Inspection on 13/02/08 for Park House

This inspection was carried out on 13th February 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Park House 28 Sherford Street Bromyard Herefordshire HR7 4DL Lead Inspector Jean Littler Unannounced Inspection 6 and 13th February 2008 12:00 th Park House DS0000070762.V356194.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 Park House DS0000070762.V356194.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. Park House DS0000070762.V356194.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Park House Address 28 Sherford Street Bromyard Herefordshire HR7 4DL 01885 488096 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) Winslow Court Limited Richard Andrew Evans Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Park House DS0000070762.V356194.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of care only: Care Home only To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning Disabilities (LD) 7 The maximum number of service users to be accommodated is 7. Date of last inspection This is the first inspection. Brief Description of the Service: The Home is part of a group of four local services for adults operated by Winslow Court Limited. The company is part of the Senad Group who also operate residential schools. Park House is within walking distance from the local facilities in Bromyard. There are seven bedrooms with en-suite facilities, two of these have a living area with kitchenette attached and are being used as semi-independent flats. The service is for people with a learning disability some of whom have complex support needs due to their behaviours. Park House DS0000070762.V356194.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was carried out by two inspectors over 9 hours on two days in February. The acting manager Mr Muldowney and a senior were on duty and helped with the process. We (the commission) spoke with two of staff and looked around the house. Three people showed us their bedrooms. Three people who live in the Home and six relatives filled out surveys to give us their views. We looked at some records such as care plans and medication. Mr Muldowney sent information about the service to us before the visit. What the service does well: People are given information about the home in a way that helps them understand it. New people are supported to visit and try out the service before moving in. People are being supported to have their health and physical care needs met. People can spend time doing things they like at home and they are helped to stay in touch with their families. The house is comfortable, homely and safe. People have nice private bedrooms with their own toilets. Park House DS0000070762.V356194.R01.S.doc Version 5.2 Page 6 People like living in the home and fell the staff are nice and listen to them. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Park House DS0000070762.V356194.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 Park House DS0000070762.V356194.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, 4. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People interested in the service have their needs assessed by their funding authorities. The service has not consistently demonstrated clearly how these needs will be met prior to admission. People have been given the chance to visit and trial the service before moving in permanently. EVIDENCE: The service became operational in October 2007 and six people have now moved in. Four of these have moved across from Winslow Court, which is a larger local service run by the owners. These people’s needs were already well known and some of the staff working with them transferred with them. Two people who had been living with their families have moved in and so their transition took longer. The records for one of these people showed that a full assessment had been completed by the funding authority. An assessment had also been completed by the registered manager Mr Evans. This did not include all the person’s needs and did not demonstrate hoe the service would be provided to meet the person’s support needs. Since admission a care plan had been developed and an intervention plan. There had been a misunderstanding between the providers and one person’s family and social worker about the staffing levels and activities that would be provided. Clearer pre-admission care planning could have been avoided these difficulties. Park House DS0000070762.V356194.R01.S.doc Version 5.2 Page 9 People were enabled to visit the house and stay overnight before moving in. A senior said a review meeting was held for each person a month after they moved in. The care plan folders were not well organised and it was not possible to find evidence to support this. Park House DS0000070762.V356194.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): 6, 7, 8, 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people using the service cannot be confident that their changing needs are reflected in their care plans. They are being supported to make personal decisions and take reasonable risks, but they could be consulted more about these and other aspects of life in their home. EVIDENCE: The people who transferred from Winslow Court brought their care plans with them. One of these plans was seen. The cover said it had been updated in January 08 by Mr Evans, however the manager had been off sick since October 07. The plan covered a wide range of areas such as the person’s likes and dislikes, personal care needs and family contact arrangements. Some information was brief and therefore not very helpful for staff such as, “needs prompting with chores”. An extensive intervention guide formed part of the care plan. This contained guidance on how staff should respond to the person’s regular behaviour patterns in a consistent manner. The risk assessments had not been reviewed since the person moved across from Winslow Court so they did not reflect the change in circumstances. These did contain some