Inspection on 22/02/06 for Lingfield Avenue, 11

This inspection was carried out on 22nd February 2006.

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 no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lingfield Avenue, 11 24/04/08

Lingfield Avenue, 11 31/08/07

Lingfield Avenue, 11 09/08/06

Lingfield Avenue, 11 02/09/05

Lingfield Avenue, 11 21/09/04

Lingfield Avenue, 11 06/05/04

Lingfield Avenue, 11 03/02/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Lingfield Avenue, 11 11 Lingfield Avenue Kingston Upon Thames Surrey KT1 2TL Lead Inspector Lee Willis Unannounced Inspection 22 February 2006 11:15a nd Lingfield Avenue, 11 DS0000013400.V276282.R01.S.doc Version 5.1 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 Lingfield Avenue, 11 DS0000013400.V276282.R01.S.doc Version 5.1 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. Lingfield Avenue, 11 DS0000013400.V276282.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Lingfield Avenue, 11 Address 11 Lingfield Avenue Kingston Upon Thames Surrey KT1 2TL 020 8546 2905 0208 546 0947 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) SCOPE Mrs Kelly Elizabeth McCorley Care Home 14 Category(ies) of Learning disability (14), Physical disability (14) registration, with number of places Lingfield Avenue, 11 DS0000013400.V276282.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. A variation has been granted to allow specified service users in the following categories to be accommodated. 1 service user Physical disability - over 65 (PD (E)) 1 service user Physical disability - over 65 (PD (E)) 1 service user Physical disability - over 65 (PD (E)) and Sensory impairment - over 65 (SI (E)) This variation remains in force until such time as the needs of the service users can no longer be met or until such time as the placements cease. 2nd September 2005 Date of last inspection Brief Description of the Service: 11 Lingfield Avenue is owned, managed and staffed by the registered charity SCOPE, a specialist provider of care services for people with Cerebral palsy. The home is registered with the Commission for Social Care Inspection to provide personal support and accommodation for up to fourteen younger adults (i.e. aged 18 to 65) with a wide range of physical and mild to moderate learning disabilities. Kelly McCorley has been in operational day-to-day control of the home since Christmas (2004) and has recently successfully undergone a fit person interview with the Commission to become the homes registered manager. The home is located in a residential area of Surbiton and is within a mile of the centre of town with its wide variety of local shops, cafes, restaurants, and pubs. The home is also on a main line bus route and is relatively close to Surbiton train station, which also has good links to central London and the surrounding areas. Built over two storeys this large detached property has eleven single occupancy bedrooms and one double. Much of the homes communal spaces are open plan to make the layout of the building more wheelchair accessible. There is a large open plan kitchen and dinning area, separate lounge, laundry room, office, and two staff sleep-in rooms. A passenger lift links both the ground and first floors. There are sufficient numbers of toilet and bathing facilities located throughout the home near service users bedrooms and communal areas. There is a garden at the rear of the property, which has a wide range of well-established flowers, plants and shrubs. Lingfield Avenue, 11 DS0000013400.V276282.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and began at 11.15 on the morning of Wednesday the 22nd February 2006. It took four hours to complete. Since the homes last inspection the Commission has not received any more comment cards in respect of this service. The majority of this inspection was spent talking to the homes recently registered manager, although a couple of care workers and the homes new activities coordinator were also met, albeit briefly. All four of the service users who were at home at the time of this inspection were met, of whom two were spoken with at length. The remainder of this inspection was spent examining the homes records and touring the premises. No additional visits or complaints investigations have been carried out by the CSCI in respect of this service in the past twelve months. What the service does well: Overall, Lingfield Avenue is a good quality service that delivers good outcomes for the service users and has significantly more strengths than weaknesses. The home is consistently managed and is viewed positively by the people who live there. All the service users met during the course of this inspection said they were very satisfied with the standard of care they received at Lingfield Avenue and were particularly impressed with the attitude of most of the staff team. The staff met, which included the manager, the activities coordinator, and all the care workers who were on duty at the time, were observed interacting with the service users and their visitors in an extremely ‘friendly’ and respectful manner at all times during the unannounced visit. The staff team is also well trained and most have attended a number of courses that enable to carry out their duties effectively, which includes; training on the basic principles of care, safe working practices, care worker roles and responsibilities, and the specific needs of the service user group. Finally, the home has a very inclusive culture and appears committed to working closely with service users, their families, the CSCI and other agencies. SCOPE has a positive and proactive approach to dealing with complaints and allegations of abuse and is commended for the open and prompt manner in which the providers dealt with a recent vulnerable adult protection issue (See the main body of this report for details). SCOPE’s arrangements for keeping the CSCI informed about the homes day-to-day operation and areas where they acknowledge they could do better is also excellent. Lingfield Avenue, 11 DS0000013400.V276282.