has improved. They felt that there was a more open, positive and inclusive atmosphere. Service users said, “They feel they are being listened to and supported”. The manager is able to communicate a clear sense of direction and leadership, which the staff and the service users responded to. The staff and service users reported that they were well supported and responded in a positive, relaxed manner in the presence of the manager. The organisation has employed a quality assurance co-ordinator who has developed some positive quality assurance processes. She now completes monthly monitoring visits of the service which include speaking to staff, residents and auditing records. However it was noted that a number of service shortfalls have been identified through the monthly monitoring process, but this has not led onto a clear action plan demonstrating how the home/organisation intend to address these issues, which needs to be included within the monitoring process. The organisation has developed a system of service user, staff and professional’s surveys which actively gaining feedback about the service. These have been collated into a report, demonstrating the action to address issues raised. Leeza Court - Welcome House DS0000031629.V317615.R01.S.doc Version 5.2 Page 30 The home maintains a record and certificates for maintenance and annual service checks. The majority of these had up to date certificates, although it was noted that the CORGI gas safety certificate was out of date. This was discussed with the manager who agreed to forward an updated certificate on completion. Mandatory training is not up-to-date for the care staff. This needs to be on going and up-dated as required. Leeza Court - Welcome House DS0000031629.V317615.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 1 2 3 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 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 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 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 2 3 3 X X 1 X Leeza Court - Welcome House DS0000031629.V317615.R01.S.doc Version 5.2 Page 32 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(1) a, b, c 5(1) a,b,c,d,e,f. Requirement The registered person needs to review and amend the homes Statement Of Purpose and Service Users Guide to comply with the regulations and to reflect an accurate picture of the service the home offers. The service users guide needs to be separate document and contain the information listed in National Minimum Standard 1.2 (Outstanding requirement from the previous 2 inspections. Timescale of 31/08/06 not met). Timescale for action 31/05/07 2. YA6 15(1)(2) The manager develops and 31/05/07 agrees with each service user an individual plan which may include treatment and rehabilitation, describing the services and facilities to be provided by the DS0000031629.V317615.R01.S.doc Version 5.2 Page 33 Leeza Court - Welcome House home, and how these services will meet current and changing needs and aspirations and achieve goals. The plan needs to be reviewed regularly. Information in the daily records needs to easily assessable so any concerns or changing needs are highlighted and identified. (Outstanding requirement from the previous inspections. (Time scale of the 31/10/06 not met). 3. YA9 13(4)(b)13(4)(c) Robust risk assessments need to be developed and implement to ensure that all risks to service users are kept to a minimum. Any activities in which service users participate are so far as reasonably practicable free from avoidable risks; and risks to the health or safety of service users are identified and so far as possible eliminated. (Outstanding requirement from previous inspections Time scale of the 31/10/06 not met). The home needs to ensure that there are • robust risk assessments in place for service users who selfadminister medication. DS0000031629.V317615.R01.S.doc 31/05/07 4. YA20 13(2) 31/05/07 Leeza Court - Welcome House Version 5.2 Page 34 • Procedures also need to be in place to ensure competency and compliance. Medication needs to stored according to the Royal Pharmaceutical Guidelines To review the practice of service users “lining up” for their medication (Outstanding requirement from previous inspections. Time scale of the 31/10/06 not met). 5. YA32 18(1)(a) 12(4)(b) All staff need to have the competencies and qualities required to meet service users’ needs. (Outstanding requirement from previous inspection. Time scale of the 31/10/07 not met). The registered person shall, 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 DS0000031629.V317615.R01.S.doc • 31/05/07 6. YA33 18(1)(a) 31/05/07 Leeza Court - Welcome House Version 5.2 Page 35 requirement from previous inspections. Time scale of the 31/10/06 not met). 7. YA34 19(4)a19(4)b19(4)c The registered person shall 28/02/07 not allow a person to work at the care home in a unless They have adhered to robust recruitment procedures and obtained all the necessary checks and information to ensure the safety and the welfare of the service users. The home needs to seek a full employment history, explore any gaps in employment, Ensure n authentic references have been obtained one of which should be from the most recent employer. (Outstanding requirement from previous inspections. Time scale of the 31/08/06 not met). 8. YA35 18(1)c(i)(ii) The registered person needs to ensure that persons employed 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 from DS0000031629.V317615.R01.S.doc 31/03/07 Leeza Court - Welcome House Version 5.2 Page 36 previous inspections. Time scale of the 30/09/06 not met). 9. YA36 18(2) The registered person shall 31/03/07 ensure that persons working at the care home are appropriately supervised. (Outstanding requirement from previous inspections. Time scale of the 31/08/06 not met). 10. YA42 23(2)(p)12(1)(a) 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. To ensure that an up to date CORGI gas safety service is completed and a copy of the certificate forwarded to the Commission. All staff need to receive the required training to ensure they have the skills to meet the needs of the service users. (Outstanding requirement from the pervious inspections Timescale of the 30/09/06 not met) 30/04/07 12. YA42 13, 31/05/07 Leeza Court - Welcome House DS0000031629.V317615.R01.S.doc Version 5.2 Page 37 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 Service Users need to be more involved in decisions made in the home, which affect their lives. 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. To ensure that there are regular opportunities for service users to take an active participation in the running of the home through resident meetings. Their needs to be staff available to help and support service users to find and keep appropriate jobs, continue their education or training, and / or take part in valued and fulfilling activities. Evidence of this needs to kept. 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. The manager needs to review the format for logging complaints to make sure confidentiality is maintained. There also needs to be evidence in place to show how complaint are acted on what the outcomes are. All staff need to receive training in safeguarding service users from all forms of abuse. 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. To ensure the safety of the premises by fitting window restrictors on the first floor windows. To ensure the safety and privacy in the garden area by removing rubbish and erecting a rear fence. To replace the well worn chopping boards in the kitchen The manager needs to obtain the necessary management qualifications and apply to the CSCI for registration. 2. 3. YA8 YA12 4. YA17 5. YA22 6. 7. YA23 YA24 8. 9. YA30 YA37 Leeza Court - Welcome House DS0000031629.V317615.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Leeza Court - Welcome House DS0000031629.V317615.R01.S.doc Version 5.2 Page 39 - 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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