helpful guidance but there were gaps, for example, it identified fences, gates, knives Park House DS0000070762.V356194.R01.S.doc Version 5.2 Page 11 and hot surfaces as possible risks but gave no guidance about these matters. A keyworker reported that a risk assessment had not been completed in relation to her key person working in a charity shop without staff support. The plan did contain some targets but many of these were none specific, for example, “to increase independence”. These would need to be more specific if the person’s progress is to be measured. There was no evidence that the person had been consulted about her plan, personal goals or ambitions. Although she is quite able and independent the plan was not in a format that she could easily understand. Mr Muldowney, the acting manager, reported in the Annual Quality Assurance Assessment, AQAA, (which is information that owners have to provide to the Commission), that care plans are read out to people or provided on a tape by the speech therapist. Another person’s goals had been identified in the assessment by the placing social worker. They included; improving her teeth cleaning skills; successfully finishing school; improving her mealtime manners; becoming more independent in her flat; and gaining experience with roads and on public transport. No evidence was seen that these had been identified as specific goals. The staff had been writing appropriate daily reports to note each person’s behaviours and related incidents, meals, activities, contact with family and health issues. The information gave a helpful overview of the each person’s wellbeing. One incident report showed that a situation had not been managed well by a worker and this had contributed to an incident developing. Mr Muldowney said he had realised this when seeing the report and had spoken to the person in charge of the outing. He had not made a note on the report of his actions. Another report showed that a worker had correctly followed the intervention plan when a person did not want to turn off their television and settle into bed at an agreed time. Mr Muldowney was aware that the care plans were poorly organised and he was taking steps to address this. Residents meetings had not been arranged, however he was planning to introduce these in the near future to improve the consultation processes. He is also aware that staff need to use sign language more to improve communication. It is positive that review meetings have been held for everyone to enable the placements to be discussed. Keyworkers are working well to supporting people to make their rooms nice and develop their range of activities. It is positive that people are being supported to become independent. For example one person now goes alone to the hairdressers. Staff assessed her capability to do this without support by following her without her knowledge. Consideration should be given to involving people in assessments in an open and adult way. The way decisions are being made need to be better recorded to demonstrate that they are aware of any risks they are taking or when a person lacks the capacity to make their own decision their best interests are being upheld in line with the Mental Capacity Act 2005. Park House DS0000070762.V356194.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People like living in the Home. They are taking part in activities they enjoy. These opportunities can to be further developed along with the balance between having their rights and being safe. People are being well supported to maintain personal relationships with friends and family. They enjoy their meals and people’s food preferences are being taken into account. EVIDENCE: The Home had a relaxed and friendly atmosphere and people obviously felt free to move around the house and use the communal areas as they wished. People reported in surveys that they liked living in the Home and choose how to spend their time. Relatives were also mainly positive. Two families said activities were slow to be organised but things had improved recently. Mr Muldowney reported that he had arranged for staff to stop locking the kitchen door unless hot food was being cooked or served. He had also questioned why staff felt people could not use the garden without being supervised and restrictions have now been lifted. Staff reported that the group is quite compatible and some friendships are developing. People use their bedrooms or Park House DS0000070762.V356194.R01.S.doc Version 5.2 Page 13 flats when they want their own space. These have been equipped with personal possessions such as music or video collections and hobby items. One person was using the staff sleep-in room to watch her favourite TV soaps as her new television had not been hung on the wall yet and she said people talking in the main lounge put her off. A timetable of activities was on display that showed the set activities that people had planned. Some activities were marked but did not show who would attend so it was difficult to establish each person’s actual activity opportunities. It did appear that there were days when people only had an activity noted for part of the day. Sundays were listed as ‘resident’s choice’, however some people may not have the abilities to decide how to fill their own time. Plans should be personalised and where possible presented in a way that is meaningful to each person. One person has been supported to get a voluntary job in a charity shop. She has enjoyed this and so now goes five days a week for varying hours. Staff reported that she likes the pub but is often tired in the evening after work. The timetables showed she is offered a walk three times a week and a computer session. Some one to one activities are provided such as, horse riding, a farm session and a Sunday morning swim. Mr Muldowney reported in the AQAA that person centred activities like this are going to be increased. Staff are provided with petty cash to cover their costs when they support