Inspection on 08/06/05 for Pax Care Home

This inspection was carried out on 8th June 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 but made no statutory requirements on the home.

Other inspections for this house

Pax Care Home 18/05/07

Pax Care Home 06/06/06

Pax Care Home 25/11/05

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 08 June 2005 09:00 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 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 Stationary 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 E53 S4354 Pax Care Home V234029 080605 Stage 4.doc Version 1.30 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 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 Mr Alvin Anthony Ribeiro CRH Care Home 2 Category(ies) of MD - Mental Disorder (2) registration, with number of places Pax Care Home E53 S4354 Pax Care Home V234029 080605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registration relates to being the registered manager for Pax Care Home accommodating two service users only. Date implemented: 12/07/04 2. 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. Date implemented: 12/07/04 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. Date implemented: 12/07/04 4. 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. Date implemented: 16/05/04 Date of last inspection 01 March 2005 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. 3. Pax Care Home E53 S4354 Pax Care Home V234029 080605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which was conducted between 2 PM and 8.30 PM and took account of the report of findings and requirements of the previous inspection. All the service users were seen during the course of the visit and one service user was interviewed in private, but informally. The registered manager who pursues other employment was not present at the start of the inspection, but arrived during his lunch break and again after he had completed his shift at his other employ. Whilst the member of staff who was rostered for duty for most of the period of the inspection remained on the premises throughout, this person spent little time in the service users quarters and only had brief contact with them. The Home is small and comfortable and provides acceptable basic care. However, as found a previous inspection, there is still concern about its ability to provide service users with an all round good quality of life. This is in relation to responding to their needs arising from their religion, culture and language, and supporting them in ways that establish their personal goals and helping them to achieve them or otherwise to live more fulfilling lives. The Home is registered for only two service users and therefore substantial time will be spent on attempting to comply with the full weight of the standards for care homes some of which might be more effectively employed in direct work with the service users. It is for this reason that the registered person is recommended to consider whether service users’ interests are best served by the Home’s current registration category. In the inspector’s judgement, being part of an Adult Placement Scheme, would be more in line with the Home resources and might provide better scope for focusing efforts on the service users more successfully. What the service does well: The Registered Persons’ and the staff’s professional background equips them to respond effectively to service users physical health care needs and in providing efficient, but sensitive support in personal care. One service user expressed complete content with the Home and its standard of care. Pax Care Home E53 S4354 Pax Care Home V234029 080605 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Pax Care Home E53 S4354 Pax Care Home V234029 080605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Pax Care Home E53 S4354 Pax Care Home V234029 080605 Stage 4.doc Version 1.30 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 standard(s) 2 The lack of up-to-date and comprehensive assessment of service users circumstances, which accurately establishes and reflects their views of their needs and aspirations, seems to be contributing to an inability by staff to provide them with an all round good quality of life. EVIDENCE: 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. The assessments and reports of subsequent reviews are detailed in explaining the nature of service users’ mental and physical health conditions and the Individual Plans which have been developed to set the course for how the Home will attend to service users health and physical care needs are deemed effective. For example, the registered manager was able to provide documentary evidence of service users receiving on going specialist treatment for their particular mental and physical conditions and a detailed daily routine of how their personal care is to be conducted. Pax Care Home E53 S4354 Pax Care Home V234029 080605 Stage 4.doc Version 1.30 Page 9 The daily routine of care includes aspects such as the service users preferred bedtimes, meals and mealtimes. It was also noted that there were instructions on service users intimate aspects of care, such as bathing, to be carried out and by whom. This is good practice because it demonstrates that account is being taken of service users wishes and some choice is being offered. With this and the foregoing in mind, it was considered that the assessment and Individual Plans were being used to respond effectively to particular service users health and physical care needs. However, it is considered that service users are not being provided with all round effective care because both the assessments and Individual Plans fail to give sufficient regard to their needs in relation to language, culture and personal aspirations. The service users are all Asian for whom English is their second language and though they can communicate in English they are not all fluent. Since none of the staff are able to communicate with them in their first language, it is therefore likely that they may not always be able to communicate their wishes and feelings, particularly in delicate personal matters. Neither the assessments nor Individual Plans take account of this or any requirements, which might arise from the service users culture and medium of communication. It is considered that this might be providing a barrier to staff having a full understanding of the service users’ personal aspirations, as they do not have a good enough understanding