Inspection on 09/08/06 for Lingfield Avenue, 11

This inspection was carried out on 9th August 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 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 15 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 22/02/06

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 Key Unannounced Inspection 9th August 2006 10:00 Lingfield Avenue, 11 DS0000013400.V301674.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 Lingfield Avenue, 11 DS0000013400.V301674.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. Lingfield Avenue, 11 DS0000013400.V301674.R01.S.doc Version 5.2 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 Vacant Care Home 14 Category(ies) of Learning disability (14), Physical disability (14) registration, with number of places Lingfield Avenue, 11 DS0000013400.V301674.R01.S.doc Version 5.2 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)) and Sensory impairment - over 65 (SI(E)) 1 service user Physical disability - over 65 (PD(E)) and Learning disability - over 65 (LD(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. 22nd February 2006 Date of last inspection Brief Description of the Service: 11 Lingfield Avenue is owned by the registered charity SCOPE, a specialist provider of care services for people with Cerebral palsy. The home is registered to take up to fourteen younger adults (18-65) of either gender with a range of physical and learning disabilities. The homes new deputy manager, Colin Mitchell, has been in operational day-to-day control of the service since July 2006. Lingfield Avenue is located on a residential street in Surbiton, which is within a mile radius of a wide variety of local shops, cafes, restaurants, pubs, and banks. The service does not have its own transport, but is on a main line bus route, relatively close to a train station, and has good links with local taxi and minibus hire company’s. Built over two storeys this large detached property has fourteen single occupancy bedrooms, although two couples who choose to share each use one of their allotted bedrooms as a private lounge. The layout of the ground floor is very open plan, which makes the communal areas wheelchair accessible. Communal space includes a large kitchen/dinning area; a separate lounge, which can be divided in two as and when required; a laundry room; two offices and a staff sleep-in room. The reasonably wellmaintained garden at the rear of the property has also been decked out to make it more wheelchair friendly. Prospective service users and their reprensentatives are given copies of the homes Statement of Purpose and Guide which contain the vast majooerty of information people need to know about the service, although it makes no reference to the range of fees they can expect to be charged for servcies and facilities provided. Lingfield Avenue, 11 DS0000013400.V301674.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. From all the available evidence gathered the Commission for Social Care Inspection (CSCI) considers this service to have substantially more strengths than weaknesses, although there remain some important areas of practice that need improving. The Commission is confident the new manager will acknowledge all the shortfalls identified in this report and will be able to address them in a timely fashion. This unannounced site visit was carried out on Wednesday 9th August 2006 between 10.00am and 3.00pm, which was followed up five days later on the morning of Monday 14th August. These two site visits latest a total of nine hours. During the course of these visits twelve service users were met, of whom six were spoken with at length. The homes newly appointed acting manager and Area manager were also spoken with at length, along with two support workers who were both informally interviewed at the time. Finally, a service user’s relative and another’s independent advocate were also met. None of the Commissions comment cards distributed to the home to ascertain service users and their representative’s views about the quality of the service being provided by Scope have been returned to the CSCI. The remainder of these site visits was spent examining the homes records and touring the premises. What the service does well: What has improved since the last inspection? Overall the service continues to improve although the number of requirements identified in the homes last inspection report that remain outstanding is unacceptably high (See the section entitled: ‘what they could do better’). Lingfield Avenue, 11 DS0000013400.V301674.R01.S.doc Version 5.2 Page 6 The Commission accepts the new acting managers comments that it would be unreasonable for him to shoulder the blame for all the homes unmet requirements as he had only been in post for less than two weeks at the time of his unannounced inspection. The Commission is confident that given more time the homes new management team will be able to address all the new and outstanding shortfalls identified in this report. As previously negotiated with Scope it was positively noted that arrangements were now in place for waking staff to work alongside sleep-in members at night to ensure the changing needs of all the service users would continued to be met. Furthermore, the new manager is very keen that the service users benefit from having as well supervised staff team and proposes to ensure each member of staff receives at least one formal supervision session with a suitably qualified senior every month. Finally, all the service users and staff spoken with at length said they were very impressed with the new managers approach to running the home that most people felt had created a far more open, positive, and inclusive atmosphere within the home. What they could do better: The positive comments made above notwithstanding