Inspection on 20/06/07 for Matlock Close 4

This inspection was carried out on 20th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 20 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Matlock Close 4 16/03/09

Matlock Close 4 24/04/08

Matlock Close 4 04/12/07

Matlock Close 4 11/09/06

Matlock Close 4 06/02/06

Matlock Close 4 21/07/05

Matlock Close 4 17/01/05

Matlock Close 4 17/08/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Matlock Close 4 Barnet Hertfordshire EN5 2RS Lead Inspector James Pitts Key Unannounced Inspection 20th June 2007 11:05 Matlock Close 4 DS0000010536.V341515.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 Matlock Close 4 DS0000010536.V341515.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. Matlock Close 4 DS0000010536.V341515.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Matlock Close 4 Address Barnet Hertfordshire EN5 2RS 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 8449 9055 020 8449 9055 spower@pentahact.org.uk www.pentahact.org.uk Adepta Miss Sandra Power Care Home 8 Category(ies) of Learning disability (8), Physical disability (8) registration, with number of places Matlock Close 4 DS0000010536.V341515.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Limited to 8 adults who have a learning disability (LD), and who may also have a physical disability (PD). 11th September 2006 Date of last inspection Brief Description of the Service: 4 Matlock Close is a large purpose built detached bungalow for eight adults with learning and physical disabilities and has been designed for residents who use wheelchairs. The home has a substantial plot with gardens to the sides and rear. There is off street parking to the front of the home for several vehicles. The home was opened in May 1995 and is managed by Adepta who provides care and support to people with special needs and maintained by Notting Hill Housing. It is situated on a relatively new housing estate in High Barnet, a short walk from local bus routes and local shops and a short bus journey to Barnet Town Centre. Barnet General Hospital, Whalebone Park and primary schools are within a short walk of the home. The fee for residents living in the home is 1,382.00 per week. The provider must make information available about the service, including inspection reports, to service users and other stakeholders. Matlock Close 4 DS0000010536.V341515.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Most of the service users who live here are not able to hold lengthy vocal conversations but all can make at least some of their needs known in other ways. It is encouraging to note that staff demonstrate a significant knowledge of the individual communication techniques that each service user employs and the specific ways in which each makes their needs known. Four members of the permanent staff team, three service users and a relative were all present during this visit. The service users who were at home all have very limited vocal communication abilities or are able to respond to questions other than to a limited degree. Therefore observation of interactions was used. This showed that staff were aware of each of these person’s needs and thought about what each person might want to be doing at different points during the day. The relative who was also present for a time gave high praise to the commitment of permanent staff, but expressed serious concern about the number of unfamiliar staff who often work at the home and the overall deterioration to the standard of care as he sees it. It is of note that the home appeared very much as if it had been in a state of limbo for some time, with a temporary manager in post for just over the last year who was due to leave anyway at the end of the week in which this visit took place. A service user who had lived at the home for some years passed away in February of this year. This is commented upon later in this report although needless to say it has been a very sad time recently, obviously for the family and friends of this person, but also for the people who live here and the staff team. What the service does well: There is clearly a commitment amongst the permanent staff team, about half of whom were met during this inspection. In these discussions it became evident that the staff are aware of what is required in order to provide a good standard of care. Service users were seen to be treated with respect during direct interactions that were observed and staff spoke about service users in a very respectful way. It is fortunate for the managing organisation that there is a core group of staff who have the appropriate attitude to meeting service users needs, even at a time when there are significant issues organisationally that could well undermine this commitment. Matlock Close 4 DS0000010536.V341515.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Service users cannot feel confidant that the home will only accept new service for admission in the proper way, or give due consideration to their needs. The staff, whether permanent or temporary, do not all necessarily know in enough detail about what service users need. There is an urgent need to review care plans and risk assessments to ensure that these properly reflect individual service user’s support needs. There needs to be improvement in the level of support that is available for each person to participate in the community, particularly at weekends. Service users can usually feel confident that they will get the right support to take care of their personal and healthcare needs. However, there is a clear risk to service user’s health if the staff team are not fully aware of how to respond to service users who have swallowing difficulties or who then encounter serious medical difficulties as a result. The service users cannot feel confident that they are living in a well maintained home, as there are significant delays in addressing repairs and refurbishment that have been identified. Service users can feel confident that there is a committed staff team to meet their needs and that these staff are safe people to support them. However, the quality of the support that is offered by the staff team could be compromised if staff are not provided with opportunities to complete the appropriate qualifications, training and to have their performance assessed. Further risk exists in the fact that the home’s permanent staff team numbers do not match the true degree of support that the home relies upon temporary staff to achieve. The service users are living in a home that has not been as diligently well managed, either internally or externally, as it should be. The organisational response to serious concerns needs to be attended to as this could seriously undermine the commitment to a good standard of direct care that is in demonstrated by the permanent staff team. Matlock Close 4 DS0000010536.V341515.R01.S.doc Version 5.2 Page 7 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. Matlock Close 4 DS0000010536.V341515.