Inspection on 24/04/08 for Matlock Close 4

This inspection was carried out on 24th April 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 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 04/12/07

Matlock Close 4 20/06/07

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 28/09/2008.

CARE HOME ADULTS 18-65 Matlock Close 4 Barnet Hertfordshire EN5 2RS Lead Inspector Tom McKervey Key Unannounced Inspection 24 & 25th April 2008 09:15 th Matlock Close 4 DS0000010536.V361342.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.V361342.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.V361342.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 www.pentahact.org.uk PentaHact Limited trading as Adepta vacant post Care Home 8 Category(ies) of Learning disability (8), Physical disability (8) registration, with number of places Matlock Close 4 DS0000010536.V361342.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). 4th December 2007 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 people who use wheelchairs. The home has a substantial plot with gardens to the sides and rear. All bathrooms and toilets are adapted to meet the needs of people with mobility problems, and wheelchair access is very good to all areas of the home. There is a large kitchen and dining room, a comfortable spacious lounge, and a another lounge at the rear of the home where the residents can relax. There is off street parking to the front of the home for several vehicles. The home provides a vehicle with a tail lift for taking residents out in the community. The property is owned and maintained by Notting Hill Housing Association. The service is managed by an organisation called Penatahact, which trades as “Adepta”. The home is situated in a quiet cul-de-sac in a housing estate in High Barnet, which has some local shops and is a short bus journey to Barnet Town Centre, Barnet General Hospital, Whalebone Park and primary schools are also located a short distance from the home. The range of fees for people living in the home is from £1,110 to £1,145 per week, depending on the level of their disability. The provider must make information available about the service, including inspection reports, to service users and other stakeholders. Matlock Close 4 DS0000010536.V361342.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes This unannounced key inspection took place over two days and was completed in seven hours, twenty minutes. The acting manager was on study leave on my first visit which made it necessary for me to return the next day to meet him and discuss what progress had been made since the last inspection. At the last key inspection in December 2007, significant failings were found that had potentially serious outcomes for the people who live in the home, particularly in relation to their safety and well-being. As a consequence, the service was rated as poor, (0 Star). Barnet Local Authority were also very concerned and stopped referring any new potential service users to the home until standards improved. At the time of this report, an independent inquiry is taking place into a fatal incident involving a resident of the home. The evidence I found during this inspection indicates that the home has worked hard to meet all the requirements at the last inspection, and they have made significant progress, particularly in training staff in how to prepare meals for people who have poor swallowing reflexes and in how to provide emergency support if an incident occurs. The main concern that remains about this service is the lack of continuity in the management of the home. Several managers have been appointed over the last three years, but they have been moved to other Adepta homes or left for other reasons. At the time of this inspection, the new manager was on extended leave from the home, to allow for an investigation into complaints by staff about her style of management. In the meantime, an acting manager is in place who has the necessary skills and experience to run the home efficiently. This inspection was carried out by visiting all areas of the home. Most of the people who live here are not able to converse but they can make their needs known in other ways that I was able to observe. However, I was able to converse with one resident. I also observed and spoke to all the staff and examined their records. Prior to the inspection, the manager sent valuable information to the Commission in a document called an Annual Quality Assurance Audit, (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives some numerical information about the service. I have referred to the AQAA in appropriate sections in this report. Matlock Close 4 DS0000010536.V361342.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The statement of purpose and service user guide have been reviewed and provide good information about the service in easy-read formats. It has been made clear that the home does not accept emergency admissions. Residents’ care plans reflect the individual’s care and support needs and their preferences. The care plans, including risk assessments, are kept under review at monthly sessions between the residents and their key workers. There is a photograph of each resident to assist new staff with identification of people who are non-verbal. The staff rota has been adjusted to provide a better level of support to enable residents to engage in more activities, particularly at weekends. Each resident has a Health Action Plan that provides clear guidelines for staff about the health needs of the person. No member of staff, whether permanent or temporary, is permitted to support residents to take their meals if they cannot demonstrate a suitable degree of competence to undertake this safely. All staff have undergone refresher training in first aid to ensure that they are aware of what to do if a resident should suffer an episode of aspiration of food. The complaints procedure is in pictorial format, which makes it easier to understand by people with a learning disability. Since the last inspection, extensive refurbishment and redecoration of the home has taken place to make a more comfortable and pleasant environment for people to live in. New call alarms have been provided for staff to summon help in emergencies. Matlock Close 4 DS0000010536.V361342.R01.S.doc Version 5.2 Page 7 Adepta senior managers send monthly reports of their visits to the home to the Commission. Following an “awayday”, the home put in place a management action plan to improve the quality of the service and delegation of responsibilities. A copy of the plan was sent to the Commission. Evidence of the most recent Gas safety, Portable appliance test, Hoists, Electrical installation and legionella certificates were seen at this 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. Matlock Close 4 DS0000010536.V361342.