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Inspection on 09/09/08 for Outreach Community & Residential Services

Also see our care home review for Outreach Community & Residential Services for more information

This inspection was carried out on 9th September 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 21 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The house is a large attractive detached home, similar to other properties in the area, which is not identifiable as a care home. There are high staffing levels in place to support people. Of the seven support staff working at the home six have completed NVQ Level 2 and two have also completed NVQ Level 3.

What has improved since the last inspection?

People`s records were in the process of being brought up to date and new recording systems were being introduced throughout the organisation. The staff team have recently received medication training to help them support people with there medication safely. A new complaints record system is in place. A senior support worker is now in post so that day-to-day management is available in the absence of the manager.

What the care home could do better:

Detailed daily records need to be kept to evidence that support workers are following identified areas of need and risk. People`s opportunities to take part in activities both outside and within the home are limited. Attention is needed to ensure that people`s healthcare needs are fully met. Shortfalls in the medication system need to be addressed so that health and safety of people is not put at risk. All staff members need to undertake safeguarding training so that they know not only what action to take in the event of an allegation or suspicion of abuse but also to become more aware of shortfalls in their practice. Standards of safety, decoration, hygiene and cleanliness must improve to enable people to live in a safe and comfortable home. Although there is full and qualified staff team in place they are not properly supervised and shortfalls in health and safety training do not ensure they have the specific knowledge and skills that they need to support people safely and effectively. The person responsible for the service must ensure that the home has a registered manager who is able to fulfil the responsibilities of the day-to-day management and monitoring the service. This needs to be done quickly to ensure the health, safety, protection and welfare of people living at the home.

CARE HOME ADULTS 18-65 Outreach Community & Residential Services 86 Meade Hill Road Prestwich Manchester M25 0DJ Lead Inspector Julie Bodell Unannounced Inspection 9th September 2008 09:45 Outreach Community & Residential Services DS0000008445.V371450.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 Outreach Community & Residential Services DS0000008445.V371450.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. Outreach Community & Residential Services DS0000008445.V371450.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Outreach Community & Residential Services Address 86 Meade Hill Road Prestwich Manchester M25 0DJ 0161 740 3256 0161 740 5678 stuart@outreach.co.uk 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) Outreach Community & Residential Services Lesley Ann Smith Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Outreach Community & Residential Services DS0000008445.V371450.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered for a maximum of 5 service users, to include: Up to 5 service users in the category of LD (Learning Disabilities under 65 years of age). The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 16th October 2007 Date of last inspection Brief Description of the Service: 86 Meade Hill Road is one of a number of care homes managed by Outreach Care Services. Outreach is a charitable organisation offering 24-hour care, mainly to Jewish people with a learning disability or mental health problems. 86 Meade Hill Road is a six bed roomed detached house owned by Greater Manchester Jewish Housing Association. The home provides care and accommodation for up to five service users with learning disabilities. The remaining bedroom is used as an office. The house is located close to local shops, pubs and Post Office. Buses to and from Prestwich and Manchester pass nearby and a metrolink station is within walking distance. A ramped path is provided to the front door and the house is accessed by one step both at the front and back entrances. A drive provides parking space and on street parking is available outside the house. A safe enclosed lawned and patio area is provided to the rear of the property. The weekly charge for accommodation and services is between £518.00 and £875.00 with an additional charge being made for hairdressing, chiropody, toiletries, some outside activities and holidays. Outreach Community & Residential Services DS0000008445.V371450.