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? The home has managed to meet all the requirements identified in its previous inspection report within the prescribed timescales for action and the number of new requirements highlighted in the main body of this one has been reduced significantly. There are a number of key areas where the home has made significant progress to improve since its last inspection: Firstly, the manager has introduced a number of new policies that now guide good working practices, which includes the homes new emergency admissions, alcohol consumption, and medication procedures. Service users care plans have also been improved to ensure, where appropriate, staff have much clearer guidance to help them deal more effectively with behaviours that may challenge the service. The service users guide and other information about the home, including SCOPE’s complaints procedures, are now available in far more accessible formats, which are suitable for the people for whom the home is intended (e.g. The home now has a video and audio versions of the service users guide). The homes Statement of purpose and service users terms and conditions of occupancy documents have also been revised and both now contain far more detailed information, which service users and their representatives may wish to know about the home, including staff qualifications and the range of fees SCOPE currently charges for services and facilities provided. All the service users bedroom doors, which did not meet the local Fire Authorities standards, have now been replaced with more suitable fire resistant ones. Finally, the manager has developed a matrix that sets out in detail all her staff teams qualifications and training needs. Sufficient numbers of the homes current staff team have also recently attended managing aggression and challenging behaviour courses. Lingfield Avenue, 11 DS0000013400.V276282.R01.S.doc Version 5.1 Page 7 What they could do better: 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. Lingfield Avenue, 11 DS0000013400.V276282.R01.S.doc Version 5.1 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 Lingfield Avenue, 11 DS0000013400.V276282.R01.S.doc Version 5.1 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, 4 & 5 The home ensures prospective new service users and their representatives have all the information they need to know about Lingfield Avenue. Furthermore, the homes admission procedures, including emergency referral protocols, are suitably robust to ensure no one is offered a ‘trial’ period of residency before their unique personal, social and health care needs have been thoroughly assessed. EVIDENCE: The registered manager last reviewed the homes Statement of purpose in December 2005 and up dated it accordingly to ensure it accurately reflected all the changes that had occurred in the past twelve months. This document now contains all the information required by the Care Homes Regulations (2001), including the relevant qualifications and experience of the new manager and her staff team, as well as and the criteria used by the home for accepting new referrals, including protocols for taking on emergency admissions. Similarly, the service users guide has also been amended to include a statement about how anyone who is interested can obtain a copy of the homes most recent CSCI inspection report. The manager said the home is also in the process of developing different versions of the guide to ensure it is far more accessible for the people for whom the service is intended (e.g. Large print and audio formats). Lingfield Avenue, 11 DS0000013400.V276282.R01.S.doc Version 5.1 Page 10 The home has accepted one new referral in the past six months. The prospective new service user had chosen to transfer from another SCOPE in the area and the manager demonstrated a good understanding of this particular individuals needs and strengths, and had clearly worked closely with all the relevant parties to obtain this information. It was also positively noted that in accordance with SCOPE’s own admissions procedures, the homes most recent arrival had been given numerous opportunities to visit Lingfield Avenue and meet the other service users, the staff, and view their bedroom, before deciding whether or not to move in. Furthermore, it is customary for all new admissions to be offered a ‘trial’ period of residency, which is always reviewed after six weeks, before any decisions about making a placement more permanent are ever taken. As required in the homes previous inspection report it was positively noted that the manager has established an emergency