Inspection on 11/06/08 for Patrick House

This inspection was carried out on 11th June 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Patrick House 11/11/08

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Patrick House 2 Patrick Road West Bridgford Nottingham NG2 7JY Lead Inspector Linda Hirst Unannounced Inspection 11th June 2008 12:00 Patrick House DS0000070895.V366277.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 Patrick House DS0000070895.V366277.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. Patrick House DS0000070895.V366277.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Patrick House Address 2 Patrick Road West Bridgford Nottingham NG2 7JY 0115 9215523 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) Mr John William Nunn Carl Dixon Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Patrick House DS0000070895.V366277.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Learning Disability - Code LD The maximum number of service users who can be accommodated is: 6 This is the first inspection of the service 2. Date of last inspection Brief Description of the Service: Patrick House is an adapted property on a residential street in West Bridgford. It is a ten minute walk from the centre of West Bridgford and people who live at the service have access to a range of shops, cafés, restaurants, places of worship and local transport facilities. The service is registered to care for up to 6 people who have a learning disability. The accommodation is homely and comfortable and spreads over three floors. There is no vertical lift at the home and it is not suitable for people who have mobility difficulties. There is a very small car park at the front of the home but plenty of on street parking is available. Each person who lives at the home is given a copy of the service user guide and a brochure. The manager tells us that they will provide a copy of the latest report for anyone who wishes to see this. The fees for the service range between £725 and £1193.02 these fees do not include the cost of some activities, travel costs, clothing, toiletries or spending money for holidays. Patrick House DS0000070895.V366277.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 that the people who use this service experience poor quality outcomes. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for people who live at the home and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. We have introduced a new way of working with providers and managers. We ask them to fill in a questionnaire about how well their service provides for the needs of the people who live there and how they can and intend to improve their service. We received this back from the manager in good time but some sections and dates were not filled in as they should have been. Some of the information he gave us helped us to plan our visit and to decide what areas to look at. We also reviewed all of the information we have received about the home since we last visited and we considered this in planning the visit and deciding what areas to look at. The main method of inspection we use is called ‘case tracking’ which involves us choosing people who live at the service and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. English is the first language of all of the people who use the service living at the home at the moment. The staff team come from a wide variety of backgrounds and experiences. We spoke to two members of staff and two of the three people who live at the service to form an opinion about the quality of the service being provided to them. We read documents as part of this visit and medication was inspected to form an opinion about the health and safety of people who live at the service. During the course of our visit we made an immediate requirement about essential repairs and maintenance. We issue these notices when we find that the people’s health and safety is at risk and where the outcome for them is poor. We expect the providers to put these matters right within 48 hours and to tell us quickly what they will do, and how they will make sure the people who live at the service are safe and receiving good care. Patrick House DS0000070895.V366277.R01.S.doc Version 5.2 Page 6 Following our inspection we have issued a further two urgent action letters. We expect the provider and manager to put these matters right within 28 days to make sure that people who live at the service are safe and well cared for. The provider has acted promptly and has written to us to say that all of the essential repairs have been completed within the timeframe. They will be expected to work with us to provide evidence of further improvement to make sure they meet the requirements and provide good quality care to the people living at the home. What the service does well: We found that the people who want to live at the home have been assessed by their social worker or people from the home to check that their needs can be met at the service, the people we spoke with told us they like living there. The All About Me booklets are used as part of the care plan to tell staff about what people like and don’t like, what their routines are and how they like to be supported. This means an individual service can be provided to each person. We found that people have their own areas of interest and that the staff work hard to try and make sure they do the things they enjoy and have a nice quality of life. We found that the staff encourage people to keep in touch regularly with the people they love and who matter to them, and they try very hard to give people help and guidance about personal and sexual relationships. The people who live at the home are supported and encouraged to do chores such as cleaning, cooking, washing and ironing so they can be as independent as possible. One person said, “I get on alright with the staff they try and help me. I do my washing but I can’t iron so they help me do that.” The staff try to help people feel good about themselves and the people we spoke to want to look and dress nicely. We found that people’s health is well cared for and that they get any tablets they have been prescribed on time and in a safe way so they stay well and healthy. People told us they feel safe and well cared for at the home. One of the people who lives at the home told us, “I like living here, the staff are all good, very nice, I just like to chill out, go to my jobs and watch my football.” Patrick House DS0000070895.V366277.