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. The inspection took place over six and a half hours. The home had not been told that we (the commission) would visit. We looked around the house and checked some paperwork about the running of the home and the care given. At the house we talked to the director of operations, the acting manager, a senior support worker and a support worker. People who live at the home have profound learning disabilities with complex needs and were unable to communicate verbally with us. Before the inspection, we also asked the manager of the home to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well and what they needed to do better. We have asked for an improvement plan from the organisation to tell us what they are going to do to improve the service and we will be inviting the person responsible for the service to meet with us to discuss this. We will be making random visits and another key inspection to check that action has been taken. What the service does well: What has improved since the last inspection? Peoples records were in the process of being brought up to date and new recording systems were being introduced throughout the organisation. The staff team have recently received medication training to help them support people with there medication safely. A new complaints record system is in place. A senior support worker is now in post so that day-to-day management is available in the absence of the manager. Outreach Community & Residential Services DS0000008445.V371450.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. Outreach Community & Residential Services DS0000008445.V371450.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 Outreach Community & Residential Services DS0000008445.V371450.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): 2 and 3 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Findings at this site visit identified that the service was not meeting the basic care needs of the people living at the home. EVIDENCE: The procedure followed by the organisation for new referrals includes a full initial assessment and visits to the home by the prospective person. Compatibility with people already living at the home would be considered. There have been significant changes at the home over the past six months with only two out of a group of five people, who had lived together for a very long time, still living at the house. One person has moved on to a service that provides nursing care and two other people have moved to other services after a long funding dispute with their placing authority. A person from another house within the organisation moved into the home for a short period of time. Outreach Community & Residential Services DS0000008445.V371450.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Plans of care and support are being brought up-to-date. Detailed daily records need to be maintained to evidence that support workers are following identified areas of need and risk. EVIDENCE: People living at the home have diverse and complex needs and require full support with most aspects of their personal care and daily living tasks. They are unable to verbally communicate easily with others and therefore support workers use their knowledge and recognition of non-verbal behaviour to promote choice and independence. The organisation is in the process of standardising recording formats and updating information on person centred plans and risk assessments. The acting manager was in the process of organising and archiving records. Some of the current information is not accurate e.g. states the person has a good nights Outreach Community & Residential Services DS0000008445.V371450.R01.S.doc Version 5.2 Page 10 sleep when they actually have on regular occasions a disturbed nights sleep. More detail is needed in daily records because people are unable to tell us what happens in their day-to-day lives. This information is crucial to help us to make a safe judgement about the quality of life experienced by the people living at the home. It was agreed that this would be a good opportunity to review each persons needs, including behavioural strategies and risk assessments and develop information systems that give clear information to support workers about what they must do to support people effectively and safely. Where possible the person concerned or someone acting on their behalf should be involved in this process. Outreach Community & Residential Services DS0000008445.V371450.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Peoples opportunities to take part in activities both outside and within the home are limited and more detailed records need to be kept about how regularly activities occur. EVIDENCE: Other than going to day centres for short periods and occasional walks people were said by a support worker to spend a lot of time in their bedrooms. One person was escorted to the day centre during our visit. The other person was spending time in their bedroom. This person prefers not to go to crowded places. More detailed records need to be maintained to show how people spend their time and what support they receive. Relatives are welcome to visit the home at any time. Meals and arrangements for food were not looked at in detail at this visit and will be assessed at our next visit. Outreach Community & Residential Services DS0000008445.V371450.R01.S.doc Version 5.2 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Attention is needed to ensure that peoples healthcare needs are fully met and shortfalls in the medication system need to be addressed so that health and safety of people is not put at risk. EVIDENCE: People are fully dependent upon support workers for all personal care tasks. There were no locks on the bathroom door (except an inappropriate one to the outside) so it could not be guaranteed that peoples privacy and dignity was being maintained. Clearer records need to be kept about the personal support people receive including the time they get up and the time they go to bed, choice of