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 Matlock Close 4 DS0000010536.V341515.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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Standards 1 & 2 were assessed at this inspection visit. Service users cannot feel confidant that the home will only accept new service for admission in the proper way, or give due consideration to their needs. EVIDENCE: At the previous key standards inspection it was required that the service users’ guide and statement of purpose must be revised. Both were revised by the time of the random inspection that took place in March 2007. It should be noted that neither the statement of purpose or service user guide give any indication that emergency admissions would be considered and no policy for accepting emergency admissions is present at the home. All but one of the service users who live here has done so for a number of years. A new service user was admitted a little less than a week before this inspection visit. This person was referred to the home approximately 48 hours before they came to live here. No completed assessment was made by the home and only scant information was available from the authority that requested the placement. This was clearly an emergency admission and indeed there is a significant need that this person has which the staff team are not currently trained to cater for. The organisational need to fill a vacancy seems Matlock Close 4 DS0000010536.V341515.R01.S.doc Version 5.2 Page 10 to have over ridden any proper consideration about whether this person could be appropriately cared for by the home. There has been a failure to adhere to the written policy that the organisation has in use. The person in question, and the other service users, had no opportunity to meet each other through introductory visits, as is supposed to occur through the organisations own admission procedure. This demonstrates scant regard or respect of the service user’s rights to be consulted or to be offered choice. The Commission received a letter the day following the visit, which informed of the admission but made no mention of the fact that it had occurred as an emergency. Matlock Close 4 DS0000010536.V341515.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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Standards 6, 7 & 9 were assessed at this inspection visit. The service users cannot feel confident that all of the staff, whether permanent or temporary, know in enough detail about what they need. There is an urgent need to review care plans and risk assessments to ensure that these properly reflect individual service user’s support needs. EVIDENCE: The previous key inspection resulted in a requirement that service user care plans should be updated and go further in outlining goals and ambitions. The sample of care plans that were viewed, two in very great detail, show that although review was said to have occurred for all in April 2007, much more still needs to be achieved. In light of the investigation report that was published in May, regarding the unexpected death of a service user at the home, further full review of all care plans is again required. All of the people who live at this Matlock Close 4 DS0000010536.V341515.R01.S.doc Version 5.2 Page 12 home have highly complex needs. These needs require that staff provide support across the entire range of each person’s daily life, personal opportunities and life experiences. Physical care support, activities of daily living, social and leisure activities and the right to adhere to personally held values and beliefs necessitate that their individual care plan must reflect the best ways to achieve positive results. Many of the service users have difficulty in making their wishes known through spoken communication. This also requires that the staff team be minutely aware of the individual methods that each person employs to express their thoughts and needs. This also means that liaison must occur with family, friends and other care professionals to ensure that each individual’s unique personality, heritage (both cultural and religious) are known. The care plan must then reflect not only these preferences, but show how support will be provided in order to show due respect for these. It is also recommended that service user care plans also include a photograph of the individual to assist new staff in identifying each person who lives here. It should be noted that four permanent staff, with which discussions were held during the course of this visit, demonstrated a detailed knowledge of service users unique personality, needs and preferences. However, this does not negate the necessity to ensure that comprehensive care plans are compiled. Care plans are working documents that at their best enable staff teams to remain acutely aware of current and changing needs and preferences, and inform all staff of how best to support each of the people who live here. This is not only important for experienced permanent staff but also for temporary staff that the home has a heavy reliance upon to provide a service (please refer to the “Staffing” section of this report for further comment about staffing of the home). It should be noted that the way in which a service user was recently admitted demonstrates