of their culture and cannot communicate with them effectively. The inspector was particularly concerned that a service user is so lacking meaningful occupation, clear rehabilitation strategy or therapy that the individual sleeps through substantial parts of usual waking hours and that this has simply become an institutionalised aspect of the person’s routine. No evidence was provided to suggest that this excessive sleeping was not as a result of boredom. Encouragingly, the registered manager reported his intention to recruit (with genuine qualification exemption if necessary) a carer with a good working knowledge of the service users ‘language, religion and culture. This is with a view to improving the effectiveness of the Home’s assessment and care planning processes both of which have been reported on critically at the last two inspections. Pax Care Home E53 S4354 Pax Care Home V234029 080605 Stage 4.doc Version 1.30 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 standard(s) 6, 7 and 9 Service users are being treated as passive recipients of a care regime, which attends adequately to their health and physical care needs, but is lacking in establishing what they require to enjoy more fulfilled lives and to be fully engaged in the decision-making process. EVIDENCE: A combination of documents, which were among service users records provide a good account of their health and physical care needs and this is the basis on which their individual plans (care plans) are developed. This departs from the requirement for the plan to give due regard to all aspects of the individual’s personal and social support requirements in addition to his or her health care needs. Although the home specialises in the care of service users with mental health problems, there was no clear plan of the part that it will play in any rehabilitation, treatment or therapeutic strategies in relation to service users’ mental health. It was therefore difficult to figure what the aims of service users’ placements at the Home are and the actions, which are required to achieve them. Pax Care Home E53 S4354 Pax Care Home V234029 080605 Stage 4.doc Version 1.30 Page 11 More importantly, the plans do not give any indication of service users aspirations in terms of personal development, i.e., greater independence, personal relations or other self-fulfilling aspects of life and what the Home might be able to do to assist. Currently, service users care plans do not make provisions for the fact that English is their second language and since arrangements for them to have ready access to an advocacy service are still to be confirmed, this leaves them somewhat isolated. There was little documentary evidence or practices observed to suggest that service users are enabled to make decisions apart from basic routine aspects of life such as the times they retire to bed and when they rise. The manager reported that service users have their own bank accounts into which their incomes are paid and living expenditure is deducted. Any support that they receive in managing those accounts and in budgeting should be documented and reviewed so that it may serve as evidence of service users being enabled to make decisions. Note, if service users are to retain the independent living skills that they had prior to entering the Home, then they must be enabled to make decisions and be supported to control as many aspects of their lives as possible. This was an aspect of care, of which critical observations were made at previous inspection, but which still needs to be addressed. In order for service users to develop and act with some independence and achieve personal goals, which might lead to fulfilment, they need to be enabled to take responsible risks. There was evidence that the registered person has conducted risk assessments, but these have been confined to one or two specific areas such as service users’ disability and potential danger in smoking habit. However, if service users’ welfare is to be properly safeguarded, the risk assessments need to be more comprehensive taking account of past and current behaviour particularly where this might make the service user vulnerable in terms of risk to self and others. Pax Care Home E53 S4354 Pax Care Home V234029 080605 Stage 4.doc Version 1.30 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15, 16 and 17 Whilst it is recognised that service users’ health and disabilities will place some restrictions on their lifestyles and personal aspirations, it is considered that more needs to be done to promote their personal development taking account of their religion and culture. Overall, service users health and wellbeing was being adequately served by the catering arrangements, which affords wholesome food at reasonable intervals and which one service user said was their choice. EVIDENCE: Currently none of the service users are engaged in any employment, education or training and only one is provided with access to day occupation centres where meaningful activities are available. Within the Home, the only form of occupation/ leisure activity seen to be available was home entertainment such as television and radio. The manager explained that one service user used to do knitting, but there was no evidence of this at inspection and, overall, the Home was not presented as a stimulating environment. Pax Care Home E53 S4354 Pax Care Home V234029 080605 Stage 4.doc Version 1.30 Page 13 Given that not all the service users are fluent in English and in one instance is understood not to be literate in their first language, one way of meaningful occupation might be, with the service user(s) consent, to enable them to take part in adult literacy or similar programmes to aid effective communication. An activity such as this might benefit service users both in relation to their personal development and in being equipped to play a more active part in their care planning process. In relation to service users being supported, “to become part of, and participate in, the local community in accordance with assessed needs and the individual plans”, it was observed that this does not feature as a discrete part of the plans. The only evidence of such involvement in the community is already mentioned above and relates to the service user who attends local day occupation centres. The registered manager did, however, report that service users are registered to vote thus making it possible for them to exercise their civic duty if they so wish. If