Inspection on 04/12/07 for Matlock Close 4

This inspection was carried out on 4th December 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 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 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 09/07/2008.

CARE HOME ADULTS 18-65 Matlock Close 4 Barnet Hertfordshire EN5 2RS Lead Inspector James Pitts Key Unannounced Inspection 4th December 2007 10:35 Matlock Close 4 DS0000010536.V354783.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.V354783.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.V354783.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.V354783.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). 3rd September 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 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. Matlock Close 4 DS0000010536.V354783.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Most of the people who use this service are not able to hold lengthy vocal conversations but all can make at least some of their needs known in other ways. It is again encouraging to note that staff continue to demonstrate a significant knowledge of the individual communication techniques that each person employs and the specific ways in which each makes their needs known. Four of the people who live here and seven members of the staff team were present during the course of this inspection. . This inspection involved a visit to the service, discussions with staff, observation of interactions with the people who use the service and examination of specific records. The previous key standards report and intervening random inspection were also taken into consideration as too was information from other sources, for example social care professionals, contact with relatives, meetings attended by the Commission and other information received. What the service does well: What has improved since the last inspection? The statement of purpose and guide for the people who live here have been reviewed and updated. Care plans, risk assessments and health action plans have also been updated and now clearly show how each person’s needs should be addressed (Please refer to the next section of this report in regard to implementation of these). The care plans now also include a photograph of the individual to who each plan refers. The picture version of the complaints procedure has been re examined as was previously required. Some repairs have been completed although more still needs to be done and staff now have a copy of a photograph or form of photographic ID on their individual personnel file at the home. Matlock Close 4 DS0000010536.V354783.R01.S.doc Version 5.2 Page 6 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.V354783.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 Matlock Close 4 DS0000010536.V354783.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 1 & 2 were assessed at this inspection visit. The people that use this service can feel more confidant that the registered provider is increasingly aware that the home should only accept new people 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 guide for people who use this service and statement of purpose must be revised to clearly indicate if emergency admissions would be considered. Since then there has been a clear indication given to the Commission that the organisation does not accept emergency admissions to this home. Some one new had come to live at the home a little less than a week before the previous key standards inspection visit. This person had been referred to the home approximately 48 hours before they came to live here. It was noted at that inspection that there was no completed assessment and only scant information was available from the authority that requested the placement. This had clearly been an emergency admission and there was a significant need that this person had which the staff team were not trained to cater for at Matlock Close 4 DS0000010536.V354783.R01.S.doc Version 5.2 Page 9 that time. At the subsequent feedback meeting that was then held after that inspection it was stated that the organisation had not sanctioned this admission but that it had been accepted by the then acting manager of the home. The person in question moved to a more appropriate placement a couple of days after this visit. The registered provider was informed as a result of the random inspection in September that should any similar issues of this kind arise in the future the Commission is entitled to commence immediate enforcement proceedings without further discussion. This remains the case. Matlock Close 4 DS0000010536.V354783.R01.S.doc Version 5.2 Page 10 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 people who use this service cannot feel confident that all of the staff, whether permanent or temporary, know in enough detail about what they need. Care plans and risk assessments have been reviewed and updated, however it is evident that these are not adhered to as completely as they should be. This places the people who use this service at serious risk. EVIDENCE: The previous key standards inspection identified that the care plans must be fully reviewed and reflect not only individual care and support needs but also individual preferences of the people who use this service. These were also required to show how support will be provided in as unambiguous a way as possible. Three care plans were reviewed at the subsequent random inspection and at that time these showed a very marked improvement and a far clearer Matlock Close 4 DS0000010536.V354783.R01.S.doc Version 5.2 Page 11 indication of the unique support needs of the people to which these plans refer. At this inspection the care plans of everyone who lives here were again seen. The remaining work to update all care plans has been completed