scant regard or respect of the service user’s rights to be consulted or to be offered choice. The service users case records include risk assessments that tell staff and other people about anything that may harm a service user and anything that the person might do that might hurt themselves. Copies of risk assessments are kept in the service users file and cover a variety of situations from accessing community activities to learning skills and activities within the home. Risk assessments are reviewed regularly, however, in light of the need to carry out a comprehensive review of care plans, risk assessments also require the same comprehensive review. Another area of significant concern is that the service user who was recently admitted in an emergency had only one risk assessment on record. This risk assessment related to this person bathing and did not include other known areas of concern such as their difficulty swallowing or general risks associated with their diagnosis of suffering from epilepsy. Matlock Close 4 DS0000010536.V341515.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Standards 12, 13, 15, 16 & 17 were assessed at this inspection visit. Service users can feel confident that the staff of the home try to provide opportunities for everyone to develop their personal and social skills. There needs to be improvement in the level of support that is available for each person to participate in the community, particularly at weekends. The opportunity for each service user to develop and maintain personal and family relations is, however, offered and is actively supported by the staff team. EVIDENCE: Service users are supported to make use of a wide range of community based facilities. These can be anything from shopping trips, to attendance at local Matlock Close 4 DS0000010536.V341515.R01.S.doc Version 5.2 Page 14 clubs run by particular organisations or daytime activities. The staff that were present during this visit demonstrated a clear understanding of the cultural and religious practise preference that each service user chooses to adhere to. They were also able to describe how respect for these is maintained and how service users who wish to attend places of religious worship are enabled to do so. Details of the social, leisure and culturally appropriate activities in which service users participate are written in their records. Service users have some opportunity to engage in a range of activities, although it should be noted that staff recognise that further opportunities should be offered. With this is mind a programme of weekend specific activities is being examined, however, staffing availability at weekends still limits these choices. Almost all of the service users require one to one support, if not greater in order to engage in specific activities. The home’s staff group continue to encourage service users to maintain relationships with their family members and virtually all do have at least some family contact. For those who do not there is independent advocacy support available. The father of one service user was present during this inspection and commented upon his liking of permanent staff but his serious concern about the home offering less choice to service users. There is an open visitors policy. The home has a key worker system and it is part of the key worker role to keep family members informed of progress made, where appropriate. Visitors can be seen in the communal areas, of which the home has a range, or service users bedrooms if it is thought to be appropriate and safe to do so. Staff were seen to interact with service users in a totally appropriate and respectful way. The home has all appropriate policies and practices on maintaining service users dignity and rights, although whether organisationally this is given the same degree of importance is open to question (please refer to the first section of this report, entitled “Choice of home”). Service users preferences for the food that they like to eat are given due consideration. The menus show that appropriately varied and nutritious meals are available. However, staff awareness of what foods may be inappropriate for anyone who has a swallowing difficulty is in question. (please refer to the next section of this report entitled “Personal and Healthcare support” for further comment). Matlock Close 4 DS0000010536.V341515.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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Standards 18, 19 & 20 were assessed at this inspection. Service users can usually feel confident that they will get the right support to take care of their personal and healthcare needs. However, there is a clear risk to service user’s health if the staff team are not fully aware of how to respond to service users who have swallowing difficulties or who then encounter serious medical difficulties as a result. Anyone who needs to take medicine regularly to help them stay well will get the proper support from staff to make sure that this happens. EVIDENCE: Each service user has a care plan that outlines to some degree the ways in which each service users wants to be cared for and supported and about what each person likes or does not like. (Please refer to the previous section of this Matlock Close 4 DS0000010536.V341515.R01.S.doc Version 5.2 Page 16 report entitled “Individual Needs and Choices” for comment about the necessity to fully review and update care plans). Some service users require very specific support in being able to eat their meals. This is as the result of “Dysphagia” and means that there is an increased risk to people with this condition of choking or of developing other complications by food or drink entering their lungs (Known as “Aspiration”). The guidelines for staff were noted in the recent investigation report into the death of a service user as being insufficient and often lacking in clarity. There is also a lack of confidence that all of the permanent staff team are sufficiently aware of what to do if there are complications identified. This is even further compounded by the fact that there is a heavy reliance of the use of “Relief” or “Agency” staff