people to access the community. It is positive that £500 is available for each person to have an annual holiday. People’s money is being held in the office. The risk assessments relating to this should be reviewed and a more enabling and approach adopted. One risk assessment seen did not explain why the person could not be supported to keep their own money tin. One person does have their own account and goes to sign to withdraw cash and she pays her own rent. Keyworkers should help people make decisions about opening savings accounts if a reasonable balance is being retained in their current account. People are being supported to stay in touch with their families, for example a keyworker supports one person to visit her mother who is unwell. Issues about relationships and sexuality are being discussed and for one person some safeguards have been implemented following a best interest meeting. Decisions about restrictions should also consider people’s potential to learn through education and supported life experiences. Meals are eaten in a relaxed manner and people were seen in the kitchen chatting to staff while lunch was being prepared. A menu was seen that runs on a four weekly cycle. A healthy option was available for each meal and staff said they also ask what people want and would go to the shops if needed. Staff should consider if the menu could become more varied e.g. no rice or oily fish were listed on the records sampled. Taster sessions can be enjoyable. Fresh fruit was accessible in the kitchen and fresh vegetables were being cooked for the evening meal. Park House DS0000070762.V356194.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are having their personal support and health needs met. There arrangements in place for the management of people’s medicines are adequate but some areas can be further improved. EVIDENCE: The staff were observed to interact with people in a positive and appropriately respectful manner and they knocked on their bedroom doors before entering. Records showed people were being supported to meet their personal care needs on a daily basis. The en-suite facilities help provide privacy, although a lack of storage in these and the communal bathrooms means people’s intimate care items are on display. Information about the support people need with their personal care is included in their care plans. As mentioned above better evidence could be provided to show people have been consulted about their daily routines and support preferences. The three people who returned surveys said they choose how to spend their time during the day. Families were positive that staff do make good efforts to keep them informed about relevant matters such as health issues. Mr Muldowney confirmed that each person is registered with a local doctor. Records seen showed that health appointments had been attended such as Park House DS0000070762.V356194.R01.S.doc Version 5.2 Page 15 dentals and psychiatrists. Daily notes showed one person had been taken to the GP and then on to hospital for an x-ray on a swollen hand. The records did not however report a conclusion and those for the following day made no mention of the matter. One person has been prescribed gym sessions by their GP. They are often tired and decline to go. Consideration should be given to the balance of weekly activities for the person’s long-term health and best interest. The owners have developed a Health Action Plan. These have not yet been completed for the people living at Park House. Those who are funded to receive this extra service have support provided by a team of professionals based at Winslow Court. These include two nurses, a speech and language therapist and a psychologist both of whom have assistants. These professionals contribute to the staff training programme e.g. the nurses train staff in epilepsy and diabetes. The manager needs to ensure that written evidence is provided demonstrating that the GP has delegated responsibility to the nurses if any treatment is given. The Home is not registered as a nursing home and therefore nursing care should not normally be directly provided. A recent review of the way the psychology team develop behaviour intervention strategies highlighted the need to modernise their methods. The organisation is taking positive action and developing new systems. The pharmacist inspector found some areas of concern about some poor arrangements for managing some medication for three residents and wrote a letter to the provider with details of the specific issues and requiring urgent action to be taken on the identified problems within a short period. We received a letter from Mr Muldowney within the required timescale telling us about the actions and improvements put in place and providing more information to explain the medication issues we found. There is a training process for staff who administer medicines but some issues identified at the inspection could indicate knowledge gaps and the need for more training. Two members of staff are involved when residents take their medicines. We discussed safe practices to follow when administering medicines so that a check of the medicine record and the label on the medicine packs can be made in the presence of the person who is to receive the medication. Staff make audit check counts of medicines but recently this had not been each week as is the company policy. The audit counts we made at the inspection indicated that residents received their medicines correctly. There were arrangements to make the necessary records of medicines received, administered and taken from the home or disposed of. Complete and accurate records about medication are important so that all medicines can be accounted for and residents are not at risk from mistakes and receiving their medicines incorrectly. Administration records looked at were up to date. Some shortfalls with the records were identified (details were included in the letter to the provider sent immediately after the inspection). Park