Inspection on 25/11/05 for Pax Care Home

This inspection was carried out on 25th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Pax Care Home 18/05/07

Pax Care Home 06/06/06

Pax Care Home 08/06/05

Pax Care Home 01/03/05

Pax Care Home 03/06/04

Pax Care Home 20/01/04

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

CARE HOME ADULTS 18-65 Pax Care Home 132-134 Pytchley Road Rugby Warwickshire CV22 5NG Lead Inspector Warren Clarke Unannounced Inspection 25th November 2005 09:30 Pax Care Home DS0000004354.V274000.R01.S.doc Version 5.1 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 Pax Care Home DS0000004354.V274000.R01.S.doc Version 5.1 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. Pax Care Home DS0000004354.V274000.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Pax Care Home Address 132-134 Pytchley Road Rugby Warwickshire CV22 5NG 01788 575009 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) Mrs A H Ribeiro Alvin Anthony Ribeiro Care Home 2 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (2) of places Pax Care Home DS0000004354.V274000.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The Registration The registration relates to being the registered manager for Pax Care Home accommodating two service users only. Hours worked per week That the registered manager, Alvin Ribeiro, works no more than twenty one hours per week as a medical practitioner and one day per week at Minster Care Home in Coventry. Training That Alvin Ribeiro undertakes training in the following subjects within 12 months from the date of registration: Mental health awareness Management and supervision Person-centred care Evidence of the training must be provided to the Commission for Social Care Inspection. Service User Category Registration is for a maximum of two service users in the category mental disorder, excluding learning disability or dementia. Service users may be of either gender. 8th June 2005 3. 4. Date of last inspection Brief Description of the Service: Pax Care Home provides accommodation for 2 service users who have enduring mental health needs. A third moved out last year. The current registration has been amended to reflect that there are only two appropriate bedrooms at this house. The accommodation is half of the ground floor of a detached house offering single bedrooms, a dining room and small lounge area, as well as access to a large lawned garden. This is part of providers’ family home where they live with their two grown up children. A majority of the care is provided by family members and by two care staff who are employed Monday to Friday 8 am to 5 pm. The property is within walking distance of Rugby town centre, as well as situated on a bus route. Pax Care Home DS0000004354.V274000.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection follows on from another, which carried out earlier this year. The inspection was conducted during an afternoon and evening when the Registered Manager was on duty. In carrying out the inspection, account was taken of the findings of the last visit and assessment was made of the Home’s performance against key standards based on direct observations, a conversation with one service user, examination of records and an interview with the Manager. Throughout the report the Home is used to refer to the place inspected. Service users mean the people who are being cared for in the home, and where the standards and the regulations are used, this means the National Minimum Standards for Adults (18 – 65) and, The Care Homes Regulations 2001, respectively. What the service does well: What has improved since the last inspection? At the last inspection a number of shortfalls in standards were identified as needing action to improve them. Manager said that he was not able to attend to all of those shortfalls, but has done the work required to introduce a quality monitoring and assurance system. He reported that he has also done the work he was asked to do in relation to producing a development plan for the Home. The quality assurance system and the development plan are means of ensuring that management action is taken to run the Home so eliminating the shortfalls identified. These systems had not yet been put into effect at the time of inspection therefore their effectiveness remains untested. Pax Care Home DS0000004354.V274000.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Pax Care Home DS0000004354.V274000.R01.S.doc Version 5.1 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 Pax Care Home DS0000004354.V274000.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 The lack of up-to-date comprehensive assessment of service users needs and aspirations is reflected in the current care plans, which are confined simply to responding to their basic physical needs thus raising issues about their rehabilitation/recovery and their overall quality of life. EVIDENCE: At the last inspection it was established that the Home specialises in the care of service users with mental health problems and of those currently resident, there was evidence of their being assessed prior to their admission. However, those assessments are primarily focused on their physical and mental health condition and were in some instances conducted in institutions and, in all cases, over five years ago. This situation has not changed and therefore it remains the case that the physical and mental health care needs of service users are assessed and are responded to in isolation. In some instances the maintenance of service users good physical health is being hampered by their behaviour, which seems to be part of their mental health condition. However, the apparent lack of a co-ordinated multidisciplinary