Inspection on 04/04/08 for Masefield Avenue

This inspection was carried out on 4th April 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 28 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Masefield Avenue 08/03/04

Masefield Avenue 22/10/03

Masefield Avenue 19/12/02

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

CARE HOME ADULTS 18-65 Masefield Avenue 12a Masefield Avenue Stratton St Margaret Swindon Wiltshire SN2 7HT Lead Inspector Alyson Fairweather Unannounced Inspection 4th April 2008 09:30 Masefield Avenue DS0000003179.V361498.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 Masefield Avenue DS0000003179.V361498.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. Masefield Avenue DS0000003179.V361498.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Masefield Avenue Address 12a Masefield Avenue Stratton St Margaret Swindon Wiltshire SN2 7HT 01793 497715 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) White Horse Care Trust Mrs Ann Barbara Prades Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Masefield Avenue DS0000003179.V361498.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 with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) 2. The maximum number of service users who can be accommodated is 6. Date of last inspection 17th March 2003 Brief Description of the Service: Masefield Avenue was an existing service which was closed by the provider in 2004. The service remained dormant, continuing to pay registration fees, whilst undergoing complete refurbishment. It is now registered to provide nursing care for up to six people with a learning disability. The home is owned and run by White Horse Care Trust (WHCT.) It is in a residential area of Swindon, and has easy access to shops, pubs, and other amenities. It is a detached bungalow, with six single bedrooms, a large communal lounge and a kitchen/dining room. Details of the costs to residents were not available during the inspection, although it was said that fees are paid by various funding authorities. Masefield Avenue DS0000003179.V361498.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 0 star. This means the people who use this service experience Poor quality outcomes. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. This inspection took place over one day in April. Several service users and staff members were present, as well as one family member. The registered manager was present for part of the time, and the locum manager for most of the time. Various documents and files were examined, including care plans, risk assessments, health and safety procedures, staff files and medication records. We also spoke to staff about residents’ needs and how they are met. As part of the inspection, six questionnaires were sent out to residents and their relatives and none were returned. Of the three staff questionnaires sent out, one was returned. What the service does well: There have been many improvements made to the fabric of the house, both internally and externally. New furniture has been purchased for the lounge, and bedrooms are decorated as residents like them. There is underfloor heating in the new extension part of the building, and there is a patio area to both sides of the house. Residents are usually referred by staff of other health or social services. This referral includes a detailed application form, risk assessments where present and details of the current care plan. The assessment information which accompanies people helps staff to understand their care needs. Residents can have several visits to the home to see if they can settle there and to give staff time to get to know them better. This helps staff to compile care plans which cater to the needs people have shown after moving in to the home. We met with one parent during the inspection. Her relative has recently come to live at Masefield, and she is very happy with the care he receives. She is able to spend a good part of the day there, and is showing staff how her son likes to be cared for. There were good relationships observed between staff and residents and relatives. Masefield Avenue DS0000003179.V361498.R01.S.doc Version 5.2 Page 6 When asked what the service did well, one staff member said to us: “The service works very closely with residents’ parents and encourages their involvement. I think this is very important as our residents are very young and have all come from the family home”. Another said: “The majority of staff are very hard working and committed to meeting the needs of the residents”. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Masefield Avenue DS0000003179.V361498.R01.S.doc Version 5.2 Page 7 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 Masefield Avenue DS0000003179.V361498.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5. Prospective residents do not have enough information to make a choice about whether they would like to stay in the home. Their needs, hopes and goals are assessed and recorded before they move in to the home. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No Statement of Purpose was available in the home when the manager was asked to let us see it. When asked, the manager said that details of the fees which individuals had to pay would be in each person’s contract. Unfortunately, some residents did not have a contract or a Service User Guide. We were told that some contracts were still being arranged. The most recent person admitted to the home had no copy of the Service User Guide. The manager has been asked to make sure that these documents are in place for all residents, and that a copy of the Statement of Purpose is sent to the Commission for Social Care Inspection (CSCI). There was good assessment information on file from when people were preparing to move in. One file contained information from the transition team at social services, the community nurse and the Strategic Health Authority, and included details of mobility, wheelchair use, safety belts and arm rests needed. This assessment information is added to by staff when the residents come for overnight visits prior to moving in. Masefield Avenue DS0000003179.V361498.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Poor record keeping in care plans means that residents’ changing needs are not always reflected. People are not always able to make choices and decisions about their own lives, but are helped in this area by staff and families. Incomplete and poorly recorded risk assessments means that staff do not have all the information needed to make people safe. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service EVIDENCE: Each resident has a care plan on file. These contain information about their likes and dislikes and about how each person’s care should be managed. This includes information about specific ways in which people must be fed and if they need to use a hoist when they are being moved. These are still being developed and will contain a personal profile which families of the people living in the home will supply. Masefield Avenue DS0000003179.V361498.R01.S.doc Version 5.2 Page 10 One person who has mobility problems was noted to have a Waterlow score of 13, which means there is a risk of pressure damage because of immobility. There had been a previous assessment made that the person was also at risk of fractures. There was no pressure care plan on file, and the manager has been asked to make sure that all residents at risk of developing pressure sores because of immobility must have a care plan on file which details how this is to be managed. Another resident had a pressure area chart which says his position must be changed every two hours. This chart was not always completed, and some days only a few entries were made. On one day there had been no entries made at all, although a record made two days previously had referred to having a “red” mark on his skin. The manager has been asked to make sure that where it is necessary to keep records that residents have had their position moved regularly, these records must be fully completed. Another resident had a “vomiting chart” kept on file. Staff were not sure why this was in place as the care plan makes no reference to it. This person also had a fluid chart to record the daily intake of fluid. However, this was not always completed or tallied at end of day. The manager has been asked to make sure that where it is necessary to keep records of residents’ fluid intake, these records must be fully completed. One person was seen to have had a very high temperature recorded. There was no record of what had been done to cool the person down and there was no sign on the Medication Administration Record (MAR) to say that medication had been given. The manager has been asked to make sure that records must detail any action taken in relation to concerns about residents’ high body temperature. One staff member said: “Care plans are a little basic due to the home being fairly new and the residents being new to the service. Communication is good between parents and staff”. Care plan information for each resident was scattered and kept in various files and folders. It is recommended that these are streamlined and that each resident has one care plan folder where all their information is kept. Masefield Avenue caters for people with complex nursing needs relating to learning disability, and are therefore mainly unable to make informed decisions. They are able to show some preferences, however, and are supported to make decisions by the staff and their families. None are able to manage their own finances, and all have family involvement. Some residents go to day services, and some like to visit their families. There were a number of risk assessments on file for residents. However, one person whose previous assessment before he came to the home said he was “at risk of fractures”, had a new risk assessment on file which says he is at risk Masefield Avenue DS0000003179.V361498.R01.S.doc Version 5.2 Page 11 of “minor injuries”. One resident had information on file which said that he had previously suffered with pressure sores. The new risk assessment says that there is a “slight possibility” of this happening, although the person is immobile. Some risk assessments were not fully completed. The manager has been asked to make sure that all risk assessment information is accurate and up to date and is consistent with any assessment information given by other professionals. They must always be fully completed. Residents’ risk assessments were all kept together alongside the risk assessments for the house, the use of the vehicle, use of chemicals, etc. and it is recommended that resident risk assessments should be kept alongside their care plans. Masefield Avenue DS0000003179.V361498.R01.S.doc Version 5.2 Page 12 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, 15, 16 and 17 Social and leisure activities are varied and but these would be increased if more staff were able to take them out in the home’s vehicle. People have a lot of contact with family and friends, and they are encouraged to visit by staff. Residents’ rights are respected and recognised in their daily lives, and their mealtimes take place in pleasant surroundings with care taken about nutritional needs. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were four residents living in Masefield Avenue; one of whom had only moved in a few days before. One person is in his last year at school, and the others go to day services two or three times a week. Some people use the hydrotherapy pool, and there was a recent trip to the Cotswolds Wildlife Park. Some people like going shopping, or visiting gardens, and one person goes to a youth club. He likes activities holidays, as well as abseiling. Music is very popular with the residents. Masefield Avenue DS0000003179.V361498.R01.S.doc Version 5.2 Page 13 One staff member told us: “There are not enough staff who can drive the house vehicle so the residents don’t have many opportunities to go out”. Staff support links between residents and their family and friends, and during the inspection one parent was in the lounge, helping her family member look through photographs with a staff member. She had been encouraged to stay and help her family member settle in. All current residents have family and all go home for overnight stays or weekends. One person had recently come back from a holiday in France with his family. The needs of the current residents are complex, and they are unable to take any responsibility for household chores. All residents have access to the whole of the house and the garden. The premises are a non-smoking area. The complex nursing needs of the residents means that some of them are unable to swallow or unable to eat enough and need long term artificial feeding. They are fed by means of a percutaneous endoscopic gastrostomy (PEG feeding). Until recently, only one resident was able to eat regular meals, so it was easy to cater for likes and dislikes. Now, however, another resident has joined the others, and staff take advice from families about food likes and dislikes. They will start to look at compiling formal menu system with pictures of all the food residents like, to enable them to have some choice. There is a large dining table and staff eat alongside residents. Masefield Avenue DS0000003179.V361498.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Residents receive personal support in they way they prefer or require. Their physical and emotional health needs are met. Poor practice in relation to medication procedures means that residents are at risk. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All residents have support plans for any personal care required. The information contained in them is gathered from the initial community care assessment, the home’s own assessment and staff knowledge of the residents. People have guidelines in place which say how they like to be helped to get washed and dressed, assisted with food and helped to and from bed. Bedrooms and bathrooms are equipped with hoists and there is a specialist bath which can be raised and lowered. All residents are registered with a GP whilst living in the home, and all other medical professionals are seen as and when required. This varies according to the needs of individuals. The home has good links with local learning disability teams, and can call for support if any crisis periods arise. Masefield Avenue DS0000003179.V361498.R01.S.doc Version 5.2 Page 15 Wheelchairs are all personalised and two people are being assessed to see if theirs need adjustments. One resident uses a nebuliser and staff have been shown how to use it by a parent. There are very clear written instructions about how to use it. All beds have pressure mattresses fitted, and all are profiling beds. Bed rails are used and are padded, and the reasons for this are recorded in care plans. One person has regular seizures and has a seizure chart in place. There are specific medications prescribed for this, although there was a record on file saying that one of these medications had caused difficulty in the past. The locum manager was clear that this would not be used, so this meant that the person’s epilepsy profile needed to be updated. The manager has been asked to ensure that this is done. The home has policies and procedures in place for medication administration, and medication is kept in a locked cupboard in the office. However, a bottle of antibiotic syrup was found in main kitchen fridge alongside food. The nurse on duty said that this medication was not now used and should have been discarded. The manager must ensure that suitable refrigeration storage is made available for those medications which require it. All medication which has been discontinued must be discarded and returned using the home’s own procedures. One resident was seen to