Inspection on 25/06/08 for 10 Love Walk

This inspection was carried out on 25th June 2008.

CSCI found this care home to be providing an Adequate service.

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 21 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

10 Love Walk 18/10/07

10 Love Walk 11/07/06

10 Love Walk 15/12/05

10 Love Walk 25/04/05

10 Love Walk 25/10/04

10 Love Walk 20/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Love Walk, 10 London SE5 8AE Lead Inspector Ms Alison Pritchard Unannounced Inspection 25 & 26th June 2008 11:40a th Love Walk, 10 DS0000007105.V364546.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 Love Walk, 10 DS0000007105.V364546.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. Love Walk, 10 DS0000007105.V364546.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Love Walk, 10 Address London SE5 8AE 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) 020 7703 3001 020 7252 4958 love-walk@missioncare.org.uk www.missioncare.org.uk Mission Care Jacqueline Perdrix-Howard Care Home 22 Category(ies) of Physical disability (22) registration, with number of places Love Walk, 10 DS0000007105.V364546.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: 2. Physical disability - Code PD The maximum number of service users who can be accommodated is: 22 18th October 2007 Date of last inspection Brief Description of the Service: 10 Love Walk is a 22-bedded care home for people with a range of physical disabilities. It is located in a quiet residential road in Camberwell. The home is situated close to local shops, public transport and services and has a small car park. The home was purpose built and each of the bedrooms is single and has a large en-suite toilet /bathing facility. There is a lift to enable residents who use wheelchairs to access the first floor. In late June 2008 there were 22 residents and no vacancies at Love Walk. Mission Care, a Christian organisation, runs the home. Mission Care also runs nursing homes for older people in the Bromley area. The Registered Manager of the home said that she provides a copy of an information pack about the home to potential residents. They are invited to visit and she ensures that they are given information about the home, Mission Care and local facilities. CSCI reports are discussed in residents’ forum meetings and copies provided for the residents. In July 2008 the weekly fees for the home ranged between £650 and £850. No additional charges are made. A new manager was registered under the Care Standards Act in November 2007. There have been no other changes in the ownership or service registration details in the last 12 months. Love Walk, 10 DS0000007105.V364546.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was unannounced and carried out over two days in late June 2008. The inspection methods included observation of care practice, discussion with residents and staff, inspection of residents’ files and a range of other records. Care plans were checked and aspects of these residents’ care were examined by case tracking. The views of relatives, staff and involved professionals were sought through surveys and discussions. The Inspector is grateful for the contributions of everyone who responded to surveys and all of the people who spoke to her during the inspection visits. The CSCI has access to information gathered through notifications from the home. A document called an ‘Annual Quality Assurance Assessment’ (AQAA) was completed by the Registered Manager of the home in advance of the inspection and returned to us. The document provides information about how the home is addressing the National Minimum Standards along with factual information about the operation of the home. All of this information has been taken into account in compiling this report. The Registered Manager and staff from the home facilitated the inspection visits; they were helpful and courteous throughout the process. What the service does well: Many residents said that they get on well with staff and that they appreciate the help that they give them. There is a consistent staff team, with little staff turnover and temporary staff are from the Mission Care staff bank. The home has assisted three previous residents to move to alternative accommodation where they can live more independently. Residents’ spiritual needs are well attended to. The home has a useful format to assess residents’ needs which arise from their gender, race, age, disability, ethnicity, religion and sexual orientation. Residents are aware of, and feel confident in the complaints procedure. Love Walk, 10 DS0000007105.V364546.R01.S.doc Version 5.2 Page 6 In November 2007 the manager of the home was registered under the Care Standards Act 2000. What has improved since the last inspection? What they could do better: The information, which is provided for residents prior to admission, needs improvement – in particular • the service user guide must include information about the fees payable at the home; • potential residents, whose needs can be met by the home, must be provided with written confirmation of this. Some staff require training in fire safety, some also require training in adult protection issues. Although some redecoration has been undertaken, parts of the building are in need of redecoration and