assessment means that no effective strategies have been advanced for dealing with this. For example, where a service user has a physical health condition and needs hospital treatment, the individual’s fear of journeying out of the Home is proving a barrier to receiving timely treatment and thus further reducing the individual’s quality of life. Nothing was found in the assessment and the individual plan in relation to addressing this issue. Pax Care Home DS0000004354.V274000.R01.S.doc Version 5.1 Page 9 Neither the information on file, which when taken together might constitute an assessment nor the individual plans suggest any clear outcome for service users in relation to rehabilitation/recovery or the progress that might reasonably be expected if it is assumed that the service users placement at the Home is permanent (i.e., home for life). Whilst the information available about health, both physical and mental, is clear about what is and needs to be done about their physical health this is less clear in regard to treatment strategy of their mental health other than medication regimen. For example, as observed at the last inspection, one service user simply retires to bed for most of the time and there is no clear explanation as to whether this is as a result of the medication regimen; whether it is a result of a lack of stimulation or other cause. All the service users are Asians for whom English is their second language, but there is no assessment or definite strategy for attending needs arising from their religion, culture and language. Similarly, there is a distinct lack of a clear understanding of their personal aspirations in terms of friendships, relationships contact with relatives and higher level needs such as education, meaningful occupation and leisure. These factors combine to create a picture and reality in which the service users are isolated and, in the inspector’s opinion, are enjoying a quality of life, which might be enhanced. That is, if their current needs and personal aspirations were comprehensively assessed, outcomes and care objectives clearly set and a strategy in the form of their individual plan put into effect. The inspector recognises that the Registered Person has made an assessment of service users routine physical care needs and is meeting those needs satisfactorily. That is, the ways in which each service user prefers their personal support to be given, their likes and dislikes in relation to food and medication regimens, are clearly documented. It is also recognised that in some aspects where deficits have been identified in the assessment and care planning process, this might not be attributed to any lack on the registered person’s part. Nevertheless, in order to demonstrate that the service users are receiving the care that they need, it is imperative that arrangements are made for each of them to have a current assessment of the type specified in standard 2.2 or as relevant 2.3. Such an assessment should be multi-disciplinary, co-ordinated by the service user’s social worker (or care manager) or the Registered Manager and must be used to inform the service user’s individual plan. The service users views and aspirations must be reflected in the assessment and their active involvement must be facilitated through interpreters and experienced advocates. The Registered Person was made aware at inspection that a requirement in this connection has already been made on three previous consecutive occasions. Pax Care Home DS0000004354.V274000.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 7 The lack of an assessment of the type referred to earlier in relation to standard 2 means that though the Home assesses, plans and delivers what the service users need regarding their day-to-day basic physical care, there remains a lack of an overall strategy in each case. This also has the effect of leaving gaps in the understanding of what service users goals are, what is important to them in terms of quality of life and how these are being supported. EVIDENCE: Standard 2 requires that service users’ needs be comprehensively assessed in a number of areas such as in relation to their treatment and rehabilitation, health, accommodation, meaningful occupation, and social and family contact. Such an assessment is also intended to consider the service users income and any other individual needs they might have arising from their religion, culture and communication difficulties. Currently there is no assessment of this type being used to inform the individual plan, which the Registered Person is required to either obtain from health/social services authority or draw up with the full involvement of the service user and his or her family or independent advocate, as relevant. Pax Care Home DS0000004354.V274000.R01.S.doc Version 5.1 Page 11 This lack of clear assessment of needs and planning is, in the inspector’s opinion, reflecting adversely in service users care and their quality of life. For example, as mentioned earlier one service user retires to bed for most of the time. There is no clear explanation for this. Apart from attendance at a Day Centre in one case, there is little to suggest that service users have opportunities to meet with others outside the Home, take part in social events or become in any way involved in the local community. None of the service users have regular face-to-face contact with relatives or friends and no advocates have been appointed to support them. All the service users are Asians with English as their second language, but this is not reflected in the Home’s staffing and there is no-one in the Home to communicate with them in their primary language. This casts doubt over the Home’s ability