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: They could make sure that each person who lives at the home has a care plan and that these tell staff about what help and support they need, as well as what things might be a risk and how to help them minimise this. We also found that the service could be quicker at making sure that if some things are risky but the person wants to do them, that decisions are made quickly about this so they can get the help and guidance they need. We found that people have not been given information about how to make complaints in a way they understand. The manager has told us someone has made a complaint since the home opened but we could not find any records of this at all and the staff didn’t know where it was. This means we can’t be sure that the service is dealing with concerns properly. The staff told us that repairs are not done very quickly and we noticed lots of things that needed repairing so we left a notice for the provider asking him to do the repairs very quickly so that people living at the home are safe. People who live at the home told us “there’s only one of the staff on a lot of the time, it makes it hard because they have three people to help, I get upset about it sometimes.” The staff also told us there are not enough staff on duty to make sure that people are safe and can do the things they enjoy. We also found that the way the service recruits people to work there is not safe and does not offer enough protection to people who are vulnerable, so they are safe from those who may abuse them. The people living at the home and the staff told us the manager is not at the home very often and he is not writing down what hours he works there, we do not think the service is being well managed at the moment. The provider is not visiting the home and writing down what he has found and whether the home is being run in the best way. We found that the people who live at the home are not being asked what they think of the service in service user meetings or in questionnaires. Nor are the services being checked and audited to make sure they are providing good quality care and are good value for money. We were worried that the people living at the home might not be safe in the event of a fire so we have asked the Fire Safety Officer to visit and tell the manager what needs to be done so this can be made better. We also found that the electrical items being used by people living at the home and staff have not been checked to make sure they are safe for use. Patrick House DS0000070895.V366277.R01.S.doc Version 5.2 Page 8 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. Patrick House DS0000070895.V366277.R01.S.doc Version 5.2 Page 9 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 Patrick House DS0000070895.V366277.R01.S.doc Version 5.2 Page 10 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 good This judgement has been made using available evidence including a visit to this service. People who may use the service have their needs fully assessed before admission so they can be assured that they choose a home that will meet their needs. EVIDENCE: We looked at the care plans for each of the three people living at the service and found they had all been assessed by a Social Worker before being admitted to the home. There is a copy of these assessments on their file along with an initial assessment and a risk assessment done by the staff at the service. When we spoke with the staff about the admissions process they told us, “we normally get an A4 piece of paper about them, the past incidents, their medical and personal history this information comes from the place they live in at that time and their social worker.” One of the people we spoke with said they lived at another home owned by the provider and told us they have settled well and like living at the home. The staff we spoke with said they have a “moving in process…visits, introductions to the other service users, for a two week transitional period they Patrick House DS0000070895.V366277.R01.S.doc Version 5.2 Page 11 still live where they are, a designated member of staff is allocated to them, we ask the existing service users for their feedback too.” Patrick House DS0000070895.V366277.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The care planning and risk assessment arrangements are not adequate and do not give staff enough information to ensure a consistent and safe service is provided to people living at the service. The lack of involvement also means that the service is not being delivered taking account of people’s needs and choices. EVIDENCE: We found the care plans of people living at the service to be inadequate, we could not find any evidence that one person had any care plans in place or that they have been involved in care planning and review and they told us they have not seen a care plan. In others we found that initial assessments of the people living at the home indicated that there are cultural needs, behaviours which may challenge the service, risks of absconding, issues of vulnerability, misuse of alcohol and sexual health and there is no corresponding care plan in Patrick House DS0000070895.V366277.R01.S.doc Version 5.2 