there remains a number new and outstanding areas of practice that it is vital for the new manager to rectify as soon as reasonably practicable. The homes new management team all acknowledged that the service could do much better in a number of clearly identifiable ways: The Residents Guide to the home needs to be revised to include more detailed information about the fees service users and their representatives can be expected to be charged for facilities and services provided. Each service users care plan must set out in far greater detail what support they will require to achieve their personal goals and be more focused on service users unique strengths and wishes. This shortfall remains outstanding from the homes previous inspection report, although the Commission is confident that the new manager will have little difficulty addressing the problem as he is already working on a new draft version of the homes care plan format. The homes arrangements for recording significant incidents, as well as keeping the Commission informed about there occurrence, is currently rather erratic and will need to be improved to make the system far more open and transparent. Lingfield Avenue, 11 DS0000013400.V301674.R01.S.doc Version 5.2 Page 7 It was concerning to note for the second consecutive inspection an unacceptable number of recording errors were found on medication administration sheets where staff had failed to sign for medicines dispensed to service users. This repeated failure represents a serious breach of the Care Homes Regulations (2001) and consequently a Statutory Requirement Notice was served to ensure future compliance. Failure to comply with the Notice within the given time scale will make the providers liable to prosecution without further notice. A suitable device to ensure the temperature of hot water emanating from a first floor shower outlet never exceeds 43 degrees Celsius needs to be fitted as a matter of urgency to minimise the risk of service users being scalded. Several service users needs have significantly altered in the last twelve months and the homes weekend staffing levels will therefore need be reviewed and adjusted accordingly to reflect these changes. For a home of this size and nature it is customary for at least three members of staff to be on duty at all times during the day, including weekends. Insufficient numbers of the homes current staff team have achieved a National Vocational Qualification in care, which includes the new manager, or attended any training in recognising, preventing, and reporting abuse. Some progress has been made by the home to establish a quality assurance system but the new manager feels the satisfaction questionnaires currently being used to ascertain major stakeholders views about the home are not suitable and has requested an additional six months to rectify this on going issue. Fire drills are not being undertaken at regular intervals to ensure all persons working at the home are familiar with the homes emergency evacuation procedures. Finally, the Commission is very keen to see a sustained period of stability for the home, which has experienced a relatively high turnover of managements in recent years. As previously mentioned the approach of the new manager seems to be a very open and inclusive one and it is hoped the service users and staff will all benefit from having a management team that remains unchanged for sometime to come. 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.V301674.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lingfield Avenue, 11 DS0000013400.V301674.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 5 Quality in this outcome area is good. This judgement has been made using all the available evidence. Prospective service users and their representatives have the majority of the information they need to make an informed choice about whether or not to move in, although the residents Guide will need to be amended further to make it more transparent regarding the homes complaints procedures and service users terms and conditions of occupancy. Each service user has an individual written contract that sets out their terms and conditions of occupancy, including the range of fees they are charged for facilities and services provided, a copy of which is held in the office for safe keeping. Lingfield Avenue, 11 DS0000013400.V301674.R01.S.doc Version 5.2 Page 10 EVIDENCE: The new acting manager was able to produce copies of the homes recently revised Statement of Purpose and Residents Guide on request. The homes new Statement of Purpose contained the vast majority of information prospective service users and their representatives would need to know about the services and facilities provided by the home. The acting manager, who is currently in the process of applying for the permanent registered managers position, is fully aware that the homes Statement of Purpose will need updating to include details about his qualifications and experience. The Residents Guide also contains a lot of the information required by the Standards. However, a more detailed summary of the homes complaints procedure will needed to be included in this document that makes it far clearer that all complaints will be formally responded to within 28 days and that people have the right to contact the CSCI if they are dissatisfied with the providers response. Furthermore, the Guide does not contain any specific details about each service users terms and conditions of occupancy, and more specifically the level of fees to be charged for facilities and services provided, methods of payment, and periods of notice regarding changes to fees and reasons for any increases. One service user and their advocate spoken with at length said they had not been provided with a standardised form of contract