and these are presented in a far clearer way. The care plans are much better at describing each person’s unique support needs and how the staff team should offer each life opportunities and experiences, as well as respecting each person’s cultural, religious and family traditions. Having said that the care plans are clearer it must also be said that the people who live here, their relatives, the placing authority and the Commission cannot feel confident that the stated care plans are actually being adhered to as diligently as they should be. Please refer to the following sections entitled “Lifestyle” & “Personal and Healthcare Support” for further comment. The home must ensure that the implementation of care plans achieves the necessary diligence in order to increase the confidence of those who use the service and other stakeholders that these are being adhered to. The care plans do continue to include a photograph of the individual to assist, particularly new staff, with identifying each person who lives here. This was also a requirement that had been made at the previous key standards inspection and had been achieved by the time of the random inspection in September. The registered provider was informed as a result of the previous inspection that they must demonstrate the proper regard and respect of the rights of the people who live here to be consulted or to be offered choice. This requirement was made in specific reference to the emergency admission that is referred to earlier in this report. As no further failures have been identified in this regard, at either the intervening random inspection or as a result of this visit, this requirement will continue to be deemed as having been achieved. However, it is once again stated that if further issues arise in this area immediate the Commission may initiate enforcement proceedings. Risk assessments for all of the people using the service were seen at the time of the previous key standards inspection to require full review in order to present the risk and the risk reduction measures in a clear and unambiguous way. It was noted at the random inspection that reviews were being undertaken, and had been completed for everyone who lives here. In regard to very urgent risks, not least in relation to people who required assistance with taken in food and fluid, it was noted that full reviews had also already occurred and that guidelines were clearly written and presented. This had been achieved as a result of input from the Speech & Language therapy department of Barnet Primary Care Trust. As the reader will see in the “Lifestyle” & “Personal and Healthcare Support” sections of this report, the risk assessments, although written, clearly are not being implemented. In one case a person who had been assessed in relation to their suffering from dysphagia, had not had their risk assessment subsequently updated, which must occur in every Matlock Close 4 DS0000010536.V354783.R01.S.doc Version 5.2 Page 12 circumstance. It cannot, therefore, be stated with any confidence that this is the case with the risk assessments that encompass other areas aside from specifically around taking food or fluid. It had been agreed previously that the full implementation timescale for all remaining risk assessments could be extended to 01/10/07, and although risk assessments have been written the lack of confidence about their implementation remains of very serious concern. A further requirement will be made in this report that risk assessment reduction measures must be known to staff and be applied at all times. Matlock Close 4 DS0000010536.V354783.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. The people that use this service can continue to feel confident that the staff of the home try to provide opportunities for everyone to develop their personal and social skills. There still 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 person to maintain personal and family relations is, however, offered and is actively supported by the staff team. EVIDENCE: As was reported at the previous key standards inspection, the people who use this service continue to be supported to make use of a wide range of community based facilities. These can be anything from shopping trips, to attendance at local clubs run by particular organisations or daytime activities. The staff that were present during this visit again demonstrated a clear Matlock Close 4 DS0000010536.V354783.R01.S.doc Version 5.2 Page 14 understanding of the cultural and religious practise preference that each person who lives here chooses to adhere to. They were also able to describe how respect for these is maintained and how those who wish to attend places of religious worship are enabled to do so. Details of the social, leisure and culturally appropriate activities in which people participate are written in their care records. As a result of the previous key standards inspection the home was required to review the level of support that is available for the people who use this service to engage in activities, particularly at weekends. At the time of the random inspection, newly appointed manager stated during that subsequent visit that this has occurred and a new rota system is being introduced from late September. Since that time the rota system has been adjusted to attempt to ensure that more of the permanent team are on duty at week ends rather than the largely bank or agency staffing that used to occur. The requirement will again remain in this report in order to assess that whether this implementation continues and if it achieves the success that it is designed to. The home’s staff group continue to encourage the people who use this service 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. 