have medication administered through his PEG. (See previous description). There was no signed consent on file for this, and although the person is unable personally to do so, consent should be sought from the next of kin. The manager must make sure that all residents or their representative give signed agreement that staff will administer medication. The home does not use the Monitored Dose System (MDS) for all residents, so staff have to hand-write residents’ medication on the Medication Administration Record (MAR). This is done by qualified nurses and should be signed by them when they have completed the entries. This had not always been done, and the manager must ensure that is done in future. In discussion with the person in charge, it was said that only nurses have access to medication. However, there are times when carers will be taking people out of the house, whether to daily activities or shopping etc. Some residents are known to have seizures and need medication at this time. All care staff must be trained to administer medication which might be needed when they are alone with residents. One resident was seen to have Nurofen brought in although he is not prescribed this, and there is no protocol for use. Where residents are to be given homely remedies, eg Nurofen, this must be done in agreement with the person’s medical practitioner. A clear protocol for its use must be in place. Masefield Avenue DS0000003179.V361498.R01.S.doc Version 5.2 Page 16 Current practice is that families order residents’ medication from their GP and bring it in to the home. There was no system in use for ordering or disposing of medication. Staff reported that families did this, although some medication for disposal was put into a large box. Staff felt that there was a contract with a firm to collect this, but when telephoned, the firm was unable to confirm this. Staff were made aware that it is the home’s responsibility to make sure that their medication procedures and practices protect residents. There was no evidence of any audit trail of medication which would have picked up any out of date medication. One person’s medication, needed to control an epileptic seizure, had expired and should have been returned. This means that there would be no seizure medication available. There was an old stock of Midazolam (another drug used to control seizures) which has been used in the past. There was a record which showed that when this was used, he had developed breathing problems and had needed oxygen. Staff were concerned that this might happen again if used. This was such an urgent matter that the nurse in charge phoned the parent who was going to get an immediate prescription that afternoon and bring it to the home. The manager has been told that she must introduce systems so that the home takes responsibility for the ordering, storage and dispensing of residents’ medication. She must seek clarification about the use of Midazolam for that particular resident, and must introduce a system of audit for medication. There was no controlled drugs storage. Although this is not needed at present, the home is still admitting residents, and as a nursing home working with people with complex needs, might need to use controlled drugs at any time. The registered person must ensure that suitable storage for controlled drugs is made available. Masefield Avenue DS0000003179.V361498.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 It was difficult to see how residents and their families can be sure their concerns are listened to and acted on, as they had not all received details of the home’s complaints’ procedures. Residents are protected from abuse, neglect and self harm by the procedures in place, but more staff training would make this more robust. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a complaints procedure in place, and it was reported that this is also in the Service User Guide, although this document was not available to inspect. Staff reported that they knew what to do if residents had a complaint, although it was not clear what this meant for people with no speech. The locum manager and staff reported that families were clear about how to complain when they had to. There had been no formal complaints made to the home or to the Commission for Social Care Inspection (CSCI). The manager has been asked to make sure that each resident and their family gets a copy of the home’s complaints procedure. The home has copies of the “No Secrets” document, and staff all receive a copy. All staff members are encouraged to report any incidences of poor practice, and a “Whistle Blowing” procedure is also available. Some staff have had training in supporting vulnerable people, although others are still to do this. Masefield Avenue DS0000003179.V361498.R01.S.doc Version 5.2 Page 18 There have been no referrals through the local Swindon and Wiltshire’s Safeguarding Procedures. The manager has been asked to make sure that all staff have training in Safeguarding Adults. Masefield Avenue DS0000003179.V361498.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 and 30 Residents live in a homely, comfortable and safe environment. The home is clean and hygienic. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Masefield Avenue is located in a residential area of Swindon, and has easy access to shops, pubs, and other amenities. It is a detached bungalow, with six single bedrooms, a large communal lounge and a kitchen/dining room, with room for wheelchair users. It has movement sensitive lighting throughout the building. There is a large communal lounge with TV, stereo, etc and a smaller quiet lounge with bean bags. The old part of the building is heated by radiators will a “coolwall” system, and the new extension has underfloor heating. There is a patio to both sides of the house. There are plans being developed to provide a sensory room. Each bedroom is individually decorated (one was recently painted by a family member) and each contains personal items, furniture and pictures. Masefield Avenue DS0000003179.V361498.R01.S.doc Version 5.2 Page 20 Staff do the residents’ laundry. Each person has their own laundry box, and these are transported on linen handcarts/trolleys to the washing machines. This cuts down handling and helps reduce risk of cross infection. The laundry has a large washing machine and separate dryer. The sluice room is currently not being used as there is no need for it. Staff use aprons and gloves when performing personal care or doing the laundry, and single use soap and towels are available. The bath mat and padding on the sides of the bath were found to be wet, and the manager has been asked to make sure that these are dried in future in order to reduce the risk of micro-organisms. Masefield Avenue DS0000003179.V361498.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, 34, 35 and 36 It was impossible to verify that residents are supported by competent and qualified staff. Not all relevant information was available to verify that residents are protected by the home’s recruitment policies and practice. Residents have their needs met by trained staff, although training in epilepsy would enhance this. They do not benefit from well supported and supervised staff. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As Masefield Avenue is a care home with nursing, there is a qualified nurse in charge of every shift. There is also a waking night shift in operation. When we visited, there were one nurse and three care staff working with residents, and keeping them amused in the lounge. It was not possible to discover how many staff had achieved an NVQ or how many were currently studying for one, because there was no record of who had done so in place. The locum manager was sure that there were three carers doing NVQ Level 3 and “several” doing NVQ Level 2. The manager has been asked to send a copy of staff qualifications to the CSCI. Masefield Avenue DS0000003179.V361498.R01.S.doc Version 5.2 Page 22 Although communication was said to be good between staff and family members, one staff member told us that: “Sometimes staff don’t always read the communication book when they come on shift”. Another staff member was concerned about maintaining staffing levels, and said: “Up until recently, if staff went off sick no-one would try to find cover”. Another comment about staff was reported earlier, when it was said that there were not enough staff who could drive the home’s vehicle, meaning residents did not get as much opportunity to go out as they might. It is planned to start up meetings for qualified nurses monthly, but this is not happening yet. Masefield Avenue is supported in its recruitment by the provider organisation, the White Horse Care Trust. Employment checks should include Criminal Records Bureau (CRB) and checks against the Protection of Vulnerable Adults (POVA) register, two written references and a medical declaration. All potential staff should complete an application form, and this should be kept on the individual staff member’s file. We looked at four staff files, one of which contained photographic ID, a job application and CV, a medical declaration and two references. Others contained much less information and one file, for a qualified nurse, was completely empty. There was no evidence of any CRB checks being done, and none of the qualified nurses had details of their professional registration (PIN number). The manager has been asked to make sure that all these details are kept on staff files. Guidance issued by CSCI says that the minimum expectation with regard to evidence of CRB checks is that on receipt of the Disclosure, the umbrella organisation or corporate body should issue a letter to providers stating the name of the person; date of Disclosure; Level of disclosure; Including POVA Check (if requested); Disclosure reference number; date POVAFirst check was received (if this was sought); and POVAFirst Reference number. Inspectors will accept the letter as evidence of the providers meeting the requirement for staff to be CRB checked. Letters (rather than Disclosures) should be kept on file in the home. This will assist CSCI inspectors when they sample Disclosures to confirm that employers have followed robust recruitment practices. All carers were said to be given an induction pack. One staff file examined showed that there were two induction packs; one from the Skills for Care and one from the White Horse Care Trust. Neither of these had been completed, and were mainly blank sheets of paper. The manager has been asked to make sure that all