which set out clearly their terms and conditions of occupancy, although a costed copy was immediately made available by the new acting manager on request. It was noted that all thirteen service users currently residing at the home each had a costed contract that was held in the office on their behalves. The statement that CSCI inspections will be carried out on an annual basis should be amended to make it clear that based on an assessment of risk services will be inspected at least once every 15 months or more frequently as and when required. The acting manager confirmed that there had been no new admissions to the home since it was last inspected and demonstrated a good understanding of the homes admissions procedures. One service user spoken with at length said they had decided to move to another home and it was positively noted during the course of the inspection that manager was observed actively supporting this particular individual, along with their independent advocate, to make arrangements to visit a prospective new placement. Lingfield Avenue, 11 DS0000013400.V301674.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is adequate. This judgement has been made using all the available evidence. The homes arrangements for developing care plans are sufficiently robust to ensure service users unique needs and personal goals are identified, but they do not describe in any great detail how the service will meet these individuals current and changing needs. Overall, suitable arrangements are in place to ensure service users have opportunities to participate in all aspects of life in the home and to take responsible risks as part of an independent lifestyle. EVIDENCE: Three care plans sampled at random each contained a wide variety of detailed information about the individuals personal, social and health care needs, as well as strategies to help staff manage any identified risks associated with certain service users assessed needs. However, the acting manager acknowledged that the information contained in these plans was rather ad hoc, not in particularly good order and lacked detail about what support each Lingfield Avenue, 11 DS0000013400.V301674.R01.S.doc Version 5.2 Page 12 service user actually required to achieve their personal goals. The new manager produced a blank template on request which he said would be used to develop a far more person centred approach to care planning. The date for action to be taken to make the homes care plans far more person centred has been extended in this report as the Commission is satisfied that the recent change of manager prevented this outstanding requirement being met within the original timescale for action. Minutes of the last residents meeting revealed that it had taken place in June 2006 and had been well attended by the majority of the service users currently residing at Lingfield Avenue. A wide variety of topics were covered at the meeting, including menu planning, ideas for summer activities/day trips, and keeping tropical fish in the house. The acting manager stated that he proposed to ask the service users if they would like to hold these meetings at more regulator intervals. A comprehensive list of assessments that set out the action to be taken by staff to minimise identified risks were available from the three care plans inspected at random and included detailed guidance to help staff deal with incidents of challenging behaviour, alcohol consumption, self-medication, and unplanned absences. The acting manager demonstrated a good understanding of the importance of these assessments and the need to kept them under constant review. It was evident from recent incidents involving a service user falling out of bed and the acting managers comments that this particular individuals changing needs would have to be reassessed as a matter of urgency. Progress on this matter will be assessed at the homes next inspection. Lingfield Avenue, 11 DS0000013400.V301674.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using all the available evidence. The social, leisure and recreational opportunities on offer at the home and in the wider community, are well managed and provide daily variety and stimulation for service users. Suitable arrangements are in place to enable service users to maintain good links with their families and friends. Meals are nutritiously well balanced, varied, and served in a congenial setting ensuring service users enjoy a healthy diet which meets their dietary preferences and needs. Lingfield Avenue, 11 DS0000013400.V301674.R01.S.doc Version 5.2 Page 14 EVIDENCE: On arrival the acting manager said one service user was attending sessions at a local day centre, another was on work experience, and three others were getting ready to go out to have lunch with a relative or staff. Two other service users spoken with at length said they planned to go for a drink in the afternoon at a local pub. The general consensus of opinion expressed by the half or dozen or so service users met during this inspection was that the number of opportunities they now had to engage in meaningful activities had been steadily improving since the appointment of the homes activities coordinator. In addition, duty rosters examined at random revealed that service users were regularly assigned a member of staff to provide them with one-to-one support to ensure their specific social needs were catered for. The new manager said he was very keen to increase the number of day trips service users went on each year and it was therefore positively noted that a minibus had already been hired to take some of the service users to Brighton on Saturday. One service users relative spoken with at length said staff always made them feel extremely welcome. The relative went on to say they had been invited to go with their loved