admissions policy that clearly states that the home will cater for emergency admissions. It is recommended that the manager should consider amending the policy further to make it more explicit that the home will only consider emergency admissions in ‘exceptional’ circumstances. Furthermore, any individuals placed in an emergency must be provided with up to date information about the home within 48 hours of arriving, have their needs assessed within 5 working days, and be relocated if the home is clearly not capable of meeting their needs. Since the homes last inspection the manager has almost completed the task of up dating all the service users written terms and conditions of occupancy. Most service users contracts now specify the exact range of fees charged by SCOPE for services and facilities provided, as well as the cost of so called ‘extras’, which are not covered by the basic price of each placement. Service users, their representatives and the manager have signed all the up dated contracts. The manager plans to up date all the service users contracts in the next few months and progress on this matter will be assessed at the homes next inspection. Lingfield Avenue, 11 DS0000013400.V276282.R01.S.doc Version 5.1 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 The homes approach to care planning ensures service users unique personal, social and healthcare needs are identified. Furthermore, significant progress has been made to improve the current care plan format and it is hoped the new versions will be introduced in the next few months making easier to plan for and met each service users personal goals. EVIDENCE: As required in the homes last inspection report the manager has now obtained a new care plan format, which is far more person centred. The manager said the document still needs further adjustments, but is confident the task of transferring each of the service users existing plans over to the new format will be completed by May 2006. Since the homes last inspection it was positively noted that the vast majority of the homes staff team have now received training in the person centred approach to care planning. As the home has made significant progress towards meeting this outstanding requirement the CSCI does not consider it unmet, but has merely repeat it and extended the timescale for action. Lingfield Avenue, 11 DS0000013400.V276282.R01.S.doc Version 5.1 Page 12 The last service users meeting was held in Decemnber’05 and was well attended by both service users and staff. Popular topics of conversation at these meetings include men and activities schedule planning. Lingfield Avenue, 11 DS0000013400.V276282.R01.S.doc Version 5.1 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 The social and recreational opportunities the service users have to engage in, are well managed, ‘age’ appropriate, and provide them with daily variety and stimulation. Dietary needs are well catered for and the meals appear to be nutritionally well balanced, nicely presented, and provide daily variation and interest for the people living at Lingfield Avenue. EVIDENCE: On arrival the homes new activities coordinator was observed reading the Bible with a service user in their bedroom. The service users Bible was written in large print, which they said helped them to read it. Another service user was seen helping themselves to brunch and a drink in the open plan kitchen, which remained unlocked throughout the course of this unannounced inspection. The manager said the majority of the service users were either already out or getting ready to go out with either their relatives or members of staff. Five service users were attending various sessions at a number of different day centres in the area and another had gone to work. One service user met, who was playing Snakes and Ladders with the homes new activities coordinator at the time, said there were always plenty of things to do in the home. Lingfield Avenue, 11 DS0000013400.V276282.R01.S.doc Version 5.1 Page 14 The home does not have its own transport, although most of the service users have their own travel cards, which entitles them to free travel on most public transport in the area. Buses seem to be quite a popular mode of transport as the home is on a main line bus route, as well as the local dial-a-ride taxi service. All the service users asked about visiting times said they were not aware of any restrictions. The manager said the home operates a fairly ‘open’ visitors policy and service users guests are only asked to call ahead if they know they will not be arriving until after 10pm. The manager went onto say that this rule is extremely flexible and will only be enforced at the discretion of the sleep-in staff on duty at the time. The CSCI considers this approach to be a ‘reasonable’ one. As required in the homes previous inspection report the manager has established a new policy statement regarding the consumption of alcohol on the premises, which makes it clear that service users are entitled to drink alcohol in their own home providing it does not adversely affect their health or behaviour. Furthermore, staff are entitled to join the service users for an alcoholic drink on duty on special occasions if they wish (e.g. Parties, toasts, ect). During a tour of the kitchen it was noted that the weeks published menu was conspicuously