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 people’s own bedroom if it is thought to be appropriate and safe to do so. Staff were again seen to interact with those who live here in a totally appropriate and respectful way. The home has all appropriate policies and practices on maintaining dignity and rights. Each person’s individual preferences for the food that they like to eat are said by the home to be given due consideration. However, staff awareness of what foods may be inappropriate for anyone who has a swallowing difficulty remains of very serious concern. (please refer to the next section of this report entitled “Personal and Healthcare support” for further comment). Matlock Close 4 DS0000010536.V354783.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 poor. This judgement has been made using available evidence including a visit to this service. Standards 18, 19 & 20 were assessed at this inspection. The people who use this service cannot feel entirely confident that they will get the right support to take care of their personal and healthcare needs. There is a clear and continuing risk to health as the staff team are not fully aware of how to respond to anyone who has swallowing difficulties or who then encounter serious medical difficulties as a result. EVIDENCE: Each of the people who use this service 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 sections of this report for comment about the review and updating of the care plans). Matlock Close 4 DS0000010536.V354783.R01.S.doc Version 5.2 Page 16 Most of the people who live here 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”). Earlier this year the guidelines for staff were noted in an investigation report into the death of a service user as being insufficient and often lacking in clarity. There is also a continuing 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 still a regular 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 was previously seen as being 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 was required not only for those who suffer from “Dysphagia”, but also for anyone who may require support to take on nutrition in other ways. Although these guidelines have been fully reviewed and re written, using the expertise of the local PCT’s speech and language therapy department, staff awareness of them is nowhere near as it should be. This is even more acutely underlined by the fact that two speech and language therapist’s were recently visiting the home during a lunchtime and observed a choking episode, although the home subsequently disputed during this visit that it was nothing more than coughing. The therapists who observed this incident raised their concerns immediately with the placing authority using the local protection of vulnerable adults procedures (please see the next section of this report for further comment). The registered provider was informed, as a result of the previous key standards inspection visit, that they 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. At the random inspection almost all staff had been internally assessed as being aware of how to support people to take their meals if they suffer from dysphagia. However, a note in the home’s communication book written by the manager on 20th November 2007 clearly informed staff who had not completed their competency assessments to do so. Given the incident that is described in the previous paragraph, which happened the following day, this fact underlines the lack of confidence in the competence of all staff to apply these guidelines. A further message to staff dated 28th November stated that inappropriate foods were still being prepared as people with Dysphagia were still being given “long beans and onion lengths”. Training was offered by the local primary care trust, however the registered provider sought training for the whole team from an external agency. The date that this training occurred was 28th September 2007, and certificates of completion were seen on staff training records. Given the utmost seriousness and learning opportunity that was made apparent from the death of someone at the home earlier this year, and even more underlined by the recent incident that is described earlier in this report, it is wholly unacceptable that this training does not appear to have Matlock Close 4 DS0000010536.V354783.R01.S.doc Version 5.2 Page 17 had the desired effect. Urgent action must be taken by the registered provider to guarantee that all staff apply the training, principles and guidelines that they now clearly have in place. The fact that there remains a significant risk by a continued lack of awareness, or even willingness, to properly implement the correct procedures for people who suffer from dysphagia is not something that the Commission can ignore. The Commission views this as an extremely serious issue and continues to keep under consideration the necessity to commence enforcement action if further failures occur. As a result of the previous key standards inspection all staff were required to receive annual first aid training updates to ensure that they remain suitably aware of what to do in the case of any person who may suffer an episode of Aspiration. At the time of the random inspection the manager of the home stated that some training has taken place with further training still to occur. Since then it has been seen that only two of the staff team have attended any update. The manager provided evidence during this visit that all remaining staff had been put on a waiting list to attend first aid training but no date had yet been set. Given the reasoning for this requirement having been previously made it is astounding that this has not received the priority that it deserves. It is wholly unacceptable that this remains the case. The registered provider has agreed to work with the Local Primary Care Trust to take up