clothes etc. It was difficult to evidence easily how regularly people were having their health checked by GPs, dentists, opticians, chiropodists etc. We had some concerns about the specific health needs of one person who had epilepsy. This person was said to see a neurologist on a regular basis. Although there was a plan and risk assessment in place it was not clear who had developed it and when. Outreach Community & Residential Services DS0000008445.V371450.R01.S.doc Version 5.2 Page 13 Detail about what action support workers should take in the event of a seizure was vague. A letter from the persons GP had recently been received to request a review of the persons medication, as seizures were not well controlled. Detailed records of seizures were being maintained but they were not organised in a way that identified trends and patterns. It was agreed that this would be a good opportunity to develop a new epilepsy plan and risk assessment by a healthcare professional who is qualified to do so that ensured clear information is in place e.g. at what point a hospital admission is required and better recording tools. In line with good practice support workers had received training in administering rectal diazepam from a person qualified to do so. The findings identified in the environment section of this report suggest that the present arrangements for managing incontinence were not adequate. It was agreed that an assessment with a healthcare professional would be undertaken to see if the situation could be improved. In line with good infection control practices disposable gloves are provided to support workers and disposable aprons. Neither of the people living at the home has been assessed as being able to safely administer their own medication. The previous manager had signed the consent to medication sheets on their behalf, which is not best practice and needs to be addressed. Medication for people is kept in a lockable cabinet in the office. The staff team have recently received medication training. The home has recently changed the pharmacist that they use. This had led to a gap on the pre- printed MAR sheet (Medication Administration Record) from month to month when stock is being delivered. It was agreed that the home would contact the pharmacist to rectify this problem. We found that the home was significantly overstocked with rectal diazepam and that the prescription for this medication did not appear on the new MAR sheet. This matter also needs to be taken up with the pharmacist. Wherever possible recording of medication should appear on the MAR sheet rather than additional checking sheets provided by the organisation to ensure accurate records are maintained. Outreach Community & Residential Services DS0000008445.V371450.R01.S.doc Version 5.2 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. All staff members need to undertake safeguarding training so that they know not only what action to take in the event of an allegation or suspicion of abuse but also to become more aware of shortfalls in their day-to-day care practice. EVIDENCE: People living at the home are unable to communicate verbally with us. No complaints have been received by either the organisation or CSCI since the last key inspection. A new complaints log has been introduced to the house. A copy of the new local authority safeguarding policy and procedures was available to support workers at the home. Updated training is needed as soon as possible to ensure that all staff members are aware about what practices are considered to be abusive including neglect of basic care, which has been identified during this site visit. Following a management review we have discussed this matter with the local safeguarding co-ordinator. It was agreed with the director of operations that a full investigation would be conducted around these findings and we would be informed of the outcome. Outreach Community & Residential Services DS0000008445.V371450.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Standards of safety, decoration, hygiene and cleanliness must improve to enable people to live in a safe and comfortable home. EVIDENCE: The home is situated in a residential area and is close to bus routes, the Metrolink and Heaton Park. The house is a large attractive detached home, similar to other properties in the area, which is not identifiable as a care home. Ramps are provided to both the front and rear doors and there is a pleasant garden at the back of the building. The décor and furnishings were domestic in style. People have use of a lounge and a dining room on the ground floor. Some items of furniture are old and worn and in need of replacement e.g. none of the dining room chairs matched. The overall appearance of the inside of the house is that it is tired and in need of attention. A housing association owns the property and they are responsible Outreach Community & Residential Services DS0000008445.V371450.R01.S.doc Version 5.2 Page 16 for general maintenance. It is appreciated that it is difficult to carry out maintenance and refurbishment plans because of the needs of people living at the home, but acceptable standards must be maintained at all times. A written programme needs to be produced and implemented which includes details of areas that are to be redecorated. We had concerns about fire safety arrangements at the home. Many of the fire doors did not close to the rebate and would not give people the required protection from smoke inhalation