who would clearly be far less aware of the current support needs of service users in this situation. For these reasons it is necessary for detailed “Health Action Plans” to be implemented and to include sufficiently unambiguous guidelines for staff about the individual support needs of service users. This is necessary not only for those who suffer from “Dysphagia”, but also for anyone who may require support to take on nutrition in other ways. The home must not permit any member of staff, whether permanent or temporary, to support service users to take their meals if they cannot demonstrate a suitable degree of awareness of how this should be achieved. In addition to this as the result of a recommendation that was made in the report referred to earlier, staff must have annual first aid training updates to ensure that they remain suitably aware of what to do in the case of any service user who may suffer an episode of “Aspiration”. All of the people who live at the home usually go to see a local GP if they are not feeling well. The staff write down anything that happens if some one becomes unwell and the dates that each service user visits a gp or any other healthcare professionals. If anyone needs to take medicine then the staff help him or her to do this. None of the service users can do this without help and the staff have written down why this is so on each of the care plans. The staff are making sure that people take their medicines so that they can stay well. The staff also make sure that no one can get hold of any medicine that they should not have and so they keep medicines locked away. Matlock Close 4 DS0000010536.V341515.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Standards 22 & 23 were assessed at this inspection. The service users can feel confident that the staff team at the home know what to do if there are complaints or concerns about abuse. The home has clear guidance for staff about the procedures to be followed in either of these circumstances. EVIDENCE: The service users complaints procedure is not compiled in an easily accessible format that is necessary to maximise ease of understanding for the people who live here. The pictorial version that exists has not been compiled using any recognise symbol associated with increasing the understanding of it by people with a learning disability. One complaint was made by a relative about suspicion of financial irregularity on an account held by their son. This matter is still under investigation by an independent auditor appointed by the placing authority. The person who raised this complaint spoke about these concerns in conversation during this inspection and was assured that the Commission will monitor the outcome of the investigation and respond accordingly once a conclusion is reached. The policy of the geographical authority in which the home is located, namely London Borough of Barnet Protection of Vulnerable Adults Procedure, is available for the staff to see at the home. One concern was raised in February Matlock Close 4 DS0000010536.V341515.R01.S.doc Version 5.2 Page 18 of this year about the unexpected death of a service user at the home. The investigation, carried out by the local primary care trust in liaison with other statutory authorities and the Commission, did not conclude that events at the home were proven to have contributed to this sad event. However, a number of serious potential risk to service users if improvements were not made, were identified. These are commented upon in other areas of this report and the Commission will be in discussion with Adepta as the care provider About the improvements that are required and the action that is necessary to ensure the continued safety and wellbeing of the service users. Matlock Close 4 DS0000010536.V341515.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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Standards 24, 29 & 30 were assessed at this inspection. The service users cannot feel confident that they are living in a well maintained home, as there are significant delays in addressing repairs and refurbishment that have been identified. EVIDENCE: An extensive tour of the home was conducted with members of the staff team. A relative who was also visiting made a number of comments about the deterioration in the maintenance and fabric of the home. There are a number of areas of improvement to the fabric of the home that are required. These range from decoration to garden maintenance and must be addressed by the development and implementation of a maintenance and Matlock Close 4 DS0000010536.V341515.R01.S.doc Version 5.2 Page 20 redecoration programme. There is clearly significant difficulty in liaison between Adepta, as the managing organisation, and Notting Hill Housing Trust who own the property. These issues must be addressed and the managing organisation must not allow the state of the home to deteriorate to such an extent without taking the necessary action to remedy them. The home has an alarm system in place that has either never been connected or has been disconnected, no-one at the home was sure which that might be. In any case it would be unsuitable for the use of the service users who live here. As noted as a result of the recent investigation into the unexpected death of a service user, there is no way of staff summoning assistance (particularly when in a service users bedroom or any of the bathrooms) without shouting for help. This is entirely unacceptable as staff must be able to summon assistance not only in the case of day to day support for service users but most specifically in the event of an emergency. The managing organisation must urgently seek an assessment to ascertain the most suitable form of alarm system that is required and ensure that an appropriate system is purchased and installed. This must allow for staff to also be able to summon assistance from other staff in the building when necessary. The home is kept clean, although with so much refurbishment needed no amount of cleaning will currently prevent the building looking very worn. Matlock Close 4 DS0000010536.V341515.