to find out accurately what service users more complex wishes and feelings are and their personal aspirations. From service users own perspective, one of them told the inspector that the care is good. This was explained in terms of the quality of the food, personal care and the comfort of the living environment. All the evidence having been considered, the Registered Person is deemed not to be complying with the essential elements of standard 6 and therefore it has not been met in full. In order to comply the registered person will need to ensure that there is a current assessment of all service users of the type specified in standard 2. An individual care plan should then be drawn up with the service users full involvement, the social services or health authority (whichever is relevant) and someone to act as advocate for the service user. The individual plan must, among the other matters set out in standard 2, be clear about the service user’s rehabilitation and treatment plan, show clearly the individual’s personal aspirations and how these are to be supported together with any agreed risk assessment, which prevents the person from pursuing any particular activity or lifestyle. Above all, the plan must be in a form that the service user can understand and available to him or her for reference and discussed with staff and/or advocate, as necessary. It should be noted that this is the fourth time in just over a year that shortfalls have been identified in compliance with the requirements of this standard. In assessing what is being done to support service users to exercise their rights to make decisions about their own lives, it was found that there was no recorded information to suggest that this is the case. There was no evidence that service users were actively involved in the planning of their daily care routines, which currently serve as their individual plans, other than reflection of what is established as their likes and dislikes. None of the service users have an advocate currently though the Manager reported that previously one of them did, and one also has some support from this individual’s place of worship. Pax Care Home DS0000004354.V274000.R01.S.doc Version 5.1 Page 12 That service users do not have an individual plan reflecting their personal goals, there is little evidence, and none recorded, of whether where choices have been made, these are made by the service user or staff. When asked about how basic choices were made such as clothes, which are bought, the Manager explained that one service user buys his own clothes, but also sadly indicated that a relative in the past chose and purchased the clothes of another service user and since a year ago when the relative has no longer been able do this no clothes have been chosen or purchased for the relevant service user. A similar situation was reported by the Manager in relation to the management of one of the service users finances. With this in mind, the inspector’s assessment is that more needs to be done to support service users to become involved in their care arrangements and to be supported to make choices and decisions about their own lives except in circumstances where they are prevented from so doing by an agreed risk assessment. Furthermore, with the assistance of the service users’ care managers, the Registered Person needs to make arrangements for service users who cannot independently manage their own finances, to receive the support that they need to do this or an appropriate agent be appointed to act for the service user. Pax Care Home DS0000004354.V274000.R01.S.doc Version 5.1 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 14, 16 and 17 Service users quality of life in terms of their feelings of belonging, community involvement and social interaction will not be enhanced, and is at risk of worsening, unless more is done by the Home to encourage, support and engage them with the community, provide opportunities for them to meet with people other than staff in the Home, and to have contact with family or advocate/befrienders. EVIDENCE: In seeking evidence of the extent to which the Home is supporting service users in relation to the standards indicated above, it was discovered that only one service user who attends a Day Centre has any opportunity to engage in activities, pursue interests and regularly meet with people other than staff in the Home. There is no record of service users being taken shopping or to any places of interest or entertainment. Other than visits to fulfil hospital appointments little is recorded or reported of initiatives by the Home to enable service users to journey out either to local amenities or beyond. In terms of service users community involvement, the Manager said all the service users are registered to vote, but have tended not to use their vote. Pax Care Home DS0000004354.V274000.R01.S.doc Version 5.1 Page 14 An assessment was made of what is being done in the Home to ensure service users are stimulated by way of support to pursue leisure activities, etc. One service user cited examples of a range of activities and outings at a Centre he attends, but other than this there was no evidence of the Home doing anything to provide service users with entertainment, group or individual activities. On the two inspection visits that the inspector has made to the Home nothing appeared to be arranged or going on, other than the television, that was in any way stimulating. The Home needs to be seen to be doing more to encourage service users to become more involved in the community and to promote activities for them both within and outside the Home. When asked whether service users have any contact with their relatives and friends, the