refurbishment, in particular, chairs must be in a safe and reasonable condition. The fire risk assessment must be reviewed annually to make sure that the fire safety arrangements are still appropriate for the needs of the home. All of the issues noted above were the subject of requirements at the last inspection of the home in October 2007. Statutory Enforcement Notices are being issued about the need to include in the service user guide, information about the fees payable; and about the need to ensure that all staff have received training in adult protection issues. Love Walk, 10 DS0000007105.V364546.R01.S.doc Version 5.2 Page 7 A new care planning format has been introduced but improvements need to be made so that each care plan reflects the full range of the resident’s needs. The management of medication, has improved since the last inspection, but remains an area which requires attention. Specific improvements needed are: • Staff competency to deal with medication must be assessed and a record made of the assessment; • Medication administration records must be completed accurately; • Assessments of residents’ ability to self administer medication have been introduced and this is an improvement. Care must be taken with the process to ensure that they consider all relevant factors; • The receiving pharmacist must be asked to verify records of returned medication. The television reception is poor in some parts of the home and residents would like it to be improved. Internal monitoring systems must be strengthened to ensure that improvements are made, especially with regard to the requirements that were not met since the last inspection of the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Love Walk, 10 DS0000007105.V364546.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 Love Walk, 10 DS0000007105.V364546.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Potential residents are able to visit the home to assess whether they would like to move there. The information given to potential residents does not include all of the information needed to make an informed choice about the home. The home’s own processes need to be improved. This will be achieved if the home carries out detailed documented assessments. On the basis of all of the information gathered the home must make a further improvement by giving written confirmation to potential residents about whether they can meet their needs. EVIDENCE: The home has a statement of purpose which is given to potential residents and people enquiring about placements at the home. At the last inspection it was required that the document be amended to remove entries which referred to named residents. This amendment has been made. Regulatory changes made in September 2006 have required information about the fees charged by the home to be included in the guide. The Registered Manager, in an improvement plan dated March 2008, stated that the document had been updated. The document given to us during the inspection does not include information about the total fee and charges made for any additional services. A Statutory Enforcement Notice is being issued about this matter. See requirement 1. Love Walk, 10 DS0000007105.V364546.R01.S.doc Version 5.2 Page 10 Two people who had recently moved to the home received information about the home and had the opportunity to visit before deciding whether to move in or not. It was required in October 2007 that, prior to their admission, potential residents are issued with written confirmation that the home can meet their needs. A letter is given to potential residents but it does not adequately meet the regulatory requirements. The letter needs to be amended to include a clear statement that the home can meet the potential resident’s needs. See requirement 2. Assessments carried out by placing social workers were seen on files but, on the file of a recently admitted resident, there was no full and detailed assessment by the home. See recommendation 1. New residents said that they were shown around the home and introduced to residents and staff. One resident had suggestions for how the admission process could be improved. the Registered Manager stated her intention to consult with recently admitted residents for feedback about their admissions so that they can learn from their experiences. Love Walk, 10 DS0000007105.V364546.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. 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 available evidence including a visit to this service. Care plans are insufficiently detailed to describe the full range of residents’ needs. Residents have the opportunity to contribute to care planning through meetings with their key worker and to decisions about the home through residents’ forum meetings. EVIDENCE: Four care plans were examined. A new format has been introduced which is an improvement on that previously used. It is acknowledged that the care plans are only recently introduced. Nevertheless it was found that the plans were insufficiently detailed and one did not reflect important information that was available in the pre-admission assessments provided by placing social workers. (This is also discussed below in the section dealing with Personal and Healthcare Support.) The Operations Director had audited some care plans and he had also noted