House DS0000070762.V356194.R01.S.doc Version 5.2 Page 16 Handwritten additions or entries on the medicine records should be signed and dated by the trained person writing them and a signed checked made by a second trained person. This helps to make sure that the information is copied accurately. There were no clear written directions to staff about how to use medicines that are prescribed to use ‘as required’. This is important for residents to make sure they receive their medicines in a consistent way in accordance with planned actions. For residents who may lack capacity to consent to treatment, more consideration about the provisions of the Mental Capacity Act 2005 must be taken into account. Care plans also now need to reflect what choices residents have made and are given about how their medicines are administered and their consent to the way in which staff handle and administer their medicines. Again where consent is not possible because of lack of capacity consideration must be given to the provisions of the Mental Capacity Act 2005 and records made of the agreement that the way in which medicines are administered is in the best interests of that particular person. We were concerned that two of the record books we saw in use in this home had previously been used in other homes in the group. This is a poor practice, as the records need to be kept in the care home to which they relate. Record books must be kept in the care home at all times. We saw that one book had been sent to parents to keep records during a period of leave. This is not needed. There is a proper controlled medication record book to keep the additional records needed for this group of medication. Some of the pages in the book needed proper headings so that it is clear to who and what the records refer to. We pointed out on page 6 on 10/01/08 that one entry was probably wrongly duplicated when new stock was received. We recommend keeping records in the controlled medicines record book about stocks of a particular liquid medicine that is kept for two residents to use in an emergency. This would help to keep a good audit trail for this product. Better records are also needed to show accountability for medication taken out of the home for trips. Suitable storage for most medication is provided but needs arranging so that medicines that are swallowed are stored segregated from those that are applied to the skin. There were some out of date inhalers for one resident. The temperature in the medicine fridge needs to be monitored daily using a maximum and minimum thermometer to make sure the medicines are stored at the right temperature (2-8°C). The arrangements for storing controlled medicines must be upgraded to comply with The Misuse of Drugs (Safe Custody) Regulations 1973. We saw there was a Medical and Health Policy (undated) but improvements are needed so that staff have clear and specific direction about how the company expects them to deal with all aspects of medication. There was a Homely Remedies policy (undated) but there was no list or protocol about the medicines to use. Park House DS0000070762.V356194.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s views are listened to but some areas for improvement have been highlighted. Suitable arrangements are in place to help protect people from abuse. EVIDENCE: Company policies and procedures are in place for the management of complaints and any adult protection concerns. Mr Muldowney reported in the AQAA that each person and their representatives had been given a Service User’s Guide that includes information about how to make a complaint. He had recorded details of a complaint he had received since becoming acting manager. One person had been unhappy about her bedroom heating. When company maintenance staff failed to respond quickly Mr Muldowney had supported her to write a letter and he delivered it to their maintenance manager. The fault was repaired soon after. No complaints have been received by the Commission since the service opened. Two people living in the Home said in their surveys that staff always listened to them and they knew how to make a complaint. Another said staff sometimes listened and they did not know how to make a complaint. Of the six relatives surveys returned all new how to raise concerns. Two felt concerns are always responded to appropriately, three felt they usually were and one felt raising concerns does not make much difference to the outcome. As mentioned earlier in the report, one person’s representatives had raised concerns about the staffing levels and activity arrangements. These issues had not been logged in the complaints record so there was no clear record of the action taken. As mentioned residents meetings have not been held yet and quality assurance surveys have yet to be introduced as a way of people giving their views. Park House DS0000070762.V356194.R01.S.doc Version 5.2 Page 18 Training on the protection of vulnerable adults is covered in the company induction. The staff confirmed that there was an open culture and that they would report any concerns promptly. No protection issues have raised since the service opened. Park House DS0000070762.V356194.