service users are to be enabled to enjoy something of a sense of belonging and not become too isolated, then efforts must be made to enable them to have greater contact with the local community. Currently none of the service users have regular contact with their families and one service user said that this person’s friends do not visit the Home. This lack of contact is not attributed to any restrictions by the Home, which has flexible visiting arrangements. However, since there is no, or infrequent, contact with relatives staff may consider working with service users to acquire photographs of family members and other mementos which they might wish to display or which might simply assist with connections between their present and past. In light of service users lack of or restricted contact with relatives and friends, the registered person might also consider working with the placing agencies to recruit, vet and train persons who might act in a befriending capacity to them. This should be with a view to promoting their links with the local community and mitigating their isolation. Aspects of service users’ physical and mental health place limitations on their ability to be fully independent and therefore certain practices have to be observed in order to maintain and enhance such independence as they might still have or may be able to achieve. In one case, the Home’s performance in supporting a service user, with significant physical disabilities, to continue to perform most activities in daily living is very good. In another case, however, the service user is treated as a passive recipient of care in that this person did not seem to take part in any routine domestic activities in the Home and there was no evidence in this person’s individual plan to suggest that this should be the case. Pax Care Home E53 S4354 Pax Care Home V234029 080605 Stage 4.doc Version 1.30 Page 14 In order for the Home to demonstrate that it is promoting independence and individual choice, staff will need to engage service users in discussions about how the Home is run. For example, choice of decoration and furniture for their own rooms and seek consensus on how the daily routine is organised. It might even be therapeutic to involve service users, subject to their condition and interests, in some of the domestic routine by way of supporting them to acquire or maintain basic independent skills. Measures are taken to enable service users privacy, such as fitting locking mechanisms to the bathroom door and knocking on bedroom doors before entering, were seen to be taken. However, on one occasion a staff member knocked on the door and entered without before being invited to do so. Greater care must be taken in this regard to ensure service user’s privacy and dignity is not compromised. For example, not waiting to be invited to enter a bedroom might cause service user loss of dignity if they were engaged in a private activity such a getting changed. Service users reported that they are provided with three meals per day and a light supper. As required, 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 forecasted in the menus. Although there was no evidence of fresh vegetables, there was an ample supply of fresh fruit. This all indicates that sufficient care is being taken with ensuring service users are provided with food of acceptable quality, quantity and variety. The only critical observation was that the Home relies on the registered manager’s wife to prepare the evening meal, which means that if she is delayed, as was the case at the time of inspection, then the meal is delayed. This indicates the need for a contingency plan. Pax Care Home E53 S4354 Pax Care Home V234029 080605 Stage 4.doc Version 1.30 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20 Staff members’ professional background and experience in health care is reflected in the Home’s performance in providing a good standard of personal support and health care for service users. EVIDENCE: There was documentary evidence in the form of hospital letters, appointment cards and other records made by staff to indicate that proper care is taken to ensure that service users receive any both curative and preventative health care as appropriate. It was noted that service users have chronic conditions, which require monitoring and specialist interventions, which 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. Service users require assistance to bathe and this assistance is provided. It was observed that the individual care plans set out the frequency at which service users prefer their ablutions to be conducted and the named staff members who will assist them. Pax Care Home E53 S4354 Pax Care Home V234029 080605 Stage 4.doc Version 1.30 Page 16 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 confirmed the above observations by explaining the daily routine, in which service users get up and go to bed at times of their choice depending on what appointments they have throughout the day. The service user also confirmed that they are assisted to bathe as regularly as they wish and that bedding is changed every week. The service user expressed content with the quality of service they are provided adding: “they cook and wash my clothes”. As highlighted at the last inspection, there was little evidence of any deliberate work being done with service users in the Home in relation to their mental health. For example, it is simply accepted that a service user has become fearful about journeying out of the Home and there are no treatment plan or therapy to address this. Were this difficulty to be addressed successfully, it may well lead to an improvement in the particular service user’s quality of life. The home is required to make provisions for the safe receipt, storage and administration of service users medication and was considered to be fulfilling this requirement. In this connection, the registered person was able to demonstrate that there is a medication procedure and that storage is provided for all service users medicines. The safety of the storage of the medication is of some concern, as this is currently in the form of a wall mounted wooden cupboard in an accessible place and secured only by a chain and padlock. In order to comply in full with the required standard, medicines, particularly any controlled drugs, must be stored in a metal cupboard. 