in the event of a fire. A cupboard above the stairs was being used to store archived records. This is a fire hazard and the cupboard needs to be emptied and kept locked shut. A fire in this cupboard could prevent people evacuating the building in the event of a fire. The staff team list of training given to us by the organisation indicates that only two support workers on the staff team has received fire training. There is an office and a staff sleep-in room. All bedrooms are single and two have en suite showers and toilets, but these smelt damp and were in need of some attention. We were informed that both the people living at the home spent most of their time in their bedrooms. We looked at the bedrooms being used by them. The first room was a large bay fronted first floor bedroom. The arrangements for lighting in the room need to be checked that they are accessible by the person using the room and adequate to see by. There was a strong malodour in this bedroom. The source was traced to the double bed, which was made up as if ready to use. The duvet was wet and the badly stained mattress protector was ineffective. The mattress was in very poor condition, badly stained, damp to both sides and smelt strongly of urine. The condition of the bed was such that it had been in this condition for a long time. The headboard and the base of the bed were also dirty. This was brought to the attention of the manager who immediately took action to replace the bed and rang a local supplier who agreed to deliver the new bed that day. It arrived in the afternoon. We requested that the director of operations came to view the bed to ensure that she knew the gravity of the situation. The acting manager and the director of operations agreed that this was unacceptable and a failure to ensure basic care was being provided to this person. We looked at the second bedroom being used. This room was very small and dark and in need of urgent decoration. There was a single bed and again the mattress was found to be in poor condition. The mattress had collapsed in the middle and must have been uncomfortable to sleep on. It was noted that this person had disturbed nights sleep and this could be a contributory factor. The plastic base for the bed was full of dust and dirt and had not been cleaned in some time. A new bed was ordered immediately. There was a comfortable lounge type chair in the room. The seat cushion was covered with a towel. Underneath the towel the seat cushion was badly soiled and had not been cleaned. The seat cushion had collapsed and was not providing the person with Outreach Community & Residential Services DS0000008445.V371450.R01.S.doc Version 5.2 Page 17 an appropriate level of comfort. Again it was agreed that this was an unacceptable standard of care. Attached to the door of a downstairs bedroom was a piece of wood that looked like the bottom half of a stable door that could be locked with a bolt. We asked for this to be removed. We checked the bathrooms and toilet areas throughout the house. There was a heavy malodour in the upstairs toilet. The floor covering in this room was badly stained with urine. We were informed that arrangements had been made to replace the floor covering. Although there was a sink there was no running water in this toilet and people were being redirected to the bathroom next door to wash their hands. This is not good control of infection practice and more so as there was no liquid soap in the bathroom to wash your hands with. A new bath had recently been fitted. The window in the bathroom opened widely and a window restrictor needed to be put in place. There was no working lock on the door to ensure privacy and there was an inappropriate candle lock on the outside of the door and we requested that it be removed unless it could be demonstrated that a restriction to the bathroom was necessary by a risk assessment that evidenced that there were no other options available. The home was not as clean as it could have been. Surface areas were generally clean but hidden areas like the base of the bed identified above and paintwork were not. The staff team list of training given to us by the organisation indicates that none of the staff team has received training in control of infection. Outreach Community & Residential Services DS0000008445.V371450.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32 33 34 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although there is full and qualified staff team in place they are not properly supervised and shortfalls in health and safety training do not ensure they have the specific knowledge and skills that they need to support people safely and effectively. EVIDENCE: A stable staff group that includes the acting manager, a senior support worker and six support workers, including waking night workers have worked at the home for over a year and no outside agency staff are used. Bank workers from the organisation sometimes work at the house. Staffing levels were high, as no reductions had been made despite three people leaving the home. On-call arrangements are in place out of office hours. Of the senior support worker and the six support staff working at the home six have achieved NVQ Level 2 and two also hold NVQ Level 3 which exceeds the national minimum standards. Outreach Community & Residential Services DS0000008445.V371450.R01.S.doc Version 5.2 Page 19 A support worker confirmed they had undertaken an induction programme. New support workers