Manager explained that none of them currently do. In one case, the service user has sporadic telephone contact with relatives overseas, but though all the service users once had regular and substantial contact this is no longer the case. Having considered each service user’s individual circumstances it appears that this aspect of their life has not been assessed and reviewed for some time. In the circumstances, the inspector’s judgement is that service users are isolated in the Home and more must be done to enable them to re-establish contact with relatives and friends, or to form new friendships. Examination of practices in the Home, which serves to respect service users ‘ rights and responsibilities and promote independence, suggests the quality indicators necessary to fulfil standard 16 have been put in place. For example, service users are afforded privacy, in part, by having an appropriate lock on the bedroom doors and whilst they are not in a position to deal with their own mail staff simply act in line with their instructions when providing support in this regard. Incidentally, the Manager explained that all the mail that service users receive is of business type, providing further evidence of their social isolation. Service users were seen to have unrestricted access to all parts of the premises registered for their use and are free to choose to be alone. The inspector observed that when the staff member on duty was the Registered Manager or a member of his family, they located themselves in the provider/manager’s accommodation, which though only separated by a door has the effect of isolating the service users. When they were actually present in the service users living quarters they were seen to interact with them, but need to spend more of the time on duty with the service users. Maybe some of this time could be used to support service users with leisure activities or help them to become more involved in the community. A service user confirmed that the catering arrangements remain, as was the case at the last inspection. That is, they are provided with three meals per day – breakfast, lunch and dinner. A light supper is also provided and drinks, fruit and cake on demand. Pax Care Home DS0000004354.V274000.R01.S.doc Version 5.1 Page 15 As required, and the menu shows - one of those meals (the evening meal) is the main hot meal of the day. All the meals provided are suitable for vegetarians and the main meal is prepared Asian style, which is what service users prefer. Stores of food, which were seen, were deemed more than adequate and were in keeping with the meals forecast in the menus. Although there was no evidence of fresh vegetables, there was an ample supply of fresh fruit. Since most of the food in store was convenience (pre-prepared) and of the same description as on the menu, the inspector asked the Manager whether the meals provided were being prepared from basic ingredients. The Manager said that this is the case, though on some occasions some of the pre-prepared meals are served. During the last two inspections, the inspector had not seen any of the meals being prepared. At the last inspection the Manager said that the Registered Provider usually prepares the evening meal when she arrives from work. One of the ways in which service users might become more engaged is to enable them to discuss, see and smell food in preparation. At the next inspection particular focus will be given to this aspect of care Pax Care Home DS0000004354.V274000.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Care practices in the Home contribute effectively towards maintenance of service users’ physical health, but more needs to be done to aid their recovery or limit deterioration of their mental health and quality of life. The presumption is that service users should be supported to manage their own medication and the Home needs to demonstrate in their risk assessments why this is not the case for those currently resident. EVIDENCE: As was the case at the last inspection and pointed out earlier in this report, the Home performs well in the physical care of service users. Evidence in the form of hospital letters, appointment cards and other records made by staff, indicate that proper care is taken to ensure that service users receive both curative and preventative health care, as appropriate. It was noted that service users have chronic conditions, which require monitoring and specialist interventions and that these were being attended. Currently, service users receive health care monitoring and treatment from the local hospital on an out-patients basis and from Community Psychiatric Nurses. All service users are registered with GPs and have access to optical, dental and chiropody services. Preventative measures such as flu vaccinations, were also recorded as having been taken. Pax Care Home DS0000004354.V274000.R01.S.doc Version 5.1 Page 17 Service users records indicated that they all require some assistance with activities in daily living such as bathing and that this is being given. It was observed, as cited earlier, that the individual care plans focus only on these aspects of the service users’ physical care. They are good in this respect because they set out the frequency at which service users prefer their ablutions to be conducted and the named staff members who will assist them. This regimen, which includes other aspects of personal care such as grooming, bedtime and mealtimes serves to demonstrate that there is some structure for ensuring that personal support tasks are carried out and in a way that takes account of the service user’s preference. A service user who was interviewed at the last inspection confirmed that the above