Page 13 place to guide staff on how to support people with these needs. Some plans were written several years ago but we found no evidence that they have been reviewed. The staff we spoke with told us, “I think the paperwork is really basic from my previous experience, I don’t think they have enough detail.” We sent an urgent action letter about these issues. We saw an “all about me,” booklet on each person’s file and these provide details about preferences (waking times, preferred night routines, food, drinks, hobbies and issues around self esteem.) We found variable evidence about how much choices and decisions are respected, one person we spoke with told us, “I go out by myself into town or wherever I want to go,” but another told us that there are times when they would like to do an activity but there are not enough staff on duty to do this. “Sometimes I get upset with them but I calm down and say sorry.” Staff we spoke with said, “they are pretty independent, if a service user wants to do something we tell the manager. For example one service user wants to go out alone. We know (they) can but we have to wait for the social worker to get back to the manager. Whilst we were waiting for the decision, the person went out alone. The person is vulnerable.” One person living at the service told us they want a pet, and have been told they cannot have one. “It’s not fair I want a pet, a cat, a dog, even a hamster or a rabbit but the manager has said we can’t have one.” We suggested the best place to discuss this would be in a service user meeting, as the manager told us in his Annual Quality Assurance Assessment that these take place. The person said, “we don’t have meetings,” and staff told us these do not take place, we could find no minutes to show that these meetings are held. We found that a basic risk assessment has been done on each person who lives at the service, this is a tick box assessment form. However, we found there was no assessment of the likelihood of the risks occurring nor was there any action plan in place to guide staff in minimising the highlighted risks in two out of the three care plans we saw. Staff gave conflicting opinions about risk assessments done at the home, one said, “they are as useful as they can be, there are always things that can go wrong, you just need to cover all areas of risk,” the other said, “they don’t give us any guidance, we use our own judgement.” We sent an urgent action letter about this issue. Patrick House DS0000070895.V366277.R01.S.doc Version 5.2 Page 14 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, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use services are able to make choices about their life style, and are supported to develop their life skills, and pursue their social, cultural and recreational interests. EVIDENCE: We found the All About Me documents give staff information about the social needs and preferences of the people living at the home, and our interviews with people suggests that people have opportunities to work and pursue their interests both at the service and in the local community, (staffing permitting see YA 32). One person does voluntary work, and others told us they enjoy shopping, music and going to nightclubs. “I love football and went to see a few Forest matches last year. I like shopping, I get £10 on a Monday and on a Friday and I save some. I just got some money out and bought myself new jeans and trainers.” The staff told us that although there is an activities Patrick House DS0000070895.V366277.R01.S.doc Version 5.2 Page 15 manager employed by the provider he does not seem to be helping the people at this service and the staff at the home are trying to find college and work placements themselves. One person living at the service confirmed this and said, “I want a job, but so far they haven’t been able to find me one.” It is clear from comments the staff and people who live at the service made to us that relationships with family members are promoted, people said, “I see my parents every week and go to see them on the bus,” and another person said, “I like living here, it is closer to where my mum lives so it’s better for her.” We found that although there is information about issues of sexuality on the home’s initial assessment and risk assessment, as well as in documents from other professionals, these are not always translated into a plan of care for the people living at the service. Staff we spoke with told us, “I think the care plans are very basic around sexuality. They don’t say anything about previous issues, I haven’t seen anything about (a named person’s) sexual needs. We need time to look at (a named person’s) sexuality in detail.” That said, we saw the staff try and promote the responsible development of relationships with people living at the service, and their sexual health and the prevention of pregnancy are addressed with them. People who live at the service are encouraged to be involved in all activities of daily living, subject to their ability. The staff told us that “people are independent in terms of daily routines…we have a cleaning rota in place to provide some structure and have a shopping day and a washing up rota as (one person) would do everything.” People living at the service confirmed, “I tidy up and like to see the place looking clean, I have been tidying up this morning and doing my washing, I’ll do my ironing this afternoon,” another said, “I get on alright with the staff they try and help me. I do my washing but I can’t iron so they help me do that.” The staff cook with the people living at the service and they said, “we did the menu with the service users, on Sunday we have a roast dinner and then they each have two days where they choose (the meal.) There is always an alternative for them, we try and give them a balanced diet.” The people we spoke with said they help to do the cooking and said the food is ok, “we all choose our favourites.” One person who lives at the service told us he likes West Indian food and staff said, “we try and do different meals or have a takeaway for him.” Patrick House DS0000070895.V366277.