displayed for all to see. The manager said they normally have three weeks of planned menus, which are rotated on a weekly basis. Service users asked about the menus said they are encouraged by staff to help plan and develop them. Three menus in current circulation provided the service users with two main meals choices each evening. Overall, the meals advertised on the published menus, which tended to be mainly traditionally English fare, were nevertheless quite varied, nutritional well balanced, and clearly based on service users food preferences. All the service users spoken with at length said they liked the food at the home. The manager said it was one of the homes primary aims to encourage the service users to make informed choices about their diets and now felt more confident that the right balance between promoting healthy eating and choice was at last being struck. It was positively noted that a large bowl of fresh fruit was left out on a kitchen worktop for service users to help themselves too. Lingfield Avenue, 11 DS0000013400.V276282.R01.S.doc Version 5.1 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 & 21 Suitable arrangements are in place to ensure that service users physical, spiritual and health care needs are planned for and met. However, although the homes arrangements for handling medication appear to be sufficiently robust, service users are nevertheless still being placed at unnecessary risk of harm because not all members of staff are implementing them. EVIDENCE: All three of the service users care plans inspected at random contained very comprehensive manual handling assessments, which set out in great detail what support they each required from staff for their physical needs to be met. Three service users spoken with at length all said they could get up and go to bed when they liked. The manager also said that one service user in particular will often choose to stay up late after everyone has gone to bed to watch videos in the main lounge. The homes accident book revealed that none of the service users had been involved in any major accidents in the last six months, although there were around a dozen or so minor accidents involving service users that largely pertained to falls and minor knocks. Records showed that these incidents had been well documented and no major injuries sustained. Lingfield Avenue, 11 DS0000013400.V276282.R01.S.doc Version 5.1 Page 16 The home continues to use a well known monitored dosage system to manage the service users medication. Having sampled three service users medication administration sheets at random it was disappointing to note that six recording errors were found on one page where a member of staff had failed to sign for medicines given. This is an unacceptable number of errors and has been identified as a major shortfall in the homes recent past. The manager said she is determined to ensure her staff team are reminded once again about the importance of appropriately maintaining service users medication records. The manager also said she was particularly dismayed that this particular problem had re-emerged as all the staff authorised to handle medication in the home had recently attended medication training. The manager has agreed to discuss this on going problem with her staff team in formal one-to-one supervisions and team meetings. These comments notwithstanding it was positively noted that all the medication administration sheets sampled at random matched the stocks of medicines currently held by the home on service users behalves. It was also positively noted that as required in the homes previous inspection report the manager had up dated the homes medication policies and establishment clearer procedures for the safe disposal of ‘unwanted’ medication and the appropriate use of ‘as required’ PRN medicines. In the past year one of Lingfield Avenues service users has sadly passed away. It was evident from the comments made by the manager that this particular individuals wishes regarding dying and death had been carried out. Three of service users and several members of staff attended their Cremation. The CSCI was notified without delay about this sad occurrence and SCOPE are commended for the sensitive way in which they handled the situation, in line with the individuals wishes. Lingfield Avenue, 11 DS0000013400.V276282.R01.S.doc Version 5.1 Page 17 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 & 23 The homes arrangements for dealing with complaints and allegations of abuse ensures service users and their representatives concerns are taken seriously and the risk of service users being harmed or abused is, so far as reasonably practicable, minimised. EVIDENCE: As required in the homes previous inspection report the manager has developed additional new formats for SCOPE’s complaints procedures, including video and audio versions. The home has not received any formal complaints about its operation in the past six months. Two service users asked about the attitude of staff said on the whole they were all very approachable and always seemed to take their concerns seriously. During the course of this inspection one service user came to see the manager in her office about the behaviour of another service user. The matter was handled extremely sensitively by the manager and other staff on duty at the