one on the forthcoming day trip to Brighton. Several service users met said staff always knocked on their bedroom doors before entering and were in the main always kind and courteous. Throughout the course of this inspection staff were always observed interacting with service users and their relatives in a very caring and professional manner. All six service users asked about food said the quality and variety of the meals provided was usually very good. The atmosphere in the open plan kitchen/dinning area over lunch felt extremely relaxed. It was noted that three different meals were served at lunchtime, which included ravioli or baked beans on toast, or assorted sandwiches. A member of staff asked about the homes arrangements for ascertaining service users mealtime choices was able to produce a hand written record of all the lunchtime orders made by service users that morning. The same member of staff went onto say that similar arrangements were in place for evening meals. The previous evening the published menu showed that half the service users had chosen to have pork pie and salad, while the rest had opted for sweet and sour chicken with noodles. Several service users met confirmed that they are actually encouraged to help plan the weekly menus every Sunday and that if they do not like any of the choices on offer at the time they can always choose an something else from the larder. The homes larder, kitchen cupboards, large top loader freezer, and two upright fridges were all well stocked with a wide variety of nutritious foodstuffs at the time of this visit. Lingfield Avenue, 11 DS0000013400.V301674.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is poor. This judgement has been made using all the available evidence. In the main sufficiently robust arrangements are in place to ensure the health care needs of the service users are recognised and met, although procedures for recording ‘significant’ incidents in the home and keeping the Commission informed about the occurrence of such events are woefully inadequate and lack transparency. Furthermore, the system that is in place for the recording of all medicines administered in the home continues to break down placing the health and safety of service users at unnecessary risk of harm. EVIDENCE: On arrival all the service users who were at home were appropriately dressed in light well-maintained summer clothes. One service user spoken with at length said they always chose the clothes they would wear each day and had recently been shopping for new clothes with their key worker. Lingfield Avenue, 11 DS0000013400.V301674.R01.S.doc Version 5.2 Page 16 All the service users spoken with at length said staff always supported them to attend appointments with various health care professionals, including GP’s, physiotherapists, dentists, and opticians. The homes accident book revealed that there had been ten accidents involving service users since February 2006. These accidents all pertained to falls and none had resulted in any service being admitted to casualty or sustaining a serious injury. The acting manager confirmed that one significant incident involving a service user had occurred in the home in past six months. However, the acting manager was unable to locate a record of the incident on request and nor had the Commission been notified about this significant event at the time. Two recording errors were noted on MAR sheets where staff had failed to sign for medicines administered in the home during the last 28 days. This was particularly concerning because medication recording errors was identified as a major shortfall at the homes last inspection. This repeated failure is placing the service users at serious risk of harm. Medication records sampled at random accurately reflected the current medication stocks held by the home on service users behalves, which are kept in a locked metal cabinet securely fixed to the wall in a small annex off the kitchen. Lingfield Avenue, 11 DS0000013400.V301674.R01.S.doc Version 5.2 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 Quality in this outcome area is good. This judgement has been made using all the available evidence. Sufficiently robust arrangements are in place to enable service users and their representatives to feel their views and concerns about the homes operation are always listened too, taken seriously, and acted upon in accordance with the provider’s complaints procedures. Suitable arrangements are also in place to protect the service users, so far a reasonably practicable, from abuse, harm, or neglect. EVIDENCE: All the service users met said staff were on the whole good listeners and always took account of their point of view. One service user spoken with at length said they had recently made a complaint about the time it sometimes took staff to respond to a call bell being activated. The call bell alarm system was activated in this particular service users bedroom at 11.25am and a member of staff promptly responded to the bell being sounded five minutes later. Furthermore, this individual’s complaint had been formally recognised in the homes complaints log and appropriate action taken at the time to resolve the matter. It was also positively noted that the complainant was generally satisfied with outcome of the investigation and with the new personal hygiene arrangements that were put in place as a result. Lingfield Avenue, 11 DS0000013400.V301674.R01.S.doc Version 5.2 Page 18 The only other complaint received about the homes operation in the past six months concerned the homes immediate neighbours. The Commission is satisfied with the action already taken by the new acting manager to resolve this security/access issue, which the manager says all the relevant parties are now happy with. One care plan was examined in some