that they were insufficiently detailed. This internal process of audit must Love Walk, 10 DS0000007105.V364546.R01.S.doc Version 5.2 Page 12 continue and care staff assisted to develop plans which are comprehensive and give sufficient information to provide person centred care. Some, but not all, of the care plans included information about the residents’ needs which reflect diversity issues using a format called ‘GRADERS’. This format allows description of residents’ needs in the areas of gender; race; age; disability; ethnicity; religion / faith and sexuality. An example of how the home seeks to meet residents’ needs in this respect is the recruitment of a member of staff who is a Spanish speaker. This assists in meeting the linguistic needs of those residents for whom Spanish is their first language. The GRADERS assessment is a useful tool and its use for each of the residents would be beneficial. See requirement 8. Residents’ signatures on the care plans confirm their involvement in the planning process. A resident showed the inspector their own copy of their plan. Notes on file showed that monthly meetings are held between the resident and their key-worker at which their care plan is reviewed. In the six months prior to the inspection visit, three residents, who had lived at the home, had been assisted to move out to places where they are able to live more independently. We recall that these residents had expressed this desire in the past and are pleased that they have been supported to achieve their goals. Residents’ feedback was that they are able to make decisions about how they spend their time. They have the opportunity to contribute to decisions about the home at the monthly residents’ forum meetings. Risk assessments were viewed in relation to the self-administration of medication, and are discussed below. Risk assessments in relation to nutrition, moving and handling and pressure relief were seen on residents’ files. In one file there were two risk assessments, only one of these was dated. The other concerned the resident’s visual impairment and, although it included the requirement that it be reviewed six monthly, there was no way of assessing whether this had happened as it was not dated. Love Walk, 10 DS0000007105.V364546.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. 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 available evidence including a visit to this service. Residents have the chance to take part in a variety of activities at home and in the local community. Residents’ spiritual needs are a focus of the work of the home. The routines of the home are flexible and residents’ privacy and choices are respected. The menu reflects the range of cultures at the home and there are opportunities for residents to talk to the chef about their needs. EVIDENCE: A member of the care staff team has recently been appointed to the role of Activities Organiser. During the inspection several residents took part in an art class with a visiting tutor. Other activities that are organised include an exercise class and bingo games. Some residents play dominoes together. Two computers have recently been bought for the residents and these are available for residents’ use. One of the computers has internet access. Some of the residents have their own computers in their rooms. Love Walk, 10 DS0000007105.V364546.R01.S.doc Version 5.2 Page 14 Several residents talked of problems with getting satisfactory television reception in some parts of the home. We saw some residents watching a film which had a distorted picture and would be likely to detract from their enjoyment. The problem with television reception has been going on for an unreasonable length of time and further efforts must be made to resolve it to the satisfaction of the residents. See requirement 9. Some people attend day centres locally. Others go out to local shops and use the library. Information about local resources is available to the residents. The home has good connections with the local Church and several residents attend services there. Some people go to other churches with family and friends. In addition a Pastoral Support Worker visits the home periodically and residents may approach him for support. He has been involved with the home for several years and familiar to many of the residents. The information about the home is clear that the approach to care is based on Christianity, but care and placements at the home are offered regardless of religion or faith. There is a wide range of ages, cultures and interests represented by the resident group. The Registered Manager stated on the AQAA that over the next year she hopes to consult further with residents about their educational and social interests and that these should be reflected in their individual care plans. This is welcomed as the current care plans include insufficient information about this area of need. Visitors are welcome at the home at all reasonable times. A visitors’ record is maintained. In addition to the residents’ own rooms there are several communal rooms available, which means that residents can see visitors in privacy. Meals are prepared by a chef and her catering team and served in a communal dining room. Those residents who need assistance to eat are provided with help in a discreet manner and adapted cutlery is available for residents who need it. The meals are prepared with regard to residents’ nutritional needs and their health conditions. The menu is a topic discussed regularly at the residents’ forum. Choices are included in the menu. The menu for the home is being reviewed following consultation with residents. There feedback about the meals prepared included the following comments: • one person said that she is pleased that the chef knows what she likes to eat and prepares her meals accordingly; • another person said that he is sometimes able to have food which reflects his culture; • one person said that he would like to be offered some of the foods which reflects other people’s culture. Love Walk, 10 DS0000007105.V364546.