observations continue to be what he experiences in practice. He explained that the daily routine is such that they are able to get up and go to bed at times of their choice; that bedding and clothing are laundered and changed regularly. At the last inspection, it was noted that though service users’ mental health was being monitored by relevant specialists, there was no evidence of recovery or treatment programme other than their medication regimen. This means that there are no clear goals for either staff or service users to work towards in terms of their condition. Because of this lack of there is, in the inspector’s opinion, an element of drift, which is limiting service users quality of life. The Registered Person therefore needs to work with the specialists – psychiatrists, GPs, community psychiatric nurses and social workers involved – to draw up recovery/treatment programmes for each service user. Such programmes must take account of the service users own aspirations, religion, culture and means of communication. A check was made to find out if the Home is complying with good practice in the safe storage, administration and disposal of discontinued or unused medication. It was noted that the administration of medication is conducted within a system introduced by the pharmacy in which a month’s supply is organised into four receptacles each with a week’s medication regimen, with compartments containing the correct doses to be administered at the prescribed frequency. It was also observed that records are kept of medication, which has been administered. The records were found to be accurate and current when checked against the quantities of medication in store. Currently none of the service users administer their own medication. It is the inspector’s opinion that in light of their circumstances it would be unsafe for them to do so. This, however, should be an agreed view resulting from an assessment of risk, but as was the case at the last inspection, it does not feature in the service users’ individual plan or in their risk assessments. Pax Care Home DS0000004354.V274000.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 There are adequate policies and procedures in place for responding to any complaints that service users might have and to protect them from abuse, but the Registered Manager needs to do more to make promotion of the complaints procedure more relevant to service users circumstances. EVIDENCE: It remains the case that a complaints procedure has been introduced and it is displayed prominently in the Home. Apart from the formal complaints process, the Registered Manager explained that in his and the staff daily contact with service users, they are vigilant to any circumstances, which might be symptomatic of abuse. Furthermore, they deliberately provide opportunities for expression of any concerns that service users might have. Service users did not express any concerns at inspection and though a complaint register is kept, as required, the manager reported that there has only been one complaint since the Home was established. The Registered Manager was, at the last inspection, reminded of the requirement to ensure that the complaints procedure is promoted to service users in a form that they will understand. However, it remains the case that the procedure is presented only in English, though this is service users second language and it does not take account of the level of service users’ literacy in either language. In short, whilst the complaints procedure is adequate, the Registered Person needs to demonstrate that service users actually understand it and, given their isolation, ensure that they have ready access to independent advocacy or supporters who might as appropriate raise concerns on their behalf. Pax Care Home DS0000004354.V274000.R01.S.doc Version 5.1 Page 19 The registered person demonstrated that the Home has given due regard to the protection of service users by providing training for some staff members in being aware of the nature of adult abuse. This is complemented by the Home’s procedure, which sets out how staff must act in the event of actual or suspected abuse of service users. Additionally, there is a whistle blowing policy, which makes clear that staff will not suffer any detriment by reporting any impropriety that they might become aware of in the running of the Home and care of service users. Service users are also being protected by the Home staff selection procedure as shown in the evidence on page 24. Pax Care Home DS0000004354.V274000.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Service users are afforded a comfortable and homely environment in which to live, but some of the furniture needs to be replaced and service users’ bedrooms and the bathroom made less stark. EVIDENCE: The Home is intended to provide a small domestic home-like environment reflecting the small number of service users accommodated and their particular needs. Situated in a residential area, reasonably close to the town centre and its amenities, the home is in a quiet location with little traffic. The premises are detached and serve both as the Registered Persons’ family home and a care home. Service users accommodation is distinct and completely selfcontained providing them with adequate bedroom and communal space. The Home continues to provide service users with a reasonably comfortable and safe environment in which to live. It is constructed in a style compatible with those that surround it thus making it largely indistinguishable and it is being maintained in good structural and decorative order. It is adequately furnished, if a little stark in some areas such as the bathroom, which, though clean and