time and resolved then and there to the complainant’s satisfaction. The home has a comprehensive set of policies and procedures in place for responding to allegations or suspected abuse, which includes Kingston Borough Councils vulnerable adult protection protocols and SCOPEs own abuse and whistle blowing procedures. Since the homes last inspection SCOPE has received an anonymous correspondence alleging members of staff who work at the home have abused service users’. In line with SCOPE and Kingston Borough Councils own vulnerable adult protection protocols the member of staff was immediately suspended without prejudice and SCOPE’s concerns passed on without delay to all the relevant agencies, including the Metropolitan Police, Kingston Social Services, and the CSCI. Lingfield Avenue, 11 DS0000013400.V276282.R01.S.doc Version 5.1 Page 18 Initial enquires were carried out by the police and the matter has now been closed as a vulnerable adult protection issue, although the police are still investigating concerns that the correspondence may have been malicious and connected to a number of similar incidents the home has experienced in recent months. The police have advised the home to establish guidelines to help staff deal with malicious correspondence and to continue passing on any concerns they may have about similar occurrences. The behaviour of some service users can challenge the home at times and detailed guidance to help staff deal appropriately with such incidents have now been established and included in the relevant service users care plans. For example, it is clear from one service users care plan that staff are permitted to turn the power off on their electric wheelchair and restrict the individuals freedom of movement, albeit temporarily, if they consider it to be in the individuals and other service users best interests to do so. The manager said this limitation is only ever used by staff as a last resort and there have been no occasions in the past six months when staff have considered it necessary to physically intervene in this way. Documentary evidence was available on request to show the service user and their care manager consented to this limitation, which was subject to routine reviews. Sufficient numbers of the homes current staff team have recently attended a managing aggression and challenging behaviour training course. The manager said under no circumstances are staff permitted to physically restrain service users. Lingfield Avenue, 11 DS0000013400.V276282.R01.S.doc Version 5.1 Page 19 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, 27 & 30 Overall, the size and open plan layout of the home, which is furnished and decorated to a reasonable standard, ensures the service users live in quite a comfortable and safe environment, which maximises their independence. Lingfield Avenue, 11 DS0000013400.V276282.R01.S.doc Version 5.1 Page 20 EVIDENCE: In the last six months all the service users bedroom and living room doors, which did not meet the London Fire and Emergency Planning Authority (LFEPA) standards, have all been replaced with more suitable fire resistant doors. During a tour of the premises it was noted that work was in progress to repaint all the homes toilet and bathroom doors and the manager said a date had now been set for volunteers from the Princes Trust to repaint the kitchen, which was looking rather worn and shabby in places. A new pest control device has also been installed in the kitchen in line with local Environmental Health officer advice. All the bedrooms viewed at random appeared to be redecorated to a reasonable standard and were very personalised with all manner of personal effects, including family photographs, pictures, ornaments, CD’s, videos and televisions. All the bedrooms have been fitted with wash hand basins with hot and cold running water. Having tested the temperature of hot water emanating from the shower facility used in the self-continued on the first floor it was found to be a safe 43 degrees Celsius at 13.55. Similarly, the water emanating from the tap attached to the Parker bath on the ground floor was also found to be a safe 42 degrees Celsius at 14.00. The homes laundry room is located on the ground floor and the doorframe is clearly wide enough to allow wheelchairs users to access this facility. Hand washing facilities are prominently sited in this room and the walls and floors of the laundry are readily cleanable. The homes washing machine is capable of thoroughly cleaning foul laundry at appropriate temperatures and also has a sluicing programme to control the risk of infection. The home also has a contract with the Local Authority for disposing of clinical waste and it was noted that adequate supplies of yellow bags, latex gloves and plastic aprons for dealing with this type of waste, were located throughout the home. Lingfield Avenue, 11 DS0000013400.V276282.R01.S.doc Version 5.1 Page 21 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 & 36 Sufficient numbers of suitably experienced and trained staff are on duty during the day to meet the health and welfare needs of the service users, although an urgent review of the homes night time arrangements needs to be undertaken to determine whether or not staffing levels remain adequate. The homes arrangements for ensuring all staff receive regular supervision