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff understand residents’ needs for their privacy and dignity to be respected. There is insufficient account of residents’ health care needs in their care plans, although the residents are assisted with their health needs in a variety of ways. The systems to manage medication continue to need improvement. EVIDENCE: Several people expressed their satisfaction with the care they receive from the home. One person said ‘the care I get from the home is good, it can’t be better.’ Some, but not all, of the care plans seen included residents’ preferences in relation to the gender of staff who provide assistance with their personal care. This should be noted on the care plans. Feedback from health care professionals was that the home acts according to residents’ wishes and respects their privacy and dignity. Two professionals commented that as strength of the home is that it ‘allows supported autonomy’. The residents have a variety of health care problems. Care plans included information about the health care conditions but were insufficiently detailed. Files contained a number of gaps, examples are: Love Walk, 10 DS0000007105.V364546.R01.S.doc Version 5.2 Page 16 • • • • The file of a resident with diabetes included information about the person’s night time monitoring needs, but no information about how the condition was monitored at other times. There was insufficient information about health issues associated with diabetes, such as the need for regular podiatry and optical care. Issues given prominence in the social worker’s assessment were not reflected in the resident’s care plan, these included fatigue and memory problems. One of the files did not contain a moving and handling assessment. See requirement 8. The residents are assisted to manage aspects of their healthcare by for instance, being supported to attend medical appointments; through monitoring of health conditions; assistance with their dietary needs and referrals to appropriate professionals. However the care planning documents do not demonstrate this level of support. Many members of the staff team have received training in some of the health care conditions experienced by residents. Their ability to provide appropriate care for residents with diabetes and other conditions will be enhanced by further training. See requirement 10. At the last inspection in October 2007 there were a number of problems identified with the management of medication in the home. A Pharmacy Inspector made a visit to the home on 12th December 2007. The findings of that visit were that, although there had been improvements since October, an immediate requirement made on 18th October 2007 had not been fully met as, although the medication had been administered the record of administration had not been completed. Accurate recording of administration of medicines continues to be a problem. See requirement 3. There are safe storage facilities for medication stocks. Appropriate records are made of medicines received into the home. Two members of staff sign the record and this ensures that the system is safe. Two members of staff do not consistently sign the record of returned medication, in some cases just one signature was present, in some there were no signatures. In addition the returned medication is not signed or stamped by the receiving pharmacist to confirm they have received the items. See requirement 11. Several of the residents look after their own medication. They have appropriate storage facilities in their bedrooms. Risk assessments have been conducted as advised by the Pharmacy Inspector so that the home can assess whether this is advisable. An entry on two of these risk assessments was that the residents had experienced confusion. In one case an additional entry noted that this was not a current problem so this did not affect the person’s ability to deal with the medication regime. In the second case no additional information was included Love Walk, 10 DS0000007105.V364546.R01.S.doc Version 5.2 Page 17 about the impact this has on the person’s ability to self-medicate. requirement 12. See Medication administration records (MAR) showed that some issues are resolved but there are still some improvements needed to the medication recording systems. Problems identified on this inspection are as follows: • The medication administration sheets had been hole-punched for filing in such a way that the full names of some medication were illegible. This prevented staff from adequately checking the names of the medication they were giving to