depth because of the number of incidents involving this particular individual in recent months. The plan contained specific guidance to enable staff to deal with incidents of challenging behaviour and the one member of staff spoken with at length on this matter was very clear about their role in minimising the risk of such incidents reoccurring. The member of staff gave a very good example of how they had deescalated a potentially difficult situation that morning by reorganising the shift plan to enable them to spend more time supporting a particular service user to get dressed. The new acting manager said there had been no allegations of abuse made within the home in the past six months and he was very aware that any such allegations that came to his attention would need to be passed on without delay to all the relevant external agencies, including the police (where applicable), Kingston vulnerable adult protection team, and the CSCI. Lingfield Avenue, 11 DS0000013400.V301674.R01.S.doc Version 5.2 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, 28 & 30 Quality in this outcome area is adequate. This judgement has been made using all the available evidence, including two site visits to the service. Overall the interior design and layout of the premises ensures service users live in a relatively safe, clean and comfortable environment, although the homes arrangements for ensuring hot water emanating from all its shower outlets remains at a constantly safe level need to be reviewed as a mater of urgency. EVIDENCE: All the service users asked about the up keep of the home said it was usually kept reasonably clean and tidy. This was confirmed during a tour of the premises, although the plastic shade covering the fluorescent ceiling light in the kitchen needs cleaning and the rather worn out slip mat in the Parker bath, which also has some mould on it, also needs replacing. Four service users gave their permission to view their bedrooms, which had all been decorated to a reasonable standard and adequately furnished. These rooms were also quite personalised with all manner of ornaments, family photographs, and home entertainment equipment noted. All the service users Lingfield Avenue, 11 DS0000013400.V301674.R01.S.doc Version 5.2 Page 20 spoken with at length said they could furnish their bedrooms how they wished and had been provided with all the equipment they needed. It was positively noted that a new bed had been purchased at the service users and staff’s request. The temperature of hot water emanating from the homes two communal baths was found to be within a safe range (i.e. below 43 degrees Celsius) when tested at 14.30 on the first day of the inspection. However, temperature of hot water running from the ground floor shower outlet nearest the office was found to be an excessive 47 degrees Celsius. The acting manager was aware that hot water used in baths, as well as showers, must never exceed 43 degree Celsius and has agreed to take immediate action to ensure an appropriate mixer valve is fitted to this water outlet. A member of staff informally interviewed said service users are always accompanied in the shower and will be reminded to be extra vigilant in the next couple of weeks while this matter is addressed. During a tour of the premises it was noted that a magnetic release device fitted to a fire resistant bedroom door on the ground floor was damaged. A couple of service users said they used the room as a private lounge area and had reported the fault a few days earlier. The acting manager said arrangements had been made for this urgent maintenance issue to be repaired in the next few days. The homes washing machine is capable of washing clothes at appropriate temperatures and also has a sluice facility. The laundry room has handwashing facilities and is far enough away from the kitchen and dinning room so that there is no need for food to be stored, prepared, or eaten in the vicinity. Lingfield Avenue, 11 DS0000013400.V301674.R01.S.doc Version 5.2 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 Quality in this outcome area is adequate. This judgement has been made using all the available evidence. On the whole sufficient numbers of staff are now employed during the day and at night to meet the collective needs of the service users, although weekend staffing levels will need to be reviewed as a matter of urgency to ensure they remain adequate to meet service users changing needs. The homes arrangements for recruiting new staff are sufficiently robust to minimise the risk of service users being harmed or abused by people who are ‘unfit’ to work with adults who are vulnerable. In the main service users individual and joint needs are being met by a suitably competent staff team, although more staff will need to attend further training to improve their basic knowledge and skills in respect of vulnerable adult abuse and NVQ’s in care. Lingfield Avenue, 11 DS0000013400.V301674.R01.S.doc Version 5.2 Page 22 EVIDENCE: The new acting manager is aware that with only member of the homes current staff team awarded a National Vocational Qualification in care (Level 2 or above) the service falls well short of ensuring at least 50 its support workers are suitably trained. The providers are required to supply the Commission with a time specific action plan setting out how the Scope propose to address this on going training issue. At the time of arrival on the morning of the first site visit three support workers, a cleaner, and the manager were all on duty. The number and names of staff on duty matched those included on the homes duty rosters for that day. The new manager said current staffing levels were adequate to met service users needs. However, staffing levels at weekends sometimes dip below three between 1pm and 2.30pm rand would need