have completed the Skills for Care induction training programme. Staff recruitment records are kept at the Outreach Head Office. A sample of recruitment files across Outreach homes was looked at during a visit to the office on 30th July 2008. In the main recruitment records indicated that all necessary recruitment checks had been undertaken. Employment checks that had been done included obtaining a photograph, employment histories, written references, medical declarations and a CRB (Criminal Records Bureau) disclosure. Records showed that in the main gaps in their employment records had been looked into. However more attention needs to be given to verifying references to confirm that the previous employer exists and where appropriate ensure that the registered manager or responsible individual and not a member of staff give the reference. All legal working documentation must be in place. An up-to-date training list for the staff team identifies that there are significant gaps in health and safety mandatory training including food hygiene, first aid, epilepsy, moving and handling, safeguarding adults, challenging behaviour, infection control and there appears to be no training available to support workers around the core values of the organisation. Regular bank workers should also undertake this training. We asked the manager to produce supervision records. They were difficult to locate and when found confirmed that support workers had received no formal supervision for at least nine months. We were informed that there had been a staff team meeting in June 2008 but no evidence could be found to substantiate this. Support workers must be appropriately supervised to ensure that they are competent to carry out their roles and responsibilities effectively and in the best interests of the people living there. Outreach Community & Residential Services DS0000008445.V371450.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37 39 and 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management and monitoring of standards at the home must be more rigorous and robust to ensure that shortfalls in practice are identified and addressed quickly to prevent the risk of harm to people. EVIDENCE: The acting manager also manages a second home within the organisation. She has worked for the organisation for over ten years and as a manager for five years. She holds the Registered Managers Award and NVQ Level 4 and has undertaken most mandatory health and safety training. The manager receives regular supervision from the director of operations of the organisation. The manager also attends monthly management meetings. It was noted that the Outreach Community & Residential Services DS0000008445.V371450.R01.S.doc Version 5.2 Page 21 organisation had as recommended at the last inspection appointed a senior support worker to the house to support the acting manager. We recently undertook a site visit at the other house managed by this manager about six weeks prior to this visit. We also identified similar concerns about practices at that house and are disappointed to find that many have been repeated at this visit. We are aware that there have been significant issues at this house that the acting manager has been dealing with and this could account in part for the shortfalls identified in this report. There was confusion about the acting managers registration status as the certificate still shows the previous managers name. Our records show that we have not been formally notified that the previous manager had left and neither have we received an application for the present acting manager. The person responsible for the service must ensure that the home has a registered manager in place who is able to fulfil the responsibilities of the day-to-day management and monitoring the home. We advised that the person responsible for the service, the director of operations and the acting manager should meet at their earliest opportunity to ensure that adequate management arrangements at this house and the second house that the manager is registered for are in place. This needs to be done quickly to ensure the health, safety, protection and welfare of people living at the home. Internal quality assurance systems are in place, which include an unannounced monitoring visit by the quality assurance manager for the service. We have advised that these visits need to be more regular, rigorous and robust to ensure that any shortfalls are identified and addressed quickly to prevent poor practices developing. Most maintenance checks have been carried out but we were not clear about whether the portable electrical appliance test was up-to-date. It was also noted that the gas safety check was due the day after the site visit. The old weekly checking book has been replaced by a new recording system. New thermometers had been purchased for the home but the manager was not clear about how to use them. The home has recently received a copy of the Safe Food Better Business guidance and record book for use in the kitchen. We advised the home to use this system to use to record kitchen checks rather than the new recording system. Regular checks to fire safety equipment had been carried out. A fire drill was last undertaken on 07.09.08. Major shortfalls in health and safety training and practice were identified during the course of the site visit including food hygiene, moving and handling, safeguarding adults, fire safety and infection control. Outreach Community & Residential Services DS0000008445.V371450.R01.S.doc Version 5.2 Page 22 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 X 2 3 3 1 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 1 ENVIRONMENT Standard No Score 24 1 25 X 26 1 27 1 28 X 29 X 30 1 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 1 X 2 X X 2 X Outreach Community & Residential Services DS0000008445.V371450.