sessions with suitably qualified senior members are currently inadequate and needs to be improved to ensure the standard of care the service users receive is not adversely affected. The homes arrangements for recruiting new members of staff are sufficiently robust to minimise the risk, so far as reasonably practicable, of service users being harmed or abused by people who are ‘unfit’ to support vulnerable adults. EVIDENCE: The manager conceded that although three of her current staff team were enrolled on National Vocational Qualification courses the home was not on target to meet Government training targets for care workers (i.e. at least 50 to have achieved an NVQ level two or above in care by the end of 2005). The manager is a qualified NVQ Assessor and completed her A1 training in 2004. It was positively noted that the vast majority of the homes current staff team have completed the Learning Disabilities Award Framework (LDAF). Lingfield Avenue, 11 DS0000013400.V276282.R01.S.doc Version 5.1 Page 22 On arrival there were three care workers, an activities coordinator, a domestic and the manager, all on duty, whose numbers and skills mix seemed more than adequate to meet the assessed needs of the service users who were at home at that time. The staff roster revealed that at least two care workers are on duty at all times throughout the day, with an additional third person employed to work at peak periods of activity (i.e. 8am to 1pm & 4pm to 10pm). At night two staff are employed to sleep-in on the premises, an arrangement that has remained unchanged since the home opened, despite the fact that some of the service users needs have changed and new service users arrived in that time. Consequently, the homes nighttime staffing levels must be reviewed, as a matter of urgency to determine whether or not they are still ‘adequate’ to meet all the services users needs. Having discussed this matter with the homes manager and her line manager it has subsequently been agreed that the home would give serious consideration to employing a waking member of night staff to work along side the member of staff who sleeps-in. Staff turnover in the past six months has remained relatively low and therefore the manager has only needed to recruit one new member of staff. The new member of staffs file was examined in some depth and found to contain all the information required by the Care Homes Regulations (2001), including: proof of their identity, two written references from their last employers, up to date Criminal Records Bureau (CRB) and Protection Of Vulnerable Adult (POVA) register checks. The dates these checks were issued confirmed that the manager had not allowed the homes new activities coordinator to start working at the home until their full CRB and POVA disclosures had been processed, in line with good recruitment practices. It was positively noted that as required in the homes previous inspection report the manager has developed a detailed matrix of all the training undertaken by her staff, which not only identifies all the staffs’ current qualifications, but more importantly there training needs. The manager said she finds the matrix extremely useful and will keep it up dated to ensure it accurately reflects her current staff’s team’s knowledge and skills in the future. The matrix revealed that most of the homes current staff team have very few training needs and are suitably qualified in a number of core and specialist areas of practice, including; fire safety, moving and handling, first aid, food hygiene, health and safety, managing aggression/challenging behaviour, adult protection, person centred care planning, disability equality, understanding epilepsy, Makaton and LDAF. The homes manager acknowledged that her staff team had not been particularly well supervised over the course of the past twelve months and that Lingfield Avenue, 11 DS0000013400.V276282.R01.S.doc Version 5.1 Page 23 on average most people had only received one formal supervision session with a senior member of staff during this time. The manager is acutely aware that all staff should have one formal supervision session with a suitably qualified senior every two months and have their work performance appraised annually. The manager is also aware that both she and the other senior members of staff who should be undertaking these supervisions and appraisals have not received the necessary training from SCOPE. The manager said a date has now been sent for this training to take place in mid March 2006. Lingfield Avenue, 11 DS0000013400.V276282.R01.S.doc Version 5.1 Page 24 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, 39 & 42 The homes arrangements for self-monitoring its performance by ascertaining the views of service users and other major stakeholders are currently inadequate. Without a professionally recognised quality assurance system in place neither the service providers nor users will be able to effectively measure how successful or not the home has been at achieving its stated aims and objectives. The health, safety and welfare of the service users, their guests and staff are protected by the robustness of the safe working practices and procedures the home has in place. Lingfield Avenue, 11 DS0000013400.V276282.R01.S.doc Version 5.1 Page 25 EVIDENCE: The homes manager, Kelly McCorley, has been in