to be reviewed as a matter of urgency. The acting manager explained that a number of service users regularly go and stay with their relatives at the weekends, but acknowledged these arrangements were subject to change and in the worst case scenario leave the home short staffed at the weekends. It was positively noted that arrangements had been made for waking members of staff to be employed at night in additional to the usual sleep-ins. Progress on this matter will be assessed at the homes next inspection. Furthermore, duty rosters inspected for the month of July 2006 revealed that the poor practice of allowing staff to work for excessively long periods without sufficient time off in between shifts had ceased. The rosters also showed that the home still employs a part-time activities coordinator and has a very flexible approach to planning rotas, with additional members of staff often employed to work at peak periods of activity. For example, it was noted that extra staff had been employed to work at the weekend to enable a group of service users and staff to go on a day trip. Records revealed that only two new members of staff had been recruited some the homes last inspection. The personal staff file for the homes most recent recruit was examined in depth and found to contain all the relevant information, including the individuals job application, recruitment interview questions, two written references, of which one came from their last employer, photograph proof of their identity, a Home Office approved work permit and up to date Criminal Bureau Records and Protection Of Vulnerable Adult register checks. All these documents had been obtained before this individual was allowed to commence working at the care home. Lingfield Avenue, 11 DS0000013400.V301674.R01.S.doc Version 5.2 Page 23 Documentary evidence was available on request to show that sufficient numbers of the current staff team had received up to date training in a number of core areas of practice, including fire safety, moving and handling; first aid; basic food hygiene; and handling medication in residential care setting. Two support workers informally interviewed said their employer regularly arranged for them to attend relevant training courses to improve their job performance. All the staff spoken with about their induction said it was compulsory for all new staff to undergo such training before being permitted to work unsupervised with service users. The manager said four support workers are in the process of studying within the Learning Disability Awareness Framework (LDAF). Records revealed that insufficient numbers of staff have yet to attend an approved recognising, preventing and reporting vulnerable adult abuse training. Staff interviewed said they are well-supervised and regularly received formal supervision sessions with their line manager at least once every three months or so. The new manager said he is very keen to improve this figure by ensuring his staff team receive at least one formal supervision session with a suitably qualified senior every month. Progress on this matter will be assessed at the homes next inspection. Lingfield Avenue, 11 DS0000013400.V301674.R01.S.doc Version 5.2 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, 38, 39 & 42 Quality in this outcome area is adequate. This judgement has been made using all the available evidence including a site visit to the home. Service users and staff have all benefited from the new managers approach to running the service, which has created a far more open, positive, and inclusive atmosphere in the home. The homes self-monitoring arrangements remain inadequate and a far more concerted effort needs to be made if the views of service users and their representatives are to affect the way the service is run and develops. In the main sufficiently robust health and safety arrangements are in place to minimise the risk of service users, their guests and staff being harmed, although fire drills need to be undertaken at more regular intervals to ensure all person working at the home are familiar with the homes emergency evacuation procedures. Lingfield Avenue, 11 DS0000013400.V301674.R01.S.doc Version 5.2 Page 25 EVIDENCE: The homes new acting manager, Colin Mitchell, had only been in operational day to day control of the home since the beginning of August 2006, although he had been working there as the deputy manager since June 2006. Collin Mitchell has a wealth of experience working in various settings with vulnerable adults in a management capacity. The new manager also holds a number of vocational qualifications that are relevant to his role, although he concedes that he is unsure if they are equivalent to a National Vocational Qualification in care and management Level 4 and will need to consult the relevant educational authorities on this matter. All the staff spoken with said they liked the approach of the manager and felt his leadership has created a far more open and inclusive atmosphere in the home. All the service users spoken with at length echoed this sentiment. It was positively noted that the services new Area manager was visiting the home at the time of this unannounced site visit and was evidently very keen to offer as much support and advice to the homes new acting manager. Records revealed that both staff and service users meetings continue to be held at regular intervals and the new manager demonstrated a good understanding of the importance of these forums for initiating debate and empowering services users and staff to have their say about how the home should be run. The new manager was aware that the home had a quality assurance system in place, but had felt the satisfaction questionnaires being used to ascertain service users and their representatives views about the home were not