new staff complete their induction training. Masefield Avenue DS0000003179.V361498.R01.S.doc Version 5.2 Page 23 One staff member said: “I feel I could have been given a better induction and support. I have fed this back and am working with my manager so other nurses entering the trust do not feel in this position”. Training which has been done for all staff includes first aid, manual handling, infection control, abuse, fire training and food hygiene. Planned training includes relationships and sexuality, sign along, Downs’ Syndrome and personal care planning. None of the nursing staff files had evidence of any training in peg-feeding or management of the tube, and there was no evidence of any epilepsy training. The manager must make sure this is done. One staff member said: “I had to request to undertake the training that was relevant to my role”. Supervision of the qualified nurses is done by the registered manager and her deputy, and there was a preceptorship system in place. Supervision was said to be done very two months, but two people had only one supervision record on file. The locum manager found another record for both people, although neither had been signed or dated. One file had no supervision notes at all. the manager has been asked to make sure that all staff have records of appropriate supervision. It is recommended that all supervision records are signed by the staff member and their supervisor. They should also have the date of the meeting recorded. One staff member told us that her manager had only started meeting with her regularly since March 2008. As a newly qualified nurse, she felt she should have been having supervisions weekly with her manager since her start date in July 2007. Masefield Avenue DS0000003179.V361498.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Residents benefit from a well run home, although this would be improved by having a permanent registered manager on the premises. Their views and that of their families will underpin the monitoring and review of care practice, once this information is recorded. Their health, safety and welfare is promoted and protected. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The current registered manager also fulfils another role within the organisation, and has to spend some of her time away from the home. The plan is that the deputy manager will be making an application to register with the CSCI. This person is on a training secondment at another of White Horse Masefield Avenue DS0000003179.V361498.R01.S.doc Version 5.2 Page 25 Care Trust’s services, and the manager from that service is covering the management role in Masefield Avenue. All three are experienced in working with people with learning disabilities. However, there is a need for a new service to have a stable management team in order that the service can begin to take on its own ethos. It is recommended that the management situation is resolved soon, and that the home has a permanent manager, who will spend their time in the home. The home has only been operational for around six months, but plan to provide an annual questionnaire for residents and their families to gauge their satisfaction with the service. White Horse Care Trust also have a system of regular internal audits. Part of the responsibility of the senior managers of registered care homes is to visit the home on a monthly basis and to write a report about what they looked at and to whom they spoke. This is to ensure that they are monitoring both the health and safety of the residents as well as the quality of the service offered. The manager has been asked to make sure that a copy of the report is sent to the Commission for Social Care Inspection (CSCI) on a monthly basis until further notice. There were health and safety records in place. The home’s fire extinguishers had been serviced; these and other equipment are serviced on a contractual basis. The home’s fridge and freezer temperatures are recorded daily, and other checks are done on a weekly, monthly or quarterly basis. There is a thermometer in the bath to check the ambient temperature, and fire panels are spread throughout the house, including the bathroom. Bothe the bathroom and the sluice room had toilet cleaners lying loose. The nurse in charge said that as all residents were in wheelchairs this was less dangerous to them than might be, as they were unable to just wander into the rooms. However, staff must take account of the need for vigilance as new residents may be more mobile. The manager has been asked to make sure that all chemicals are locked up under Control of Substances Hazardous to Health (COSHH) guidelines. Masefield Avenue DS0000003179.V361498.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 1 2 X 3 3 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 2 36 2 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 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 X 2 X 2 X X 2 X Masefield Avenue DS0000003179.V361498.