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People have a comfortable, clean and well-equipped home in a location that will help them become part of a community. They have private bedrooms with en-suite facilities and a good range of communal space. EVIDENCE: The location means people can easily access local facilities and transport links. The building was specifically converted for the purpose in 2007. The room sizes meet the National Minimum Standards. There are seven bedrooms, two of which have additional kitchen/diners next to them forming semi-independent living flats. All bedrooms have en-suite toilet facilities and some also have baths or showers. Communal bathroom and toilet facilities are also on both floors. The downstairs bathroom has no shower attachment so a jug is being used to wash people’s hair. Five bedrooms are upstairs and there is also office space, staff sleep-in room, and a training room that is used for meetings, one to one sessions and care reviews. This contains the home’s computer for people to use and a worker said they are hoping to get a keyboard with symbols that one person is accustomed to using. On the ground floor there is a kitchen, dining room, lounge and laundry. All are newly decorated and have Park House DS0000070762.V356194.R01.S.doc Version 5.2 Page 20 been well furnished. The lounge is an odd shape that means one section is not easily used. The dining room is large and airy and has a door to the garden. There is hard standing for parking and a good sized planted garden with two lawn areas. There are plans to fence off a sloped area so people can ride their bikes more safely. There is a third floor but access to this has been removed. There is a pay phone under the stairs. This does not provide privacy for calls, but some people also have their own mobiles. Locks are fitted to the bedrooms and some people are using keys. Some of the door closure mechanisms have caused problems, as they were too heavy to operate. Some have been changed and others are due to be changed in the near future. One is not fitted to the dining room and the door was open but marked with a fire sign saying keep closed. The owners need to consider what should be fitted to this door to ensure fire safety is not compromised. All people living in the Home are mobile but some have a physical disability or epilepsy. One family raised concerns about their son coming down the stairs so a handrail has been fitted at the right height for him. As a result of their concerns railings have also been fitted to prevent anyone from climbing over the banister. Some of the bedrooms have been fitted with built in beds. A worker was aware of the reason for one person but not for another. This person has epilepsy and a normal double bed may have been more suitable than a fixed single with a protective mat on the floor that could be a trip hazard. He is not being permitted to go upstairs due to his epilepsy. This means he cannot access the training room facilities. Consideration should be given to a solution to this so he is not discriminated against because of his condition. Some people are having their personal items locked away. This is understandable when people have damaged expensive electrical possessions. The practice of locking clothes and less valuable possessions away should be kept under review and people should wherever possible have a goal and be supported to learn to care for their possessions. The house was clean and tidy and is becoming homely. People said in their surveys that the home was always clean and fresh. Cleaning schedules are in place as care staff are responsible for cleaning. People are encouraged to clean their rooms and be involved in doing their own laundry. Appropriate equipment has been provided and systems set up to reduce the risk of infection. Handwashing arrangements could be improved as staff are sharing hand towels. An Environmental Health inspection in November 07 led to three recommendations being made. Mr Muldowney said these had been actioned. Park House DS0000070762.V356194.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people using the service are being supported by a committed staff team but staffing shortfalls and a lack of leadership have caused difficulties since the service opened. People are being protected by the homes recruitment practices but records could be clearer. Effective training arrangements are in place for staff, however more of the team need to become qualified. EVIDENCE: The minimum staffing level is four during the waking day. Funding is in place for a fifth worker At night one of these sleeps in and a waking night worker is also on duty. The company provides management support at all times by phone. There is a good balance between male and female staff, which reflects the mix of people living in the Home. One worker has left since the service opened. There are currently two vacancies but interviews are planned. There have been staff shortages during the first few months and the manager’s absence has increased the workload on the senior staff taking them away from hands on tasks. The rota was seen for October and December. Novembers was missing. Some staff have been working overtime to cover gaps but this is being monitored now to ensure people do not work excessive hours. The use of agency staff has been minimal because of staff doing overtime and staff from Park House DS0000070762.V356194.R01.S.doc Version 5.2 Page 22 Winslow Court working as relief cover. Staff are not currently being allocated to support particular people. This should be considered so people know who to go to for support and to help shift planning. Mr Muldowney agreed to consider this for one person in particular who is at risk from trying to climb the stairs and falling when unsupervised. As detailed earlier the main staff team is supported by a team of specialised staff based at Winslow Court. Feedback from surveys was positive about the staff team and the people living in the Home said they liked them all. One family said staff are motivated and are not seen watching television or chatting amongst themselves. The staff seen were professional and seemed well organised and motivated. The two spoken with in more depth were enthusiastic about their role and the developing service. One felt that activity plans had taken longer than they should have done to develop people but that were now starting to have their needs fully met. She felt it was positive that intervention-planning meetings had now started with the psychologist. Both felt there was good team morale. One said there had not been any staff meetings but she had had some supervisions sessions and training opportunities. Mr Muldowney said he had held two meetings since coming to manage the service. If