properly equipped, in the inspector’s opinion presents as clinical and uninviting. Pax Care Home DS0000004354.V274000.R01.S.doc Version 5.1 Page 21 It was noted that a light in the bathroom and one in a corridor were not working and when this was pointed out to the Manager, the defective light bulbs were replaced. It was observed, and documentary evidence was provided, that the premises conform to the requirements of the local fire service. That is, there is a fire alarm system installed and smoke and heat detecting devices are fitted. Throughout, the Home was presented as clean, free of any unpleasant odours and provided sufficient ventilation. Service users’ bedrooms are spacious, but as pointed out at the last inspection, they are poorly furnished i.e., the quality of furnishings is variable. Some items – chest of drawer, wardrobes and bedside cabinets - are old, worn and unattractive. The Manager told the inspector that he plans to replace the bedroom furniture before the next inspection. Attempts will also need to be made to support service users to personalise their rooms, as they remain stark. It was noted that there are no restrictors on the window openings in service users bedrooms. Even though these rooms are on the ground floor, fitting restrictors, which enables sufficient ventilation but would deter service users attempts to climb out or intruders to enter, is likely to improve safety and security. The bathroom and toilet facilities, which are specifically equipped with aids such as a hoist, to meet service users’ needs were also considered to provide sufficient privacy. They too, however, presented as stark and might be made more homely and inviting with indoor plants and display of appropriate bathroom paraphernalia. All the necessary measures have been taken to ensure that the Home is kept clean and hygienic. Evidence for this comes from there being a cleaning schedule and the utility room, which is equipped with washing and drying machines sink and ample worktops, is located in a discrete area adjacent to the bathroom, but away from dining and food preparation areas. These measures contribute to preventing the risk of spread of infection. Pax Care Home DS0000004354.V274000.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 The number of staff employed is commensurate with the number of service users, but in light of the deficits identified at this and previous inspections their deployment, supervision, qualifications training and development need to be reviewed. EVIDENCE: Since the last inspection one new member of staff has commenced employment at the Home filling a post, which was vacant. Currently the Home is staffed by The Registered Manager and three members of his family who have other employment, but work on a casual basis when they are available. In addition, two care assistants are employed on a part-time basis working shifts between the hours 8am to 5pm on weekdays. As required the Home has a staff recruitment and selection procedure, which is intended to ensure that those employed to care for service users are fit to do so. The inspector was satisfied that, having examined a sample of staff records, staff members were properly appointed and have been properly vetted. That is, there was evidence of verification of their identity, application forms, satisfactory references, and criminal records checks being made. It was noted that a checklist is used to ensure that the strict vetting process is followed and this is commendable practice. Pax Care Home DS0000004354.V274000.R01.S.doc Version 5.1 Page 23 However, the Manager must ensure that where there appear to be gaps in candidates’ employment/training history, these are satisfactorily explained. In one member of staff’s application there was a three year gap, but no record of this being satisfactorily explained. Although a staff induction programme has still not been established, staff records show that they have had previous experience of caring for adults and have received sound foundation training, which includes First Aid, Manual Handling, Protection of Vulnerable Adults and which should fit them to attend service users’ health and physical care competently and safely. The Manager said he is still in the process of drawing up staff member’s individual training profiles and in the absence of these the evidence available suggests that staff have not received any training in promoting independence or in techniques for rehabilitation and recovery. This is training that they must have if they are to support service users in emotional maintenance, recovery or rehabilitation. Care staff members are required to have achieved National Vocational Qualification level 2 or 3 in Care or be working towards this, and 50 of the team must by now have achieved NVQ level 2. Staff records suggest that this is not the case and therefore the Registered Person must make provisions for staff to be appropriately trained. At the last inspection, the manager was made aware of the deficits outlined above in relation to staff training and development, and recognised that in order to comply with the required standards and, more importantly, to demonstrate that service users needs are met by staff who are appropriately trained, the following need to be put in place:• • • • • • An induction and foundation training programme Equal opportunities training including Disability Awareness training Promoting independence, recovery and rehabilitation System for assessing staff training needs and to maintain a record of their training and development profile. Opportunities for service users to influence or contribute to staff selection and training needs assessment Apportionment of funds to finance the annual staff training and development programme Pax Care Home DS0000004354.V274000.