training geared to establishing a greater awareness among staff about the specific needs of the individual service users who live at Matlock Close and how to respond to specific difficulties that may arise. The Commission expects that this stated commitment will be achieved. All of the people who live at the home usually go to see a local GP if they are not feeling well. The staff do still 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 still appear to properly help him or her to do this. None of the people who live here can do this without help and the reason is written down why this is so on each of the care plans. Just before this visit an allegation was made by a relative that a medication error had occurred the previous week end. This, at the current time, is being responded to by the registered provider who has been informed keep the placing authority and Commission updated on the investigation and its outcome. Examination of records at this visit did not indicate that an administration error had in fact occurred although this will be looked into again if evidence comes to light to suggest that further examination is necessary. The staff team are all due to undertake medication training on 5th December 2007 and evidence that this course has been booked was seen during this visit. Matlock Close 4 DS0000010536.V354783.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Standards 22 & 23 were assessed at this inspection. The people who use this service cannot feel entirely confident that the staff team at the home know what to do to properly keep them safe from harm, even if this is unintentional. EVIDENCE: The pictorial version of the complaints procedure that exists was required to be re-assessed as a result of the previous key standards inspection. It has now been and is noted as not, even using a more appropriate form of picture / symbol format, accessible. The needs of the people who use this service are such that written or picture versions would not be of particular use. The Commission accepts that this is unfortunately the case. However, the organisation should keep in mind that at all times staff should continue to remember to engage as fully as possible with the people who use this service to gather their views. Three complaints have been made to L.B. Barnet about the standard of care by one relative, and one by another relative of the same person. The authority is managing three of these under their statutory complaints procedures at present. The other one is being examined by the registered provider. A further complaint was made to the home by another relative about the behaviour of a Matlock Close 4 DS0000010536.V354783.R01.S.doc Version 5.2 Page 19 visitor, this was dealt with directly by the home in liaison with the placing authority. 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 of this year about the unexpected death of a service user at the home. The initial 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. The findings of that original enquiry were challenged by the family of the person concerned and this is currently undergoing further review within the local authority statutory complaints procedure. However, a number of serious potential risk to the people who use this service were identified if improvements were not made. A more recent protection of vulnerable adults investigation was initiated for very similar reasons, although on this occasion no more serious harm resulted from the failures at the home to respond appropriately. The exact nature of these serious concerns are commented upon in other areas of this report. Although there is no evidence to suggest that deliberate attempt has been made to harm anyone who lives here, failure to abide by procedures that are designed to safeguard the wellbeing of the people in residence is classed as neglect and could potentially constitute abuse. The Commission will consider any further failure to pose a significant and unacceptable risk to the people who use this service. Matlock Close 4 DS0000010536.V354783.R01.S.doc Version 5.2 Page 20 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 adequate. This judgement has been made using available evidence including a visit to this service. Standards 24, 29 & 30 were assessed at this inspection. The people who use this service cannot feel confident that they are living in a well maintained home, even though some improvements have been made there are significant delays in addressing all of the repairs and refurbishment that have been identified. EVIDENCE: The refurbishment and maintenance issues that were identified at the previous key standards inspection were still seen to need attending to by the time of the subsequent random inspection. The Commission acknowledges that there have been significant delays in agreeing a programme of works with the building’s owners. Since that time a number of improvements have occurred, not least in garden maintenance and some general smaller areas of repair. However, there Matlock Close 4 DS0000010536.V354783.R01.S.doc Version 5.2 Page 21 is still a need to fully address everything that has required attention for quite some considerable time. The home has an alarm system in place that, at the time of the previous key standards inspection, was seen to have either never been connected or had been disconnected. It was later confirmed that the alarm system had been disconnected some 10 years previously. The registered provider was then required to 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. At the time of the random inspection in early September it was stated that the alarm call system was to be upgraded and made fully operational by 10th September 2007. Since then this upgrade has occurred, however, two separate mobile alarm systems have been purchased. One of these is