the worker was off duty the minutes should have been made available to her. Training is managed centrally at Winslow Court where a rolling programme of core and basic training is provided. Existing staff who need refreshers are called to attend these sessions as required. New staff attend an induction and then go on core training during a foundation programme over the first three to six months. This leads to them gaining their Learning Disability Award Framework. They then are encouraged to gain NVQ awards. Currently only the three seniors are qualified to NVQ 3 level and two support staff are working towards a level 2. Mr Muldowney reported in the AQAA that he is aware that others will need to enrol this year. Some specialised training is also routinely provided for staff e.g. Autism Awareness, Adult Protection, Epilepsy, Positive Approaches to Challenging Behaviour and Physical Intervention training. Annual refreshers are provided appropriately to help ensure good practice is maintained. All staff should attend training in the Mental Capacity Act. Training records for all staff were held together. Those for the registered manager and one new worker were sampled. The new worker had attended induction courses. The manager’s information was incomplete as there was no record of him attending food hygiene and adult protection training. The recruitment records were seen for a new worker. A check list was in place to show when checks had been completed. Some of the information was confusing and seemed to indicate that the reference from the last employer and work permit details had not been received until after the person started work. Other references and the CRB had been obtained beforehand but there was no record of who had made the decision to start the person without the other information. It is positive that Mr Muldowney plans to enable people who use the service to be involved in future staff interviews. Park House DS0000070762.V356194.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41, 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people using the service have not benefited from a well run service, although staff have made good efforts to meet their needs in the absence of a manager and clear leadership. The owners have allowed some management shortfalls to put people at risk, however they have a good track record with other adult services so we have confidence that standards will be improved. EVIDENCE: The manager Mr Evans has not worked in the Home very much since it became operational on October 5th 2007. He had three weeks holiday in October and then became unwell soon after his return. He is still off sick but hopes to return in the near future. Mr Muldowney was transferred from Winslow Court towards the end of December to take temporary responsibility for the service. He has many years relevant experience and normally works supporting the manager of Winslow Court in the role of Head of Care. He did Park House DS0000070762.V356194.R01.S.doc Version 5.2 Page 24 report that he had not been trained to manage medication safely. Training should be arranged if the registered manager does not return to post in the near future. The three senior support workers managed the service in the interim weeks. One spoken with had felt she could call senior colleagues for support during this time. She had not, however, been offered any formal supervision during this ten week period. This was a particularly challenging time as the service was new, people were moving in and were unsettled, there were new staff and also some staff shortages. An extension was given to the owners to return the AQAA because of the circumstances, however this deadline passed as Mr Muldowney had not been made aware of it. He did complete and return the information following the inspection and it was received on 25th February. It contained detailed information and showed that action has been identified to improve the outcomes for people. Mr Muldowney reported that many of the company record keeping system were not in place when he arrived and he has been setting these up. Mr Evans had been in post for several months prior to the Home opening. He had not been a manager before but had been supported by more experienced colleagues. It is therefore concerning that the management systems were not in place and that shortfalls had not been identified by senior staff more quickly. Mr Muldowney was making progress but some records were still disorganised or contained incomplete or inaccurate information e.g. care plans, rotas, provider visit reports and medication charts. He had become aware that fire records had not been completed since the service opened. The call points and alarm had not been tested and no fire drills had been held. A fire risk assessment could not be found. During the inspection one person was seen sitting on a chair that was holding open the kitchen fire door while staff were preparing his lunch. An urgent action letter was sent to the owners on 14th February about these safety shortfalls. Mr Muldowney reported on 19th February that suitable action had been taken. We have written to the fire authority to make them aware of our findings. The senior support staff had set up a recording system for people’s finances and a sample seen showed clear traceable records. One senior said the manager did not get involved in the system, however they did not have all the relevant information as they were not aware who people’s appointees were. Inventories of valuables were being maintained. The company has a quality assurance system however this has not yet been implemented yet. Mr Muldowney had been given some support from the company’s health and safety manager with risk assessments in the care plans. He was not aware if any work place or environmental ones had been completed e.g. the use of the two kitchenettes. There was no emergency plan in place. The kitchen checks were being completed regularly. A senior had kept the COSHH risk assessment folder up to date but a worker spoken with had not read these. A potential trip hazard in one person’s bedroom did not seem to have been considered. Park House DS0000070762.V356194.