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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Standards 32, 33, 34 & 35 were assessed at this inspection. Service users can feel confident that there is a committed staff team to meet their needs and that these staff are safe people to support them. However, the quality of the support that is offered by the staff team could be compromised if staff are not provided with opportunities to complete the appropriate qualifications, training and to have their performance assessed. Further risk exists in the fact that the home’s permanent staff team numbers do not match the true degree of support that the home relies upon temporary staff to achieve. EVIDENCE: It is necessary by law for half of the staff team to have a proper qualification to work with adults who need support in a care home. The name of this qualification is NVQ 2. There is no system in place to ensure that staff are provided with the opportunity to obtain this qualification, which must be remedied without further delay. (It should be noted that evidence supplied by Matlock Close 4 DS0000010536.V341515.R01.S.doc Version 5.2 Page 22 the home prior to this inspection gave no indication that any permanent staff were qualified at NVQ level 2 or higher and no evidence exists on the sample of staff files that were seen at this inspection visit). The are a significant number of staff shifts that require the home to use bank or agency workers. The managing organisation’s own staffing assessment states that just over 13.5 full time equivalent staff posts are required in order to cover the current staffing requirement during the two waking day shifts (This excludes night staff support). Given that the home cares for people who have highly complex support needs, and the resulting necessity to have very knowledgeable staff who are aware of these, it is surprising that there is not more effort to recruit to most of these posts. The home currently has 7 full time staff, including the manager’s post, 1 x 30 hr per week post, 1 x 24 hr per week post and 1 x 20 hour per week post. From these positions there is one person on Maternity leave, one on long term sick leave and one vacancy. The managing organisation must therefore clarify in writing with the Commission the current staffing position This has subsequently been achieved). This must also include the action that will be taken to ensure that the staffing situation does not result in any unnecessary risks to the consistency of service user’s care. Relief and agency staff are expected to refer to an induction folder prior to commencing their support duties with service users. It has also been stated that a member of the permanent staff team discusses this with new temporary workers and spends a shift inducting them. Given the tight staffing resources on each shift it is doubtful whether this would truly occur as stated. None the less, it is at the very least necessary to update the induction folder to ensure that it contains relevant service user support needs in line with the updates to care plans and risk assessments that are necessary (please refer to the earlier comments in this report under the section entitled “Individual Needs and Choice”) Adepta, as the managing company that owns the home, carries out checks to make sure that those who work here are safe people to work with the service users. These checks include things like checking if a new member of staff has ever been found guilty of a crime (known as a CRB check), and asking people who used to employ them if their work was good and if they are the right sort of person to work with the service users and to support them. However, staff files do not in most cases contain a copy of a photographic form of identification, even though the temporary manager of the home had previously assured the Commission that they now did. The previous requirement in this area, therefore, remains unmet and must be achieved without further unnecessary delay. The home keeps records that say what training courses staff have done, and when they did them. These records show that staff training is sporadic and still fails to meet the previous requirement that was made in this regard. Matlock Close 4 DS0000010536.V341515.R01.S.doc Version 5.2 Page 23 Additionally there is no indication that appraisals or training and development plans are in place. This must be remedied. Matlock Close 4 DS0000010536.V341515.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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Standards 37, 39 & 42 were assessed at this inspection. The service users cannot feel confident that they are living in a home that has been well managed, either internally or externally. The organisational response to serious concerns needs to be attended to as this could seriously undermine the commitment to a good standard of direct care that is in demonstrated by the permanent staff team. EVIDENCE: The current manager is temporary, and in fact was due to leave the home at the end of the week in which this inspection visit took place. Members of the staff team did say that they have been informed that a new permanent manager has been appointed and is expected to start work at the home in the next couple of weeks. Direct internal management of the home will not be Matlock Close 4 DS0000010536.V341515.R01.S.doc Version 5.2 Page 25 commented upon further at this time, however, it is worth noting that serious issues have been identified at this inspection that have direct connection to the way the home has been managed both internally and externally. Monthly visits under Regulation 26 are occurring and a copy of the reports of these visits is being sent to the Commission intermittently. It is of concern, however, that the managing organisation does not appear to have as diligent a system in place as is necessary to identify serious concerns that have arisen at the home. These issues significantly undermine its effective operation. This report identifies areas of concern that have direct relevance to an evident lack of organisational oversight for this home. Adepta are therefore required to continue to submit the monthly reports of the visits that are carried out under regulation 26 to the Commission’s local office. Additionally a management action plan is also required in order to outline what steps will be taken to ensure improvement at the home and to provide an undertaking that increased diligence in organisational oversight will occur. Information that was provided by the home on a pre inspection questionnaire that was sent to the Commission showed that all standard safety inspections for the home were in need of updating, with the exception of the fire alarm system. Therefore the managing organisation must submit copies to the local Commission office of the most recent, Gas safety, Portable appliance test, Hoists, Electrical installation and legionellosis certificates. Matlock Close 4 DS0000010536.V341515.