residents. This introduces unnecessary risks to the system. It was agreed that in future, sheets will be filed in clear filing pockets to prevent this recurring. • Some items had unexplained gaps on the MAR sheets. These had not been picked up by the home’s daily checking system, which had been introduced since the last inspection. • An entry of O (other) on a MAR did not have a written explanation. • Two staff had not signed a hand written MAR at the time of completion. When this was pointed out to the Registered Manager, she and a senior member of staff checked and signed the document. Some of the MAR did not have the month noted on the sheet. This means that their use for auditing purposes is limited, as the record is incomplete. Staff have received training in the safe administration of medication from a Practice Development Nurse employed by Mission Care. Assessments of staff members’ competency to administer medication have not been carried out. These are required and must be documented. See requirement 13. Although the home has introduced monitoring systems they have not picked up the omissions found on this inspection, this brings into question the effectiveness of the monitoring. Love Walk, 10 DS0000007105.V364546.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents know how to use the complaints procedure. It was required at the last inspection that those staff who have not had recent training in safeguarding adults be trained. This has not been done. EVIDENCE: Residents said that they knew how to make a complaint. Several mentioned their key workers and the manager as people they would speak to if they had concerns. Residents have used the process and investigations made by the Registered Manager into the matters raised. No complaints were upheld in the year prior to the completion of the AQAA. The Registered Manager of the home stated that the safeguarding adults policy and procedure of Mission Care is under review. She has a copy of the procedures from Southwark Social Services Department, but not from other boroughs that have placed residents in the home. It is recommended that a copies of the relevant procedures are obtained. No investigations of this nature have been made over the last year. Six of the fourteen care staff have received training in adult protection issues during 2006 and 2007. It was required at the last inspection that all staff receive training in these issues by February 2008. This has not been met. In an improvement plan dated March 2008 the Registered Manager stated that this issue was outstanding as it was dependent upon the recruitment of a member of staff with responsibility for safeguarding issues. A Statutory Enforcement Notice is being issued about this matter. See requirement 4. Love Walk, 10 DS0000007105.V364546.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 28, 29, 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home needs significant redecoration and refurbishment to provide a homely and comfortable environment. There is specialist equipment available to meet residents’ needs and they benefit from bedrooms with en-suite bathrooms. EVIDENCE: The home is purpose built and facilities are spread over two floors. Bedrooms are on the ground and first floor of the home. Most of the communal facilities, two living rooms, a dining room and a large activity room are on the ground floor. Another activity room is located on the first floor. A gazebo in the garden has been designated as the home’s smoking area. A passenger lift allows access between the floors for all residents. The corridors have hand-rails fitted and bedrooms and bathrooms are equipped with the necessary aids to allow residents to be as independent as possible. Each of the bedrooms has en-suite facilities. On the ground floor there are two additional toilets available, although only one is wheelchair accessible. Love Walk, 10 DS0000007105.V364546.R01.S.doc Version 5.2 Page 20 The building requires substantial redecoration and refurbishment. Some communal areas have been redecorated, although other rooms and the corridors and stairwells remain in a poor condition. In addition furnishings are dated and damaged. Particular areas of concern were: • damaged chairs in each of the three ground floor sitting rooms; • in the small communal room there was an unsightly dirty stain on a wall; • latex gloves were seen in an open waste bin in a communal room. The Registered Manager and Operations Director were informed about these so that they could arrange the removal of those items, which could present a risk. At the last inspection it was required that redecoration and refurbishment continue so that residents can benefit from a more homely environment. See requirement 5. The Registered Manager’s improvement plan of March 2008 stated that a timetable has been agreed. The Operations Director gave a verbal commitment at this visit that the work would be completed before Christmas 2008. This will be monitored by CSCI. There are laundry facilities for the general needs of the home and for residents to use independently. There are two domestic staff on duty each day, cleaning the home. There were no offensive odours at the time of the inspection and were suitably heated, lit and ventilated. The issues raised above about the disposal of latex gloves in an open bin and the dirty stain on the wall raise concerns about the standards of hygiene and understanding of infection control issues in the home. See requirement 14. Love Walk, 10 DS0000007105.V364546.