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 The deficits identified in earlier sections of this report are in large part attributable to lack of advanced care management capable of effectively aligning the Home’s Statement of Purpose with the implementation of a quality monitoring and assurance system to meet service users needs, aspirations and predetermined outcomes. However, a range of precautionary measures, which are in place are proving effective in promoting service users health and safety and protecting them from avoidable harm. EVIDENCE: Standard 37 requires that the Registered Manager is able to demonstrate that the Home is run well and therefore benefits service users. A number of persistent deficits, as highlighted in earlier sections of the report and in the requirement section show, there are, in this connection, some causes for concern. Pax Care Home DS0000004354.V274000.R01.S.doc Version 5.1 Page 25 The Registered Manager is a qualified and practising medical doctor who has had some supervisory experience in residential care in his capacity of registered provider of a care home for older people. Although the Manager has received foundation training in care and is undertaking a course leading to the award of Certificate in Management studies, he does not possess, and has not yet enrolled on a course leading to the NVQ level 4 in management and care. Care home managers are required to have this qualification as evidence of their being accredited to operate at a level to run a home effectively. The Registered Manager must therefore act to achieve accreditation a NVQ level 4 in management and care at the earliest opportunity. In light of the deficits identified at the last inspection, it was concluded that the Home’s Statement of Purpose had become a document developed out of a bureaucratic requirement. This is rather than it being used as a declaration of the principles and methods by which the Home is run and the framework for monitoring and assuring the quality of service provided. At that time there was no system in place for monitoring, reviewing and developing care practices, and for the running of the Home influenced by service users’ circumstances, views and the professional and business environment in which the Home operates. The Manager said that he has now developed a quality assurance system, which will be used to inform an annual development plan for the Home and, as required, will be able to show year-on-year progress in the care and treatment of service users. This system had not been implemented at the time of the current inspection, but will be monitored in follow up visits and at the next inspection. Measures have been put in place for the health and safety of service users. These include training staff in First Aid and in Manual Handling so that they are able to respond to service users’ health emergencies and support them in aspects of personal care, such as bathing, safely. Care is being taken to ensure that substances, which might be hazardous to health such as cleaning solutions, are securely stored and the necessary fire precautions are being taken. In this regard, it was noted that there is a fire risk assessment and that fire detection and alarm systems have been fitted. The records showed that these systems are serviced and tested at intervals recommended by the Fire Service. It was, however, observed that there were no records of fire drills and the Registered Person must therefore ensure that these are carried out at the intervals recommended by the Fire Service and that the outcome and any corrective measures taken are recorded. Pax Care Home DS0000004354.V274000.R01.S.doc Version 5.1 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 2 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 X 27 X 28 x 29 x 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X X X LIFESTYLES Standard No Score 11 X 12 X 13 2 14 2 15 2 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 x 2 2 X 2 x Pax Care Home DS0000004354.V274000.R01.S.doc Version 5.1 Page 27 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA2 Regulation 14 Requirement The registered person must ensure that there is a current comprehensive assessment of all service users, which must involve the individual, be updated periodically, as necessary, and take account of the following:- (i) The service users physical and mental health. (ii) Disability - and any special needs and provisions required. (iii) Education, training or meaningful occupation. iv) Religion, language and culture. (v) Ability to communicate and preferred or most effective medium for communication. (vi) Contact with relatives and friends and personal relationships. Leisure interests. Independent living skills. (vii) Risk assessment in relation to self and other both within and outside the Home. Note, the previous timescales for this were 01/09/04, 01/06/05 and 7/10/05 Timescale for action 28/02/06 Pax Care Home DS0000004354.V274000.R01.S.doc Version 5.1 Page 28 2 YA6 15 3 YA7 12 The Registered Person must, in collaboration with each service user, develop an individual Service User Plan, which will give effect to the actions needed to address successfully the needs identified in the assessment explained at requirement 1 above and with particular regard to the service users personal aspirations. The Plan must be in a language and format that the service user can understand and reviewed at least every six months. The review must include the service user, relevant professional and the service users family or preferred representative. This replaces requirement 3 of the last inspection