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA3 Regulation 12 Requirement The person responsible must be able to demonstrate that the home has the capacity to meet the assessed needs and promote the health and welfare of the people living there. The updating of peoples plans of care must reflect each person’s needs, choices, goals, support requirements and risk assessments to ensure that the full range of people’s needs are addressed. (Outstanding 01/03/08) That an epilepsy support plan and risk assessment is developed for the identified person by someone qualified to do so and support workers receive epilepsy training. This must be done to ensure the health and safety of the person. An incontinence assessment by a person qualified to do needs to be undertaken to help improve the present arrangements and reduce the discomfort experienced by the person concerned. That the issues relating to DS0000008445.V371450.R01.S.doc Timescale for action 31/10/08 2. YA6 YA9 15 31/10/08 3. YA19 13 31/10/08 4. YA19 13 31/10/08 5. YA20 13 31/10/08 Page 24 Outreach Community & Residential Services Version 5.2 6. YA23 13 7. 8. YA24 YA24 23 23 9. YA24 13 10. YA26 16 11. YA27 16 overstocked medication and gaps in the pre-printed MAR are addressed to improve the safety of the medication system. All staff members need to undertake safeguarding training so that they know not only what action to take in the event of an allegation or suspicion of abuse but also to become more aware of shortfalls in their practice. We must also be formally notified about the outcome of the current investigation into practices at the home. A renewal and redecoration programme must be completed covering the whole house. To ensure the health and safety of people in the event of a fire. All fire doors must close to the rebate to give people the required protection from smoke inhalation. The cupboard over the stairs needs to be emptied and kept locked shut to ensure a clear means of escape for people in the event of a fire. The inappropriate locks identified throughout this report need to be removed or a risk assessment needs to be developed where there is no alternative and there is a need for them to be continued to be used, to identify that a restriction is in place. The condition of the decoration, lighting and furnishings in peoples bedrooms need to be addressed to ensure that they meet acceptable standards of safety and comfort of people using them. The floor covering in the upstairs toilet needs to be replaced and running water needs to be made available for people to wash their DS0000008445.V371450.R01.S.doc 31/10/08 31/10/08 31/10/08 31/10/08 31/10/08 31/10/08 Outreach Community & Residential Services Version 5.2 Page 25 hands to prevent cross infection. 12. YA27 13 A window restrictor needs to be fitted to the bathroom window restrictor to ensure the health and safety of people. An appropriate lock needs to be put on the bathroom door, which ensures peoples privacy and dignity. The whole house needs a thorough clean to ensure the safety and comfort of the people that live there. The staff team need to receive infection control training so that they know what action to take to ensure best practice including the disposal of clinical waste. Verification of references to confirm the existence of previous employer’s and complete legal working documentation must be in place to ensure the protection of vulnerable people. An ongoing programme of staff training must continue so that all staff members have received up to date training in all the mandatory topics including food hygiene, first aid, epilepsy, moving and handling, safeguarding adults, challenging behaviour and infection control. The staff team must receive formal supervision to ensure that support workers are competent and are clear about their role and responsibilities. The person responsible for the service must ensure there is a competent manager in place who has adequate time available to fulfil the responsibilities in the day-to-day management and monitoring the home. The responsible person must confirm that the electrical testing DS0000008445.V371450.R01.S.doc 31/10/08 13. YA27 13 31/10/08 14. YA30 13 31/10/08 15. YA30 13 31/10/08 16. YA34 19 31/10/08 17. YA35 18 31/10/08 18. YA36 18 31/10/08 19. YA37 18 31/10/08 20. YA42 13 31/10/08 Outreach Community & Residential Services Version 5.2 Page 26 of portable electrical appliances certificate is valid and that a gas safety test has been undertaken to ensure the health and safety of people living and working at the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA39 Good Practice Recommendations We strongly advise that Regulation 26 visits are more rigorous and robust to ensure that any shortfalls are identified and addressed quickly to prevent poor practices developing. Outreach Community & Residential Services DS0000008445.V371450.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 Outreach Community & Residential Services DS0000008445.V371450.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. 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