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff team have all achieved or are working towards, the minimum training standard of NVQ 2 or above. Additional training has been provided so that staff are knowledgeable about the range of needs presented by the residents. Residents would benefit further by the staff receiving training in some health care conditions, including diabetes. Gaps in some staff member’s training were identified at the last inspection and these have not yet been addressed. Evening staffing levels must be monitored to ensure that they are adequate. Staff recruitment includes taking up the appropriate checks and references and this helps to protect residents. EVIDENCE: The staff team consists of, in addition to the Registered Manager, a Deputy Manager, two senior care staff, an Activity Organiser and ten care staff. Seven staff have achieved NVQ2; nine people have achieved NVQ3 and four people are working towards NVQ3. Love Walk, 10 DS0000007105.V364546.R01.S.doc Version 5.2 Page 22 All of the staff received training in care planning and in drug awareness in the last six months. Four staff have received training in stroke awareness; six people have been trained in HIV; and all but one of the staff have been trained in drug awareness. The Registered Manager stated her intention to arrange training in alcohol awareness, as several of the residents have a history of alcohol dependence and, for some, this is a current issue. Training should also provided so that staff have skills to assist residents to manage health care conditions such as diabetes. The Registered Manager has developed a training matrix which identifies the gaps in individual staff members’ training history. Gaps in staff training profiles which were identified at the last inspection have not yet been filled. As in October 2007 six members of the team have not received training in adult protection and there are only two staff members who have been noted as having recent training in fire safety issues, (see requirement 6). The information provided showed that five staff have not received training in moving and handling. All of the training needs must be addressed quickly to ensure the safety of residents and staff. See requirement 15. Copies of the rota showed that generally there are four or five staff on duty in the mornings and early afternoon. In the later afternoon and evenings there are three or four members of staff working. The rota showed that there are only three staff on duty in the evenings for more than half of the time. This will limit the activities and the amount of individual assistance available to residents in the evening. Care needs to be taken to ensure the adequacy of staffing levels at all times. See recommendation2. Overnight two members of staff provide waking night cover. Additional assistance is available from a manager through the on call system. Bank staff fill vacancies in the rota caused by sickness and annual leave, there is a limited number of bank staff so this helps in the provision of consistent care. One new member of the bank staff team had been recruited since the last inspection. The recruitment records were examined and found to include the appropriate checks and references. There is a three month probationary period before a member of staff is confirmed in post. Love Walk, 10 DS0000007105.V364546.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Registered Manager is appropriately qualified and experienced for the role. The internal monitoring systems need to be improved. Appropriate health and safety checks are carried out but there are gaps in staff training about matters including fire safety and moving and handling. As at the last inspection the fire risk assessment requires review. EVIDENCE: The manager of the home has been registered under the Care Standards Act since November 2007. She is currently undertaking the necessary training courses – NVQ4 and the Registered Managers Award. She and the Deputy Manager have attended management skills training recently. Senior managers make visits to the home, one had taken place on the day before our visit. On the second day that we were in the home the Operations Manager was also visiting. He is familiar to the residents and this allows a further opportunity for them to raise issues of concern. Love Walk, 10 DS0000007105.V364546.R01.S.doc Version 5.2 Page 24 The management monitoring systems need to be improved so that the issues raised in this report are addressed. It has been noted above that a monitoring system introduced to improve the management of medication in the home did not address the shortcomings. The AQAA was completed fully but some of the statements made about how the home meets the standards were not borne put by the findings of the inspection. An example of this is in care planning, which needs further development to fully reflect the person centred model of care. Fire safety systems included weekly tests of the alarm system and regular drills (three had taken place this year – in January, March and May 2008). The emergency lighting is tested monthly. The fire risk