report, for which the timescales actions were 01/09/04 and 1/6/05. The Registered Person must 31/03/06 demonstrate that service users are enabled to make decisions about their own lives and where decisions are made by others the reason for this is recorded. Where service users cannot manage their own finances or need assistance to do so, the Registered Person must provide them with the necessary assistance and this must be recorded in the individual plan. Pax Care Home DS0000004354.V274000.R01.S.doc Version 5.1 Page 29 4 YA7 12 5 YA13 16 Conduct, in collaboration with 31/01/06 service users, an audit of their independent living skills and include in their individual Plan a strategy for maintaining those skills that they have and to acquire those that they lack. Any limitations placed on service users in relation to any curtailment of their rights to act with independence and the autonomy that befits their adult status, must be approved and documented. Note, the several timescales have already been given for this requirement to be met the last being 07/10/05. The Registered Person must seek 31/03/06 to involve service users in community life so as to reduce their isolation. It might be necessary to work in conjunction with their placing authority to achieve this. Suitable and properly vetted befrienders may be one way to approach this. Previous timescale for action was 07/10/05 . The Registered Provider must ensure service users have access to social and leisure activities including an annual holiday and keep a record of the occasions on which they have been involved in such activities. The Registered Provider must, where possible, support service users to re-establish and maintain contact with their family and enable them to have opportunities to engage in social and community activities so that they might establish friendships. 6 YA14 16 (2) (n) 28/02/06 7 YA15 16 (2)(m) 31/03/06 Pax Care Home DS0000004354.V274000.R01.S.doc Version 5.1 Page 30 8 YA20 13 9 YA22 22 (2) 10 YA24 If, as it appears to be the case, service users are not able to keep and administer their own medication because of assesed risks, this must be documented in their individual plan. The Registered Person must ensure that the complaints procedure is presented in a form that most effectively communicates its contents to service users. The Registered Person must address the following: i. Fit restrictors to service users’ bedroom windows so that there is sufficient ventilation, but reduced risk of their occupants being at risk by trying to climb out or intruders attempting to enter. ii. Replace the worn and dated furniture in service users bedrooms, encourage them to personalise their room and act to make the bedrooms and bathroom less stark. The previous timescales for action of this are 01/09/04, 01/06/05 and 07/10/05. 28/02/06 28/2/06 28/02/06 Pax Care Home DS0000004354.V274000.R01.S.doc Version 5.1 Page 31 11 YA32 18 12 YA35 18 13 YA36 18 The Registered Person must ensure staff are appropriately trained in the care of adults with mental illness, with emphasis on promoting independence, recovery and treatment. The Registered Person must also ensure that staff are trained such that they achieve National Vocational Qualification(NVQ) Level 2 or 3 in care noting that 50 of the staff team are required to be so accredited by 2005. Evidence of staff being enrolled in the relevant NVQ programmes must be provided by the date in the adjacent column. Conduct a staff training needs assessment to inform staffs training and development profile and apportion sufficient funds to finance any training requirements. The training must include an established induction and foundation programme and, as a priority, equal opportunities including disability awareness and assessment and care management. Previous timescales for action of this were 01/10/04, 01/06/05 and 07/10/05. Arrangements must be made for staff supervision at the frequency specified in standard 36 and an annual appraisal all of which must be recorded. Previous timescales for action are 01/10/04, 15/04/05 and 07/10/05. 31/03/06 28/02/06 28/2/06 Pax Care Home DS0000004354.V274000.R01.S.doc Version 5.1 Page 32 14 YA37 18 15 YA40 12 and 17 16 YA42 23 (4) The Registered Manager must, 31/03/06 as required, achieve accreditation at NVQ level 4 in management and care. Evidence of the postholder’s enrolment in a relevant training programme to achieve this must be produced by the date given in the adjacent column. The registered person must put 28/2/06 in place policies and procedures as necessary to guide staff in all aspects of their work and to support the Statement of Purpose. This is an unmet requirement from the previous inspection report, for which the timescales for action were 01/10/04, 01/06/05 and 07/10/05. The Registered Person must 28/2/06 ensure fire drills are carried out at the frequency recommeded by the Fire Service and are recorded. Pax Care Home DS0000004354.V274000.R01.S.doc Version 5.1 Page 33 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 YA34 YA1 Good Practice Recommendations The Registered Person should check for any gaps in potential staff members’ employment/training history and seek satisfactory explanations where such gaps appear. The Registered Person is advised to consider whether service users interests are best served by the Home’s current category of registration. Given that so few service users are accommodated, it might be that the Adult Placement Scheme is more appropriate. Pax Care Home DS0000004354.V274000.R01.S.doc Version 5.1 Page 34 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 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. 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