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.V361342.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including visiting all areas of the home. Potential users of the service can feel confident that the home will provide good information about what to expect from the service and they will carry out an assessment of their needs to make sure the home is suitable for them. People with physical disabilities are able to move about freely in all areas of the home. EVIDENCE: At the time of this inspection there were seven people living in the home and there was one vacancy. Since the last key inspection in December 2007 when the service was rated as poor, the local authority have not referred any new people to the home until they are satisfied that the standards have significantly improved. The Statement of Purpose states that the home does not accept emergency admissions. This was also confirmed by the acting manager. The Service User Guide has pictures to support the text so that people with learning disabilities can understand it more easily. All but one of the service users has lived in the home for a number of years. Each person has a tenancy agreement with the landlord, Notting Hill Housing Association. This document is also supported by pictures. Matlock Close 4 DS0000010536.V361342.R01.S.doc Version 5.2 Page 10 I examined four peoples’ case files. These contained very good information about them; their background history, their needs and how they wish to be supported. These are further developed in their care plan documents. The local authority carried out a review of the care of the residents in December 2007. After the inspection, I was sent copies of three of these reviews by the acting manager, who said that recommendations made by the reviewing officer had been implemented. He was also requesting the reports about the other four residents to be sent to the home. The majority of people who live in the home use wheelchairs. The home is purpose-built for people who have mobility problems and all doors and corridors are wide enough to allow wheelchair access to all areas of the home. There are assisted baths and other adaptations provided throughout the building. Matlock Close 4 DS0000010536.V361342.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including looking at residents’ care plans and other records. The people who live in the home can feel confident that all of the staff have a good knowledge and understanding of their needs and how best to support them. Residents’ care plans and risk assessments are kept up to date to ensure that they properly reflect the person’s current support needs. EVIDENCE: All of the people who live at this home have highly complex needs and the majority are unable to communicate verbally. However, each person has a care plan that provides guidance for staff to help them understand their needs and wishes; for example by facial expression, gestures and using objects of reference. I examined four residents’ care plans at random and was satisfied that reviews of the plans had taken place. The care plans were written in a person-centred Matlock Close 4 DS0000010536.V361342.R01.S.doc Version 5.2 Page 12 way and addressed a wide range of needs, for example; mobility, nutrition and eating skills, social contacts and rituals. The person’s preferred day and night routines and important rituals were documented in their care plan. Each resident has a key worker and I saw records that showed that the key worker and resident meet once a month to review the care plan and the risk assessments. This was a requirement at the last key inspection, particularly regarding review of risks associated with eating and drinking. I spoke to a resident who was able to communicate verbally. They told me they liked living in the home and liked all the staff who were very friendly and helped them. They said they were able to choose activities themselves and told staff what they liked to eat. They could go to bed when they liked and spend time on their own in their room if they wished. However, most of the people who live in the home have difficulty in making their wishes known through spoken communication. The staff described to me how they support these residents to make choices for instance, about the colour schemes in their bedrooms and choosing meals, some of which are shown in pictures. In some cases, the wishes of parents are consulted and one person has an advocate to support them in making their views known. Unfortunately, when I was inspecting the home, I was not made aware until after they had left, that the advocate had visited the resident that day, as I would have liked to have spoken to them. There are records showing that the people who live in the home are supported by staff to do the shopping and other household tasks in the general running of the home. There were a substantial number of risks identified in the care plans. These addressed a wide range of activities that the residents participated in at home and in the community. There were guidelines for minimising each risk so that the person was not restricted from enjoying these activities. Matlock Close 4 DS0000010536.V361342.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): All these standards were assessed. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including observation and looking at records. The people who live in the home can feel confident that they will be supported to enjoy a wide range of opportunities to develop their personal and social skills and to choose how they wish to lead their lives. Residents have choice about their meals and staff make sure that people who need particular help with eating, are supported safely. EVIDENCE: The people who live in the home are supported to avail themselves of a wide range of community facilities. These include shopping trips, attending day centres and colleges and local clubs. Baking cakes is an example of what happens in the home. Many of these activities are captured in photographs which are on display. I was told that it is intended to make more use of the rear lounge and develop a sensory area for the residents. Activities in the day centres are recorded in peoples’ files, for example; hydrotherapy. It is stated in the AQAA that the home intends to allocate Matlock Close 4 DS0000010536.V361342.R01.S.doc Version 5.2 Page 14 special responsibilities to a member of the team to co-ordinate social activities and to implement more pictorial charts of these events. On one of my visits, an outside entertainer who comes once a week was in the home. I was told that this session is very popular, particularly by one person who joins in the singing. I noted that a resident is an ardent football supporter and has several posters/photographs etc in their bedroom. The staff also support this person to go to football matches. One resident goes home to their family for a few days every week, and there were records of frequent contact between residents and relatives in the visitors book. The residents can see visitors in the various communal areas or in their bedrooms if appropriate and safe to do so. All the residents have had a holiday; indeed, while I was there, one person had just returned from a week in Wiltshire where they were supported by two staff. The resident was able to convey to me how much they had enjoyed themselves. The staff who I spoke to on my visits, demonstrated a clear understanding of the cultural and religious practise preference of each resident and how they support people who wish to attend places of religious worship. Staff described to me how the residents make their preferences known about what they like to eat. For people who are non-verbal, they may use pictures of meals and relatives’ have also provided advice to enable choice. The menus showed that meals are varied and nutritious. There has been considerable focus and staff training recently on how to support someone who has a swallowing difficulty. I observed staff preparing lunch for such a resident. I also observed staff supporting two people with eating. This was done in an unhurried and dignified manner. The food was finely chopped and thickener was added to drinks in accordance with the guidelines for that person; (see also comments in the Personal & Healthcare Support section of the report). Matlock Close 4 DS0000010536.V361342.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including observation and looking at residents’ records. The people who live in the home can feel confident that the staff are able to support them in their personal and healthcare needs to maintain their wellbeing. They can also be assured that the staff can respond appropriately if anyone has swallowing difficulties or encounters a serious incident 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: Following the last key inspection, the staff underwent a substantial training programme around care planning, risk assessment and emergency procedures if a resident is choking. The swallowing-reflex assessments were carried out by a speech and language therapist from the Primary Health Care Trust, who also provided intensive training about how to deal with emergency situations if a person starts to choke. Matlock Close 4 DS0000010536.V361342.R01.S.doc Version 5.2 Page 16 Each person living in the home now has a laminated guide about how their food and drink should be prepared. There are also guidelines about how to intervene if someone begins to choke and special cushions have been provided to assist staff to administer first aid, which they demonstrated to me. The staff said they felt confident that they could manage any emergency situations well. I was assured that no staff were permitted to support residents with dysphasia until they had been trained in the above procedures. This includes agency staff. New alarms have also been purchased recently. These are designed to alert staff when a person suffers an epileptic seizure. I was informed that the speech and language therapist was coming to the home soon to induct the staff in the use of this equipment. I noted that staff wore alarm devices which activate when they need to summon help urgently from anywhere in the home. At the time of the inspection, all the residents were in good health. One person had successfully undergone surgery recently. This person was supported by the home’s staff while they were in hospital. I saw a letter from this person’s parents expressing gratitude to the staff for this support. The parents wrote; “The staff took charge of his personal care and took him to the canteen whenever possible and generally made his life happier than it would otherwise have been. In so far as this is typical of the attitude and behaviour of staff at Matlock, I do not see how anybody could be critical of it. Their devotion to the people in their care deserves to be recognised, and family members should be very grateful.” Each person is registered with a local GP. There are records of appointments to the surgery and to other appropriate healthcare professionals, for example the consultant psychiatrist, who monitors residents’ medication. The residents have Health Action Plans, which record their medical history, any allergies and immunisation status. None of the people who live in the home are able to take medication by themselves. I was satisfied that medication was being administered safely, and staff are only permitted to do this after appropriate training. The medication was properly stored and accounted for in the MAR sheets. Matlock Close 4 DS0000010536.V361342.