assessment on file was dated April 2006. This document should be reviewed annually and this was a requirement of the inspection in October 2007. Since the inspection the Registered Manager has informed us that she has arranged for the document to be reviewed. See requirement 7. Staff have received some training in health and safety matters, but there remain some gaps, which need to be addressed. The majority of the care staff have received first aid training. However, only two staff have been trained in fire safety issues some have not received recent training in moving and handling. The need for fire safety training was the subject of a requirement in October 2007. Since the inspection the Registered Manager has informed us that, for the short term, fire safety videos have been obtained for staff to watch and additional training is being arranged through a newly appointed Training and Development Officer. See requirements 6 and 15. Love Walk, 10 DS0000007105.V364546.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 2 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 3 29 3 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 3 X 2 X X 2 X Love Walk, 10 DS0000007105.V364546.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 5(1)(bb) Requirement The Service User Guide must include details of the total fee payable in respect of the services referred to in subparagraphs (b) and (ba) and the arrangements for the payment of such a fee. Enforcement action is being taken. 2. YA3 14(1)(d) It is required that, prior to their admission, the Registered Person provide residents with written confirmation that the home can meet their needs. The previous date for compliance was 12/12/0. The requirement is repeated and a new date for compliance set. 3. YA20 13(2) The Registered Person must ensure that staff confirm the administration of medication by making an accurate entry on the medication administration record. 28/07/08 18/08/08 Timescale for action 01/09/08 Love Walk, 10 DS0000007105.V364546.R01.S.doc Version 5.2 Page 27 4. YA23 YA35 13(6) The registered person shall make arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. Enforcement action is being taken. 01/09/08 5. YA24 23(2)(d) The Registered Person must ensure that redecoration and refurbishment work continues to ensure that the residents benefit from an environment which is suitably decorated and homely. 01/01/09 6. YA42 YA35 The previous date for compliance was 01/02/08. The requirement is repeated and a new date for compliance set. 13(6)23(4)(d) The Registered Person must ensure that all staff receive regular training in fire safety issues. The previous date for compliance was 01/02/08. The requirement is repeated and a new date for compliance set. 01/09/08 7. YA42 23(4)(c)(v) It is required that the Registered Person ensure that the fire risk assessment is reviewed annually. The previous date for compliance was 12/12/07. The requirement is repeated and a new date for compliance set. 01/09/08 8. YA6 15(1) The Registered Person must DS0000007105.V364546.R01.S.doc 18/08/08 Page 28 Love Walk, 10 Version 5.2 YA19 ensure that the residents’ care plans fully reflect their health and welfare needs and how they will be met. 16(2)(n) The Registered Person must take action to improve the quality of the television reception received in the home. The Registered Person must ensure that staff receive training in the health care conditions experienced by residents. This must include diabetes. The Registered Person must ensure that the receiving pharmacist is asked to sign or stamp the records of returned medication to confirm their receipt. The Registered Person must ensure that assessments of residents’ ability to selfmedicate take account of all relevant factors, including confusion and note how this impacts on their ability to look after their medication. 01/09/08 9. YA14 10. YA19 YA35 18(c)(i) 01/09/08 11. YA20 13(2) 18/08/08 12. YA20 13(2) 18/08/08 13. YA20 13(2) The Registered Person must 18/08/08 ensure that the competency of staff responsible for administering medication is assessed and a record kept of this assessment. The Registered Person must ensure that the home is kept in a clean and hygienic condition throughout; protective clothing must be disposed of with regard for hygiene and infection control. DS0000007105.V364546.R01.S.doc 14. YA30 13(3) 18/08/08 Love Walk, 10 Version 5.2 Page 29 15. YA35 YA42 13(5) The Registered Person must ensure that all staff receive training in safe moving and handling practice. The Registered Person must review the internal monitoring systems to ensure that they are effective and contribute to the achievement of the national minimum standards and regulatory requirements. 01/09/08 16. YA39 24 01/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA2 Good Practice Recommendations The Registered Person should ensure that an assessment of potential residents’ needs is carried out by the home prior to admission. The Registered Person should monitor the evening staffing levels to ensure they are sufficient to meet residents’ needs. 2. YA33 Love Walk, 10 DS0000007105.V364546.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Love Walk, 10 DS0000007105.V364546.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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