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: We found that all of the people living at the service are independent in terms of personal care tasks. One person has specialist hair and skin care products and staff understand that these are needed to keep his skin and hair healthy. Both of the people we spoke with said they like to look good, and they take pride in their appearance. The people who live at the service dress in clothes they like and which are appropriate for their age. One person told us he goes out to the barber to have his hair cut. As we stated in YA 6 the care plans do not reflect the current needs of the people living at the service but the comments from staff indicate that people have access to people who can help them with their health care and emotional needs. They told us, “we have psychiatrists, Community Nurses and chiropodists,” (involved with service users), (a named person) “had a well man check recently and the Doctor’s surgery are very good at checking and Patrick House DS0000070895.V366277.R01.S.doc Version 5.2 Page 17 assessing health needs.” The people we spoke to told us about their health care needs and showed an understanding of some of their treatments (for Diabetes and their mental health and wellbeing.) We looked at the arrangements for medication and found the storage and recording to be safe. We saw one person sign the Medication Administration Record before they gave out the medicines but when this was brought to their attention the matter was addressed by the next medication round. The staff we spoke with said they have had recent training on medication. One person told us they have Diabetes and said, “I have to be careful but I can eat savoury things and I can have a treat sometimes, especially if my readings are good.” We found the staff we spoke to have a good understanding of what a “normal” range of readings is for this person, and what action to take if these readings were either high or low. This information is also in a plan of care. Patrick House DS0000070895.V366277.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The arrangements for making complaints are not publicised and the record keeping is not good enough to ensure that people living at the service have their concerns recorded and responded to appropriately. People who live at the service feel safe and protected by trained staff. EVIDENCE: The manager told us in his Annual Quality Assurance Assessment that there has been one complaint since the service was registered which was responded to within 28 days, but as we could not locate the records we cannot say what this was about. We received an anonymous complaint about a broken lock on a door and this was replaced quickly. We have sent the provider a letter about maintaining proper records of complaints. The staff we spoke with told us the complaints procedure is not displayed anywhere in the home, they told us, “I have never dealt with any complaints, the manager would deal with this, I think that any complaints would be dealt with properly and efficiently.” People living at the service told us, “I don’t want to talk about complaining, I just like to chill out, my mum told me to just talk to the staff if I have a problem.” Another person said they were confident the manager would sort out any problems. The service has a copy of the local safeguarding procedures, and the staff told us they have had training on safeguarding and on Non Abusive Physical and Patrick House DS0000070895.V366277.R01.S.doc Version 5.2 Page 19 Psychological Intervention (NAPPI) techniques. There have been no safeguarding allegations since the home was registered. The staff showed a good understanding of abusive behaviour and said they would report any poor practice to the manager. The people living at the service told us that the staff make sure they are ok and they said they feel safe at the home. Patrick House DS0000070895.V366277.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The accommodation is homely and clean but it is not properly maintained and this can impact on the health and safety of the people living at the service. EVIDENCE: We were shown around the service by one of the people who lives there. The accommodation is clean and tidy throughout, and the people who live there said they keep the home clean with staff support. The people living in the service said they like their rooms and like living at the home. We noticed various areas needing repair during our visit. One person living at the service keeps their money in an open tin and they are unable to lock their room as the lock is broken. Staff told us the lock has been broken since February, the door has a hole where the lock was positioned and as this is a fire resistant door, it compromises the fire safety of the person who occupies the room. We also found the gate is broken and staff expressed concern about Patrick House DS0000070895.V366277.R01.S.doc Version 5.2 Page 21 the safety of one of the people who lives at the service as they use the gate when taking the dustbin out for emptying. This is also a fire escape route and may impede people from leaving the premises quickly and safely in the event of a fire. The staff told us this has been damaged for two months. We also noted various other issues which we referred to the Fire and Rescue service for their attention and recommendations. We were told that repairs are not done promptly at the service, “ we are buying things out of petty cash as the owner is slow at providing the things we need.” We left an immediate requirement about some of the repairs to make sure the environment protects the health and safety of the people living there. Patrick House DS0000070895.V366277.