designed to alert staff at night if particular people are experiencing an epileptic seizure whilst they are in bed. This is able to alert staff of the location of the person who is in difficulty. The other is a mobile pager system that enables staff to alert other colleagues in the home that they require assistance. The registered provider has, subsequent to this visit, undertaken a risk assessment to evidence how staff would readily be able to locate their colleagues who were summoning assistance in the home. A copy of the risk assessment has been approved by the Commission as being sufficiently detailed and informative about how this system must be operated by the staff team. The home is kept clean. With the refurbishment that is still needed, not least to the Bathrooms and parts of the kitchen, areas of the building understandably look very worn. Matlock Close 4 DS0000010536.V354783.R01.S.doc Version 5.2 Page 22 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. The people who use this service users can feel confident that the staff are recruited in a way that means that proper background checks are carried out to prove that these 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 still exist 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. Almost all of the staff team are qualified at NVQ level 2, and those that are not are undertaking this qualification. Matlock Close 4 DS0000010536.V354783.R01.S.doc Version 5.2 Page 23 The are still a significant number of staff shifts that require the home to use bank or agency workers, although this has reduced to some degree since the previous key and random inspections. The registered provider’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). 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 two vacancies (being covered by contracted agency staff). The deputy manager is due to leave their post at the home within the next two weeks. The registered provider is once again required to clarify with the Commission the current staffing position. Given the continued and significant failings that are identified in other areas of this report, this must also again include the action that will be taken to ensure that the staffing situation does not result in any unnecessary risks to the consistency of 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 still doubtful whether this would truly occur as stated. Adepta, as the registered provider, carries out checks to make sure that those who work here are safe people to work with vulnerable adults. These 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 people who live here. As was previously required, staff files do now contain a copy of a photographic form of identification, or separate photograph. The home keeps records that say what training courses staff have done, and when they did them. These records show that staff training is still sporadic and although more recent moving and handling training, as well as Dysphagia training has occurred, the range of training in general still fails to meet the previous requirement that was made in this regard. Additionally there is no indication that appraisals or training and development plans are in place. It was said that the aim is to make progress on this soon, although a requirement in this regard will be included in this report. Matlock Close 4 DS0000010536.V354783.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 people who use this service cannot feel confident that they are living in a home that has been historically well managed, either internally or externally. The organisational response to serious concerns has yet to attended to as diligently as required. EVIDENCE: The current manager came into post in July 2007, shortly after the previous key standards inspection. The application for this person to be registered by the Commission was said to have been made a couple of days after this visit, although the Commission is aware that a RB request was made but the application was returned as it was not fully completed. Matlock Close 4 DS0000010536.V354783.R01.S.doc Version 5.2 Page 25 Direct internal management of the home has improved in some areas although a lot of very serious issues still need to be addressed. It is worth noting that these issues have been identified as having a direct relationship to the way in which the home has experienced poor internal and external management for quite some time. The current manager has made progress with the way that the home is internally managed, however, there are clearly many issues problems that have lead to a historical failure to address the ongoing issues at the home. A detailed action plan has been provided by the recently appointed “Director of Operations” and the Commission expects that this will be achieved, as too will the requirements contained in this report. Monthly visits under Regulation 26 are occurring and a copy of the reports of these visits is being sent to the Commission as has been previously required. It is of concern, however, that the managing organisation still does not appear to have as diligent a system in place as is necessary to identify serious concerns that have arisen at the home, that may do in future, or to make the necessary urgent progress on addressing them. These issues significantly undermine its effective operation. This report once again identifies continuing areas of serious concern that have direct relevance to an evident lack of organisational oversight for this home. Adepta are therefore required to continue to submit the reports of the visits that are carried out under regulation 26 to the Commission’s local office and to carry out visits as frequently as necessary to ensure close continued monitoring of the home. Additionally a management action plan is once again 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. It