available in particularly accessible formats. The manager agreed that the process of developing more service ser friendly surveys, distributing them, analysing the feedback and then publishing the results should be completed within the next six months. The homes fire records indicated that its fire alarm system continues to be tested on a weekly basis, although fire drills are not being undertaken at regular enough intervals to ensure all staff participate in at least one every six months. Records revealed the homes last fire drill was carried out in February 2006. During a tour of the kitchen and homes larder it was noted that all items of food kept in fridges and freezers were being correctly stored in line with basic food hygiene standards. Staff also monitor all the homes fridge and freezer temperature and appropriately maintain records of their daily temperature checks. Lingfield Avenue, 11 DS0000013400.V301674.R01.S.doc Version 5.2 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 2 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 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 2 28 2 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 1 1 X 2 3 1 X X 2 X Lingfield Avenue, 11 DS0000013400.V301674.R01.S.doc Version 5.2 Page 27 Yes 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 YA1 Regulation Requirement Timescale for action 01/11/06 2. YA1 3. YA1 4. YA6 5(1)(b) (c) The residents Guide must & 5(A) contain details about service users terms and conditions of occupancy, such as levels of fees, payment arrangements, and periods of notice regarding fee changes, including reasons for any increases. 5(1)(e) A summary of the homes complaints procedure included in the service users Guide must be kept in far greater detail and make it explicit that all complaints need to be responded to within 28 days. 5(2) Each service user and the commission must be supplied with up dated versions of the new Guide on its completion. 15(1) Care plans must be far more person centred and set out in greater detail each service users unique strengths, personal goals, and more specifically what support they will require to achieve their goals. Previous timescale for action of 1st May 2006 not met. DS0000013400.V301674.R01.S.doc 01/11/06 01/11/06 01/12/06 Lingfield Avenue, 11 Version 5.2 Page 28 5. YA9 13(4) & 17(1)(a), Sch 3.3(q) 6. YA19 17(1)(a), Sch 3.3(j) & 37(1)(e) 7. YA20 13(2) & 17(1)(a) Sch 3.3(i) 8. YA27 13(4) & 23(2)(c) 9. YA28 23(2)(d) 10. YA32 18(1) 11. YA33 18(1) The risks associated with a service user falling out of bed must be assessed and in discussion with the service user and their representatives; management strategies agreed and recorded in the individuals care plan. Any limitations agreed with a service user as to their freedom of movement must be constantly reviewed. Staff must appropriately maintain a record of the occurrence of any ‘significant’ incident in the home involving service users and a written copy supplied to the Commission without delay. MAR sheets used to record the date on which medicines are administered in the home must be appropriately maintained. Previous timescale for action of 1st March not met and a statutory requirement notice issued. Preset, tamper poof and failsafe thermostatic mixer valves must be fitted to all the homes baths and showers to ensure hot water emanating from these outlets never exceeds 43 degrees Celsius. The dirty fluorescent light cover in the kitchen and the mouldy slip mat in a ground floor bath must be either cleaned or replaced. A time specific action plan setting out how the providers propose to ensure at least 50 of the homes support workers have either achieved an NVQ Level 2 in care or are at least enrolled on a suitable course must be established. Staffing levels at weekends are reviewed as a matter of urgency DS0000013400.V301674.R01.S.doc 01/09/06 09/08/06 09/08/06 24/08/06 01/09/06 01/12/06 01/12/06 Lingfield Avenue, 11 Version 5.2 Page 29 12. YA35 13. YA37 14. YA39 15. YA42 and increased accordingly to reflect service users needs (i.e. At least three support workers are on duty at all times). 13(6), Sufficient numbers of staff must 18(1) & 19, be suitably trained to recognise, Sch 2.4 prevent, and report vulnerable adult abuse. Documentary evidence of this training must be made available for inspection on request. 9(2)(b)(i)_ A time specific action plan setting out how the providers propose to ensure the new manager has either achieved an NVQ Level 4 in Management and Care or at least be enrolled on a suitable course must be established. 12(3) & An effective quality assurance 24(1,2 & 3) system must be introduced and the results of any service user and/or other stakeholder surveys undertaken by the home published on an annual basis. Previous timescale for action of 1st May 2006 not met. 17(2), Sch All persons working at the home 4.14 & and, so far as practicable, 23(4)(e) service users, must participate in at least one fire drill every six months and records of these practices appropriately maintained. 01/12/06 01/12/06 01/03/07 01/09/06 Lingfield Avenue, 11 DS0000013400.V301674.R01.S.doc Version 5.2 Page 30 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 YA1 Good Practice Recommendations The residents Guide should be amended to make it clearer that CSCI inspections will be carried out at least every 15 months or more frequently as the situation demands, and that anyone who is dissatisfied with the providers response to a formal complaint they have made may pass their concerns onto the Commission. Lingfield Avenue, 11 DS0000013400.V301674.R01.S.doc Version 5.2 Page 31 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.V301674.R01.S.doc Version 5.2 Page 32 - 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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