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): Both standards were assessed. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including speaking to residents and looking at records. People who live in the home and their representatives cannot be confident that complaints will be responded to appropriately as the system of recording these is not good. However, they can feel confident that the staff team know what to do if there are concerns or suspicions about abuse. EVIDENCE: The complaints procedure is in picture format and is pinned to the residents’ notice board. There is a note on the procedure saying that it is available in Braile or audio format. I examined the complaints log. Four complaints were documented as received in the past twelve months. However, it is not clear how many of these are still outstanding, as the records of some of these were not complete, e.g, the responses and outcomes were not all recorded. I was informed that two complaints were now at stage 2 of the complaints procedure, one of which was being investigated independently at the behest of the local authority. I was also informed by the operations manager that a complaint by a relative about the registered manager was also at stage 2, but this complaint was not logged in the home’s records. I have made a requirement about this to ensure that a clearer system of logging complaints is set up so that they can be tracked and audited properly. I spoke to a resident who said they liked living in the home and they were always treated with respect by the staff. I observed that all the people I saw appeared well cared for and looked happy. Matlock Close 4 DS0000010536.V361342.R01.S.doc Version 5.2 Page 18 The staff records showed that they had attended training in adult protection. In my discussions with them, I was satisfied that they were fully aware of abuse issues and how to report any concerns or suspicions of abuse. Matlock Close 4 DS0000010536.V361342.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, 25, 27, 28, 29 & 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including visiting all areas of the home. The residents can feel confident that they are living in an attractive, well maintained home. The landlord is refurbishing the property so that residents can live in a comfortable and safe environment. EVIDENCE: I visited all areas of the home, including residents’ bedrooms. At the time of the inspection, the home was being decorated and the bathrooms were being refurbished. New doors were installed in the kitchen cupboards. It was evident that, since the last inspection, the landlords were putting in much needed investment in bringing the property up to acceptable standards. I was told that the bedrooms were to be redecorated when the major works were completed. Matlock Close 4 DS0000010536.V361342.R01.S.doc Version 5.2 Page 20 I saw a book for recording maintenance and repair issues and noted that the response times were good. Monthly meetings take place between the home and Notting Hill Housing Association to discuss ongoing maintenance issues. The garden was well maintained but the various water features appear to have been neglected and should be re-instated to function properly. There are large paved areas around the building, which enable access for wheelchair users. The bedrooms are decorated in what I was informed, is the preferred taste of each resident. The bedrooms either have carpets or laminate flooring, depending on the needs of the resident. Each person had pictures and other personal mementoes on display. One resident has a particular interest in football and there were posters of their favourite team on the walls. The home is well equipped with hoists, assisted baths and other adaptations to assist staff in supporting the residents in a safe manner. There were records to show that the equipment is serviced regularly. It is stated in the AQAA, that the rear lounge area was going to be developed into a sensory room, which will be a valuable asset for the people who live in the home. The laundry has appropriate washing and drying machines, and I noted that buckets and mops were colour-coded to prevent the spread of infection. The kitchen furniture and cupboards were in good repair. The kitchen is large enough to allow access for the residents to sit in and eat if they wish. There is a large, very attractive conservatory-style room at the front of the home, which is comfortably furnished. I was told that meetings are held here. A cleaner is employed in the home and at the time of the inspection, the home was clean and tidy and smelled fresh. Matlock Close 4 DS0000010536.V361342.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 35 & 36 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including speaking to staff and looking at their records. People who live in the home can feel confident that the staff team is able to meet their needs by being trained in how best to support them safely. The staff receive regular supervision to monitor performance and ensure that they maintain good practice. EVIDENCE: The staff rota confirmed the members of staff who were on duty during my two visits to the home. There are normally four staff on the am shift, four on the pm, one waking and one sleep-in staff at night. The deputy manager told me that the rota had been adjusted after the last inspection, to reduce the handover period. This has enabled more staff to be available to support residents in their activities. The staff to whom I spoke said they were satisfied with this level of staffing. It was not possible to check recruitment records as these are held at Adepta head office with the agreement of the Commission. However, the AQAA states that proper procedures are followed, including obtaining references and Criminal Records Bureau checks before staff start working in the home. Matlock Close 4 DS0000010536.V361342.R01.S.doc Version 5.2 Page 22 It was described to me how people who live in the home are able to have an input when new staff are being recruited. This is by potential recruits being observed by the manager and other staff while they undertake