is also noted that as a direct result of the previous key standards inspection that Adepta informed the Commission of the home being classified within the organisation as a “service of concern”. This is an internal process that is designed to ensure that senior management within Adepta are able to monitor progress and agree action to address concerns. A meeting between the Adepta’s Chief Executive and Assistant Director of Operations, senior officers of the London Borough of Barnet and officers of the Commission was held on 30th November 2007 (a few days prior to this inspection). At that meeting Adepta’s Chief Executive informed those present that Matlock Close was not presently identified for monitoring as a “service of concern” under the organisation’s own procedures, but now would be. The Commission had been informed that this home would be placed on this procedure back in July 2007. Given that such serious concerns continued to exist, even prior to the reason for this later meeting having occurred, the decision to not implement close monitoring, or to have then ceased close monitoring, is very surprising. A requirement will be made in this report that the registered provider must ensure that they implement proper quality assurance systems with particular emphasis on improving the performance of the service and the quality of care for those who live at Matlock Close. Matlock Close 4 DS0000010536.V354783.R01.S.doc Version 5.2 Page 26 Information that was previously 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. It has subsequently been confirmed that the Gas safety, Portable appliance test, Hoists, and Electrical installation checks are now up to date. Matlock Close 4 DS0000010536.V354783.R01.S.doc Version 5.2 Page 27 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 X 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 1 34 1 35 1 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 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 2 3 x 1 X 1 X X 3 x Matlock Close 4 DS0000010536.V354783.R01.S.doc Version 5.2 Page 28 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 (2) (b), ( c ), & (d) Requirement The registered person shall keep the service user’s plan under review. The registered person must ensure that the implementation of care plans achieves the necessary diligence in order to increase the confidence of those who use the service and other stakeholders that these are being adhered to. 2. YA9 13 (4) ( c ) The registered person shall ensure that unecessary risks to the health and safety of service users are identified and so far as possible eliminated. 28/02/08 Timescale for action 28/02/08 3. YA12 16 (m) & (n) Risk assessments for anyone whose care needs change, or are in need of review as a result of assessment of complex need, must be updated without unnecessary delay. The registered person shall 28/02/08 consult service users about the programme of activities arranged by or on behalf of the care DS0000010536.V354783.R01.S.doc Version 5.2 Page 29 Matlock Close 4 home, and provide facilities for recreation including, having regard to the needs of service users, activities in relation to recreation, fitness and training. The registered person shall keep under review the level of support that is available for the people who use the service to engage in activities, particularly at weekends. 4. YA19 17 (1) (a) Schedule 3 (3) (m) The registered person shall ensure that they keep details of any plan relating to the service user in respect of medication, nursing, specialist healthcare or nutrition: This means that the staff team must be fully aware of, and apply, the more detailed Health Action Plans 28/02/08 5. YA19 13 (4) ( c ) & 18 (1) ( c ) (i) The registered person shall ensure that unecessary risks to the health and safety of service users are identified and so far as possible eliminated. 28/02/08 6. YA22 13 (6) All staff must receive first aid training updates to ensure that they remain suitably aware of what to do in the case of anyone who may suffer an episode of Aspiration. The registered person shall make 17/01/08 arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. Service users must be protected from harm from the failure to Matlock Close 4 DS0000010536.V354783.R01.S.doc Version 5.2 Page 30 7. YA24 23 (2) (b) properly address their care and support needs. The registered person shall ensure that the premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally. The refurbishment and maintenance issues have yet to be fully addressed. 28/02/08 8. YA33 18 (1) (a) & (b) The registered person shall ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. The registered person must once again clarify, in writing with the Commission, the current staffing position. 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. 12/02/08 9. YA35 18 (1) ( c ) (i) The registered person shall ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform. All staff must have an annual appraisal, which then results in a personal training and development plan which includes their individual training needs. The registered person shall ensure that an application to register a manager for the home DS0000010536.V354783.R01.S.doc 30/03/08 10. YA37 8&9 29/02/08 Matlock Close 4 Version 5.2 Page 31 11. YA39 24 (1) (a) & (b) is made to the Commission without delay. The registered person shall establish and maintain a system for reviewing at appropriate intervals and improving the quality of care at the home. 09/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Matlock Close 4 DS0000010536.V354783.R01.S.doc Version 5.2 Page 32 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.V354783.R01.S.doc Version 5.2 Page 33 - 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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