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. There are insufficient trained and competent staff to support the people who live at the service and the recruitment practices leave them at risk because the service cannot be certain that the staff employed are suitable to work with vulnerable people. EVIDENCE: We could not find a staff training record and not all of the staff files we saw contained certificates, the staff we spoke with said they have done Non Abusive Physical and Psychological Intervention techniques training, National Vocational Qualification level 3, Fire Safety training and safeguarding but we did not see any evidence of this. The Annual Quality Assurance Assessment the manager sent to us indicates that none of the staff who work at the service have achieved or started their National Vocational Qualification level 2, but the staff we spoke with said they are enrolled on this. The people who live at the service said the staff are good but did not have specific comments to make about their training. Patrick House DS0000070895.V366277.R01.S.doc Version 5.2 Page 23 We looked at the staff rota and saw that there are sometimes two staff on a shift, but frequently only one person is on a shift. The manager told us in his Annual Quality Assurance Assessment that the service operates a staffing ratio of 1:3 but the evidence we received from staff and the people living at the service indicates that this is not sufficient to meet people’s needs. Staff told us, “I don’t think one member of staff to this group of service users is enough, because if one person wants to do something the others might not want to do that and you have to try and compromise,” another said “there was an incident with (a named person) and I could not do anything, I was alone (with the service users) I could not have restrained (the person) alone. Another member of staff had to come in early to help me.” We saw evidence in the person’s care plan to indicate that this concern has foundation. (See also YA7, YA12). We have sent the provider an urgent action letter about the staffing levels at the service. We looked at five staff files to check they have the information and documentation required by Law to protect vulnerable people. All of these files had information or documents missing. We found there were missing references, that the guidance from the Criminal Records Bureau has not been followed and that people who live at the service are not being properly protected from those who may not be suitable to work with vulnerable people. The people we interviewed said they supplied all of the information but the start dates they gave us also provides evidence that they started work at the service and were working unsupervised before Protection of Vulnerable Adults and Criminal Records Bureau checks were returned. The people living at the service would not be aware of this and had no comments to make. We sent an urgent action letter to the provider about this issue. Patrick House DS0000070895.V366277.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The service is not well managed and does not run in the best interests of the people living there. EVIDENCE: We recently registered the manager, but part of the discussion at his fit person interview was around our concerns about how frequently he would be at the service and the implications this may have for service delivery. He gave us assurances that he would be working at the service most of the time. We looked at the staff rota and found his hours are not recorded. The staff we interviewed told us, “the manager is only on site for one to one and a half days a week, and we are not told when this will be…he will have discussions with the service users and is then not around and this can create behaviour Patrick House DS0000070895.V366277.R01.S.doc Version 5.2 Page 25 problems for us.” Both of the people we spoke with said the manager is at the service for one or two days a week, one told us, “they aren’t here very often, sometimes only once a week. They have to work at the other homes.” We also found that the provider has not done a visit to the service and a monthly report since March this year. One person who lives at the service could not tell me who the owner is and staff said he does not visit very often. Given the concerns we have identified in this inspection (YA6, YA7, YA9, YA22, YA24, YA32, YA 33, YA34, YA35, YA37, YA 39, YA42) and the impact on people living at the service this is extremely concerning. Action must be taken to address the management of the service and to ensure that it runs in the best interests of the people living there. Failure to do this will reflect on the fitness of the manager and provider and could affect their continued registration. We have written to the provider to request urgent action on this issue. We could not find any evidence that Quality Assurance has been undertaken, there were no records to indicate it has started, and the people living at the service and staff told us they have not been asked for their views. There are no service user meetings at present (see YA 7.) The Annual Quality Assurance Assessment we received from the manager stated that there has been checks and servicing on most of the equipment but no dates have been entered as evidence that the servicing has taken place. We looked for evidence that the Portable Appliance Testing has been done, but could not find any. We sent an urgent action letter to the provider about this issue. We looked at the fire safety testing record and found the Fire Alarm Tests and fire drills are not being undertaken as required. We could find no written evidence of staff training on this subject although the people we spoke with said that they have done Fire training. We found a blank fire safety risk assessment form but could not find one which has been completed. As a result of these and other concerns (See YA24 we have made a referral to the Fire Safety Officer for him to undertake an assessment of the fire safety arrangements at the service. Patrick House DS0000070895.V366277.