operational day-to-day control of Lingfield Avenue for just over a year and has a wealth of experience working with vulnerable adults in a senior management capacity in both residential and nursing care settings. The manager says the organisation that runs the National Vocational Qualification level 4 training course she was enrolled on recently went into liquidation, as they were no longer financially viable. Consequently, the manager has dad to enrol on another NVQ course, which she hopes to restart in March 2006. Progress on this matter will be assessed at the homes next inspection. The manager is aware that the home does not currently have a professionally recognised quality assurance in place. The manager has agreed to develop some satisfaction questionnaires to ascertain service users and their representative’s views about the quality of service provided by the home. This process of self-monitoring must be continuous and the results of any service users/stakeholder surveys undertaken by the home always be published. Up to date Certificates of worthiness were in place as proof that the homes gas installations, fire alarms system, fire extinguishers, portable electrical appliances and passenger lift had all been tested by suitably qualified engineers in the past twelve months. Similarly, the homes water tank had been checked for legionella in this same period and the emergency lighting tested in the last six months. Representatives from the LFEPA last visited the home in February’05 and all the requirements identified in their subsequent report have been addressed in a timely fashion, including replacing all the service users bedrooms doors with more suitable fire resistant ones and making fire action notices more visible. The homes fire record revealed staff continue to test the fire alarm system on a weekly basis and have fire drills at regular intervals. It was positively noted that due to the poor response by staff at the homes last unannounced fire drill the manager took prompt action to rectify the problem and remind staff about their fire safety responsibilities. During a tour of the kitchen it was noted that several items of food, which had been taken out of their original packaging, were being stored in unmarked containers in the fridge. The manager must remind her staff team that in accordance with basic food hygiene standards any items of food taken out of its original packaging must be stored in a marked container, which clearly identifies its contents and the date it was opened. Lingfield Avenue, 11 DS0000013400.V276282.R01.S.doc Version 5.1 Page 26 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 3 2 3 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X X X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 4 3 X 2 X X 2 X Lingfield Avenue, 11 DS0000013400.V276282.R01.S.doc Version 5.1 Page 27 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15(1) Requirement Care plans must set out in greater detail service users unique strengths, personal goals, and the actual support they will require to achieve these aims. Records of all medicines administered in the home must be appropriately maintained from now on. The home must employ a waking member of staff to ensure sufficient numbers of staff are on duty at night to meet the service users needs. All staff must receive at least one formal supervision session with a suitably qualified senior at least once every two months, as well as an appraisal of their job performance each year. Timescale for action 01/05/06 2. YA20 13,17,Sh 3.3,18 01/03/06 3. YA33 18(1)(a) 01/09/06 4. YA36 18(2) 01/04/06 Lingfield Avenue, 11 DS0000013400.V276282.R01.S.doc Version 5.1 Page 28 5. YA36 9(2)(b) & 18(1) 6. YA39 12(3) & 24(1,2 & 3) 7. YA42 16(2)(j) All staff ‘authorised’ to supervise and appraise their colleagues must be suitably trained to perform this task. An effective quality assurance system must be introduced and the results of any service user and/or other stakeholder surveys undertaken by the home published at least annually. All food taken out of its original packaging must be stored in a clearly marked and dated container, in accordance with basic food hygiene standards. 01/04/06 01/05/06 01/03/06 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 YA4 Good Practice Recommendations The manager should consider amending the homes admission procedures to make it more explicit that individuals placed in an emergency will only be accepted in ‘exceptional’ circumstances, and providing they are supplied with all the information about the home within 48 hours, have their needs assessed within 5 working days, and are relocated if the home is clearly not capable of meeting their identified needs. At least 50 of the homes care staff team should have achieved an NVQ in care - level 2 or above. The manager should have achieved an NVQ level 4 or equivalent in management and care. 2. 3. YA32 YA37 Lingfield Avenue, 11 DS0000013400.V276282.R01.S.doc Version 5.1 Page 29 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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. Extracts may not be used or reproduced without the express permission of CSCI Lingfield Avenue, 11 DS0000013400.V276282.R01.S.doc Version 5.1 Page 30 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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