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No 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 2 Standard YA1 YA1 Regulation 5 (1) (b) 4 (2) Requirement Each resident must be given a copy of the home’s Service User Guide. A copy of the home’s Statement of Purpose must be made sent to the Commission for Social Care Inspection and must be kept available in the home for inspection at all times. All residents must have a contract/statement of terms and conditions on file. All residents at risk of developing pressure sores because of immobility must have a care plan on file which details how this is to be managed. Where it is necessary to keep records that residents have had their position moved regularly, these records must be fully completed. Where it is necessary to keep records of residents’ fluid intake, these records must be fully completed. Records must detail any action taken in relation to concerns about residents’ high body temperature. DS0000003179.V361498.R01.S.doc Timescale for action 04/06/08 16/06/08 3 4 YA5 YA6 5 (1) (c) 12 (1) (a) 13 (4) (c) 04/07/08 04/06/08 5 YA6 17 (1) (a) Schedule 3 (m) 17 (1) (a) Schedule 3 (m) 17 (1) (a) Schedule 3 (k) 04/06/08 6 YA6 04/06/08 7 YA6 04/06/08 Masefield Avenue Version 5.2 Page 28 8 YA9 13 (4) (c) 10 YA19 13 (4) (c) 11 YA20 13 (2) 12 YA20 13 (2) 13 YA20 13 (2) 14 YA20 18 (1) (c) (i) 13 (2) 15 YA20 16 YA20 13 (2) 17 YA20 13 (2) 18 19 YA20 YA20 13 (2) 13 (2) All risk assessment information must be accurate and up to date and must be consistent with any assessment information given by other professionals. They must be fully completed. A new epilepsy profile must be drawn up for the resident identified as having a problem with one of the medications prescribed. Suitable refrigeration storage must be made available for those medications which require it. All medication which has been discontinued must be discarded and returned using the home’s own procedures. All hand written entries on the Medication Administration Record (MAR) must be signed by staff when completed. All care staff must be trained to administer medication which might be needed when they are alone with residents. Where residents are to be given homely remedies, eg Nurofen, this must be done in agreement with the person’s medical practitioner. A clear protocol for its use must be in place. The registered person must introduce systems so that the home takes responsibility for the ordering, storage and dispensing of residents’ medication. The registered person must seek clarification about the use of Midazolam for a particular resident. The registered person must introduce a system of audit for medication. All controlled drugs must be stored in a cupboard which meets the current storage DS0000003179.V361498.R01.S.doc 04/06/08 04/06/08 04/07/08 04/06/08 04/06/08 04/07/08 04/06/08 04/06/08 04/06/08 04/07/08 04/07/08 Masefield Avenue Version 5.2 Page 29 20 YA22 22 (5) 21 22 YA23 YA32 13 (6) 18 (1) (a) 23 YA34 17 Schedule 2 (1-9) 24 25 26 YA34 YA35 YA35 17 Schedule 2 (7) 18 (1) (c) 18 (1) (c) 27 28 YA36 YA39 18 (2) (a) 26 29 YA42 13 (4) (a regulations (The Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007) All residents and their relative/representative must have a copy of the home’s complaints procedure. All staff must have training in Safeguarding Adults. The registered provider must send an up-to-date record of the number of staff with NVQ and the number of staff still studying for NVQ to the CSCI. All staff files must contain two written references, a full employment history, together with a satisfactory written explanation of any gaps in employment, photographic identification, documentary evidence of any relevent qualifications and training, and evidence of nurses’ PIN numbers where relevant. All staff must have evidence of an enhaced level CRB and POVA check. All staff must have evidence of completed induction training on file. Specialist training must be provided to make sure that staff have the skills and knowledge to meet the individual needs of people who use the service. All staff must receive supervision on a regular basis. Copies of the report of the monthly monitoring visits to the home must be sent to the CSCI until further notice. All chemicals must be kept locked up under Control of Substances Hazardous to Health (COSHH) guidelines. DS0000003179.V361498.R01.S.doc 04/06/08 04/07/08 04/06/08 04/06/08 04/06/08 04/07/08 04/07/08 04/07/08 04/06/08 04/06/08 Masefield Avenue 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 2 3 Refer to Standard YA6 YA9 YA13 Good Practice Recommendations All residents should have one care plan folder where all their information is kept. Residents risk assessments should be kept alongside their care plans. Consideration should be made to employing staff who are able to drive the home’s vehicle so that residents will be able to get and about more. Residents or their representatives should give signed agreement that staff will administer medication. Bath mats and padding should be dried after cleaning to prevent growth of micro-organisms. All supervision records should signed by the staff member and their supervisor. They should also have the date of the meeting recorded. It is recommended that the management situation is resolved soon, and that the home has a permanent manager, who will spend their time in the home. 4 5 6 7 YA20 YA30 YA36 YA37 Masefield Avenue DS0000003179.V361498.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Masefield Avenue DS0000003179.V361498.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. 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