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 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 1 23 3 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 1 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 X 1 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 2 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 1 X 1 X X 1 X Patrick House DS0000070895.V366277.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 Requirement Every person who lives at the service must have a plan of care which they have been involved in developing so they know how staff intend to assist them with their needs. This is an urgent action Each care plan must reflect the current needs of the person in detail so that staff have the guidance they need to support people who live at the service in a consistent way. This is an urgent action Decisions about risk which impact on the choices or safety of people living at the service must be made promptly and communicated to them and staff without undue delay. There must be detailed action plans on people who live at the service where issues of concern have been highlighted by your risk assessments, so the staff are clear about how to minimise the risks to them, taking account of their wishes and feelings. DS0000070895.V366277.R01.S.doc Timescale for action 11/07/08 2. YA6 14(2)(a & b) 11/07/08 3. YA7 12(2)& (3) 15/07/08 4 YA9 13(4) (a) & (c) 11/07/08 Patrick House Version 5.2 Page 28 This is an urgent action 5. YA22 22 There must be a record of every 27/06/08 complaint made about the service, it’s investigation and outcome and this must be available at all times to ensure that the concerns of people living at the service are heard and responded to appropriately. This is an urgent action The service must be properly maintained to ensure the safety of people living there. You must • Replace the lock to the identified bedroom • Repair or replace the gate • Repair the shower in the identified bedroom • Provide a suitable lock for the front door which satisfies Fire Safety Regulations. 13/06/08 6. YA24 23 7. YA33 18(1)(a) This is an immediate requirement An assessment must be carried 11/07/08 out on service users’ needs to provide evidence as to how you calculate the appropriate staffing levels to meet the health, safety and welfare needs of service users accommodated. This is an urgent action. Staff must not be employed to work at the service until you have obtained the information and documentation required by Law to protect vulnerable people who use your service. This is an urgent action The management of the service must improve to make sure that the service being delivered is safe and that the home runs in the best interests of the people DS0000070895.V366277.R01.S.doc 8. YA34 19, Sch 2 11/07/08 9. YA37 10(1) 11/07/08 Patrick House Version 5.2 Page 29 living there. 10. YA37 17(2), Sch 4(7) This is an urgent action There must be a record of the hours the manager works at the home including in what capacity he is working to ensure that the needs of people living at the service are met. 11/07/08 11. *RQN 26 This is an urgent action There must be a report by the 11/07/08 provider (or their representative) done once a month about how the home is being managed and conducted. A copy of these reports must be sent to us every month to meet legal requirement. This is an urgent action Quality Assurance audits of the home must be carried out to inform the development of a business plan aimed at improving the quality of the service for the people who live there. All of the electrical items at the home must be tested to make sure that they are safe for the people living at the home and staff to use. This is an urgent action Any requirements or recommendations the Fire Safety Officer makes must be adhered to within the timescales they set to ensure the people living at the service are safe in the event of a fire. 15/08/08 12. YA39 24 13. YA42 23(2)(c) 27/06/08 14. YA42 23(4) 15/07/08 Patrick House DS0000070895.V366277.R01.S.doc Version 5.2 Page 30 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 YA7 Good Practice Recommendations Formal meetings with people who live at the service should be held and their content recorded so that there is clear evidence of the issues raised by them and what action is being taken to address these. Care plans cover people’s sexual needs and preferences so that staff have the information they need to support and guide them about being safe and maintaining their sexual health. Every person living at the service should be made aware of their right to raise concerns and how they should do this. This information should be in a format that they could understand so they know what to do if they have any concerns about the service they receive. There should be a place for staff to report repairs or maintenance issues to make sure there is a clear audit trail from when repairs are reported to when they are completed. This will ensure that repairs are done quickly and that the home is safe for the people living there and well maintained. There should be a record of training undertaken by staff to make sure they are competent and understand the needs of people who use the service, 2. YA15 3. YA22 4. YA24 5. YA32 Patrick House DS0000070895.V366277.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Patrick House DS0000070895.V366277.R01.S.doc Version 5.2 Page 32 - 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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