a particular task to support a resident. By observing how the candidate and resident react to each other, a judgement is made about the suitability of the candidate. There are still four care staff vacancies, which the operations manager said they are trying to recruit to. In the meantime, agency staff make up the shortfall. I spoke to some of these staff who said they have worked at the home on a regular basis and know the residents well. They have also undergone the “competencies” training required to support residents with dysphasia. The permanent staff said they monitor agency staff to make sure they support residents safely. The staff informed me that they had benefited from the team building exercise they had this year and the special dysphasia training, which made them feel more confident in supporting the people who live in the home. In the AQAA, the manager has stated that four staff have completed their National Vocational Qualification level 2 and one is currently on this course. I was shown a spreadsheet which is used to record all the training that staff have undergone and any that is still outstanding. I was satisfied that they had been trained in all the mandatory health and safety subjects and POVA, as well as specialist ones like epilepsy and dysphasia as mentioned above. There were records of regular staff supervision, and all staff had an annual appraisal in the past year. All of the above was confirmed by the staff I spoke to. Matlock Close 4 DS0000010536.V361342.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41 & 42 People who use this service experience adequate outcomes in this area. This judgement has been made by discussing management issues with a senior manager and the staff. The residents cannot feel confident that they are living in a home that has been well managed. The organisational response to this issue is not acceptable as demonstrated by the frequent change of managers. This needs to be addressed urgently as this could seriously undermine the staffs’ morale and their obvious commitment to improving the standards of care EVIDENCE: This service has undergone several changes of manager over the past few years. None of the previous managers have stayed for very long. This had serious consequences for how the service was run, which is reflected in several reports of previous inspections, the last one rating the service as “poor”. Matlock Close 4 DS0000010536.V361342.R01.S.doc Version 5.2 Page 24 The current registered manager is on long-term leave from the home while an investigation into complaints from staff about her management style takes place. Another person is currently in charge, but it is unclear what this person’s status will be when and if the manager returns. The acting manager is very experienced at running a residential care home for people with learning disabilities and has managed to support the staff team through a very difficult period. He is supported by a deputy who has been in post for several years, but this person is also leaving soon to work in another Adepta home. In speaking to the staff it was evident that they had serious concerns about the registered manager. One person told me that the manager had a poor rapport with the staff team and the residents and some staff said they would leave if she returned. It was also apparent from their comments, that they regarded the acting manager as very competent and supportive, and they enjoyed working with him. I informed the operations manager about these comments, but at the time of writing this report, the Commission has not been informed of what arrangements have been made for the future management of this home. I found evidence that there has been significant progress in other outcome areas relating to the National Minimum Standards, but the delay in addressing the management of the home is unacceptable. As a consequence of the shortfalls found in the last inspection, the staff spent valuable time together away from the home to concentrate on care planning and other issues relating to the development of the service. I examined the personal finance records of four residents. Receipts were kept for purchases and two staff sign when they withdraw money from residents’ money pouches, which are then sealed until the next transaction. The sums of cash remaining, balance with the records. I saw minutes of residents and staff meetings, and also relatives’ meetings which are held regularly so that everyone has an opportunity to have an input into how the home is run. Senior managers visit the home and monitor the service monthly. Reports of these visits are sent to the Commission. With the exception of the complaints records, I found all other records to be well structured and up to date. These include fire alarm tests and drills and temperature monitoring of fridges and freezers. The major service installations were serviced in the past year and there was a current insurance certificate on display. Matlock Close 4 DS0000010536.V361342.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 X 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 3 3 X 3 3 X Matlock Close 4 DS0000010536.V361342.R01.S.doc Version 5.2 Page 26 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 YA22 Regulation 22 (Schedule 4.11) Requirement Timescale for action 31/05/08 2. YA37 8(1) All complaints must be logged in a way which clearly documents the date and nature of the complaint, the response time, the outcome, and whether the complainant is satisfied. This will demonstrate that complaints are taken seriously and addressed properly. Senior management from Adepta 30/06/08 must ensure that a permanent manager is installed in the home who is competent and able to maintain good professional relationships with the staff team, residents and their relatives. 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.V361342.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow 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. Extracts may not be used or reproduced without the express permission of CSCI Matlock Close 4 DS0000010536.V361342.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!