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 1 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 3 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 1 30 3 STAFFING Standard No Score 31 X 32 1 33 1 34 1 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 X 1 X LIFESTYLES Standard No Score 11 3 12 2 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 3 x 3 X 1 X 1 X x Matlock Close 4 DS0000010536.V341515.R01.S.doc Version 5.2 Page 27 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 4 (1) ( c ) Schedule 1 (8) Requirement The statement of purpose and service user guide must accurately reflect what the home does, including whether emergency admissions would be considered. The home must adhere to the written admissions policy that the organisation has in use. Timescale for action 01/08/07 2. YA2 4 (1) ( c ) Schedule 1 (8) & 12 (3) 12 (1) (a) 01/08/07 3. YA2 The home must not admit 01/08/07 service users for that have specific needs, which the staff team are not trained to cater for. The care plans must be fully reviewed and reflect not only individual care and support needs but also individual service users preferences. They must also show how support will be provided in as unambiguous a way as possible. Service user care plans must also include a photograph of the individual to assist, particularly new staff, with identifying each DS0000010536.V341515.R01.S.doc 4. YA6 15 (2) (b), ( c ), & (d) 01/08/07 5. YA6 17 (1) (a) Schedule 3 (2) 01/08/07 Matlock Close 4 Version 5.2 Page 28 person who lives here. 6. YA7 12 (3) The organisation must demonstrate the proper regard and respect of the service user’s rights to be consulted or to be offered choice. Risk assessments for all service users must be fully reviewed along with the care plan review mention above and must present the risk and the risk reduction measures in a clear and unambiguous way. The home must complete full and adequate risk assessments that encompass all known risks for any new service user that is admitted to the home. The home must review the level of support that is available for service users to engage in activities, particularly at weekends. It is necessary for detailed “Health Action Plans” to be compiled and implemented and to include sufficiently unambiguous guidelines for staff about the individual support needs of service users. The home must not permit any member of staff, whether permanent or temporary, to support service users to take their meals if they cannot demonstrate a suitable degree of awareness of how this can be safely achieved. All staff must receive annual first aid training updates to ensure that they remain suitably aware of what to do in the case of any service user who may suffer an DS0000010536.V341515.R01.S.doc 01/08/07 7. YA9 13 (4) (a), (b) & (c) 01/10/07 8. YA9 13 (4) (a), (b) & (c) 16 (m) & (n) 01/08/07 9. YA12 01/08/07 10. YA18 17 (1) (a) Schedule 3 (3) (m) 01/10/07 11. YA19 13 (6) & 18 (1) ( c ) (i) 01/08/07 12. YA19 13 (4) ( c ) & 18 (1) ( c ) (i) 01/08/07 Matlock Close 4 Version 5.2 Page 29 episode of “Aspiration”. 13. YA22 22 (2) The pictorial version of the complaints procedure that exists must be compiled again and use a format that is more suited to increasing the understanding of it by people with a learning disability. The refurbishment and maintenance issues must be addressed. The managing organisation must not allow the state of the home to deteriorate to such an extent without taking the necessary remedial action. The managing organisation must urgently seek an assessment to ascertain the most suitable form of alarm system that is required and ensure that an appropriate system is purchased and installed. This must allow for staff to also be able to summon assistance from other staff in the building when required. There is no system in place to ensure that staff are provided with the opportunity to obtain the NVQ level 2 qualification, which must be remedied without unnecessary delay. The registered persons must ensure that all staff has a recent photograph in their file. (Timescales of 20/10/06 and 01/04/07 were not met). Adepta are required to continue to submit the monthly reports of the visits that are carried out under regulation 26 to the Commission’s local office. 01/08/07 14. YA24 23 (2) (b) 01/08/07 15. YA29 13 (4) (a), (b) & ( c ) and 23 (1) (a) (2) (a) 01/08/07 16. YA32 18 (1) ( c ) (ii) 01/08/07 17. YA34 19 (1) (b) (i) Schedule 2 26 (2), (4) ( c ) & (5) (a) 01/08/07 18. YA39 01/08/07 Matlock Close 4 DS0000010536.V341515.R01.S.doc Version 5.2 Page 30 19. YA39 24 (1) & (2) A management action plan is required in order to outline what steps will be taken to ensure improvement at the home and to provide an undertaking that increased diligence in organisational oversight will occur. The managing organisation must submit copies to the local Commission office of the most recent, Gas safety, Portable appliance test, Hoists, Electrical installation and legionellosis certificates. 01/08/07 20. YA42 13 (4) ( c ) & 23 (2) (c) 01/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Matlock Close 4 DS0000010536.V341515.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Harrow Area Office 4th Floor, Aspect Gate 166 College Road Harrow London HA1 1BH 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. 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