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 2 3 x 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 4 25 4 26 3 27 2 28 4 29 3 30 3 STAFFING Standard No Score 31 x 32 2 33 2 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 2 x LIFESTYLES Standard No Score 11 2 12 2 13 3 14 3 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 2 1 x 1 2 x Park House DS0000070762.V356194.R01.S.doc Version 5.2 Page 26 N/A. 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 YA20 Regulation 13 Requirement Make arrangements to check with the doctor what medicines the residents identified are supposed to receive. Also check with the doctor that medicines you are administering to all the other residents are correct. Make arrangements to always keep in stock for each resident the correct medication that is within the manufacturer’s expiry date. Always keep complete and accurate records for all residents about the medicines received and administered. When medicines are prescribed to be administered “when required” there must be clear guidelines to staff on how to reach decisions about the administration of these, and also that staff make a record on how they have reached the decision to administer these medicines in accordance with the provisions of the Mental Capacity Act 2005. DS0000070762.V356194.R01.S.doc Timescale for action 14/02/08 Park House Version 5.2 Page 27 2 YA20 13 Included in an urgent action letter sent to the Provider on 07/02/08. Upgrade the storage 30/04/08 arrangements for controlled medicines to comply with The Misuse of Drugs (Safe Custody) Regulations 1973 so that this group of medicines are stored safely in accordance with the law. To safeguard the people living in 29/02/08 the Home the registered people must ensure staff carry out their responsibilities in relation to fire safety arrangements and take part in fire evacuation drills in line with the Home’s policy. Included in an urgent action letter sent to the Provider on 14/02/08. 3 YA35 18 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA2 YA6 YA7 YA18 Good Practice Recommendations Show through the assessment process how a new person’s needs will be met before they move in. Ensure each person has their current support needs included in their care plans. Where possible, consult the person about how they are supported and provide the information in a format they can understand. 3 YA8 YA9 Where possible, consult the person about decisions that will effect their lives and enable them to make informed choices about risk taking. Park House DS0000070762.V356194.R01.S.doc Version 5.2 Page 28 4 5 6 YA11 YA19 YA20 Whenever possible enable people to be independent, for example with money management. Support each person to develop a preventative health action plan. Care plans should reflect what choices people who live in the home are given about how their medicines are administered and their consent to the way in which staff administer their medicines. Where consent is not possible because of lack of capacity, records should be made of the agreement that the way in which medicines are administered is in the best interests of that particular person and in accordance with the provisions of the Mental Capacity Act 2005. Store medicines that are swallowed properly separated in the medicine cupboard from medicines that are applied externally. Keep records of the identified liquid medication in the controlled drug record book. Review the medicine policy and procedures to make sure that all aspects about the management of medication are included. Include a list of medicines and protocol for use with the Homely Remedies policy. This is so that staff have clear and specific directions about how the company expects them to deal with all aspects of medication. Make sure that handwritten entries on medicine charts are signed and dated by the member of staff writing this with a second member of staff checking and signing as correct. Use a maximum and minimum thermometer to keep daily records of the temperature in the medicine fridge. This will help to make sure medicines are kept at the right temperature to retain their potency. Improve the recording systems for keeping full account of all medication taken out of the home for trips. Provide a shower attachment to communal baths for hair washing. Provide storage so people can keep their intimate care items out of sight to better maintain their dignity. 7 YA20 8 9 YA20 YA20 10 YA20 11 YA20 12 13 YA20 YA27 YA18 Park House DS0000070762.V356194.R01.S.doc Version 5.2 Page 29 14 YA30 Review hand washing arrangements to reduce the risk of cross infection. Ensure staff are clear about how to manage soiled laundry appropriately as the medical cycle on the washing machine is marked as out of order. 15 YA32 YA35 Support more staff to enrol and gain an NVQ in Health and Social Care. Ensure training records are accurate and a training plan is in place for the service that reflects the needs of those living in the home. 16 YA39 Implement a quality assurance system that includes consultation with stakeholders. The findings from this should be linked into the AQAA that will be required in January 2009. Develop an action plan for the service to improve standards over the coming year. 17 YA41 Ensure all required records are in place, accurately completed and available for inspection to help safeguard the people using the service. Review health and safety arrangements and ensure suitable systems are in place to safeguard the people using the service and the staff employed at the Home. 18 YA42 Park House DS0000070762.V356194.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Park House DS0000070762.V356194.R01.S.doc Version 5.2 Page 31 - 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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