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. In addition, records are kept of medication, which has been administered. They were found to be accurate and current, as they were reconciled with the supply of medication held 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 though this does not feature in the individual plan or risk assessments as ought to be the case. Pax Care Home E53 S4354 Pax Care Home V234029 080605 Stage 4.doc Version 1.30 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 The Home has policies, procedures and working practices, which, with the exception of one or two deficits, are sufficient to protect service users and to respond effectively to their concerns and complaints. EVIDENCE: The registered manager was interviewed in relation to the arrangements for protecting service users and dealing with their concerns and complaints. In summary, he reported that policies, procedures and practices have been developed and adopted in this regard. However, in his and the staff daily contact with service users they are vigilant to any circumstances, which might be symptomatic of abuse and 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 not kept, as required, the manager reported that there have been no complaints since the last inspection and that there has been only one formal complaint since the Home was established. It was observed that there is a complaints procedure a copy of which is prominently displayed in the Home. However, it is in written only in English though this is service users second language; is not in large font and poor sight features among service users difficulties and does not take account of levels of literacy. If the complaints procedure is to be accessible and understood by all service users, it must be in forms relevant to their needs. The same applies to any information in this connection, which is conveyed in the Service Users Guide. Pax Care Home E53 S4354 Pax Care Home V234029 080605 Stage 4.doc Version 1.30 Page 18 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. The inspector was satisfied that the manager is aware of the measures that must be taken in staff selection in order to protect service users. For example, all those who are currently employed have had satisfactory Criminal Records Bureau checks and though no members of staff have been appointed since the introduction of these standards, the manager is aware of safeguards, which must be applied to new recruits. Pax Care Home E53 S4354 Pax Care Home V234029 080605 Stage 4.doc Version 1.30 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 27 and 30 Accounting for service users conditions, needs and the principles on which the Home is meant to be run (as set out in the Statement of Purpose, the environment, facilities and services provided are generally good. Further, the Home is considered to provide a largely safe and comfortable environment. 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 reasonably quiet location with little traffic. The premises are detached and serve both as the registered person’s family home and a care home. Service users accommodation is distinct and completely selfcontained providing them with adequate bedroom and communal space. In judging the Home comfortable and safe, account was taken of the condition in which it is being maintained both inside and outside and whether it is in keeping with the other dwellings in the community. Pax Care Home E53 S4354 Pax Care Home V234029 080605 Stage 4.doc Version 1.30 Page 20 In both respects the required standards have been met in that the Home, which is constructed in a style compatible with those that surround it thus making it largely indistinguishable and 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. 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 light and ventilation. Service users’ bedrooms were not measured to establish conformity to the required standard, but they appeared adequate, providing sufficient useable floor area. These rooms are furnished, but the quality of furnishings is variable. Some items – chest of drawer, wardrobes and bedside cabinets - are old, worn and unattractive. The carpet in one of the bedrooms was stained and therefore needs to be cleaned or replaced and, in the inspector’s opinion, provision needs to be made to support service users to personalise the rooms, which in all cases present as stark. Attention to these details will enhance the appearance and comfort of these rooms and complement the acceptable quality of the beds, bedding and curtains. It was noted that there are no restrainers on the window openings in service users bedrooms. Even though these rooms are on the ground floor, fitting restrainers, 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 a hoist, to meet service users’ needs were also considered to provide sufficiency privacy. It too, however, presents 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. For example there is a cleaning schedule and the laundry, which is equipped with washing and drying machines sink and ample worktops, is in a discrete area adjacent to the bathroom, but away from the sitting, dining and food preparation areas. This being the case, though there is currently no cause to deal with foul laundry, if the need should arise, the risk of contamination or spread of infection would be greatly reduced. Pax Care Home E53 S4354 Pax Care Home V234029 080605 Stage 4.doc Version 1.30 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34, 35 and 36 The procedure, which the registered person has adopted for the recruitment of staff is sound and, if it is always used in the way intended, should assure the protection of service users. Current staff’s personal attributes, experience and training is sufficient to meet most of the service users individual needs, but staff require further development and training to respond to services users’ cultural and self-fulfilment requirements. EVIDENCE: No-one has recently commenced employment at the Home, which is currently staffed by the proprietor who also acts as the registered manager, 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 normally employed on a part-time basis covering the hours 8am to 5pm on weekdays. The occupants of one of these posts resigned a week ago thus one post was vacant. All those currently employed were appointed prior to the introduction of these standards thus it was only possible to assess whether the procedure exists for the safe recruitment of any new staff and whether the is any lack in how existing staff were selected as might present a risk to service users. Pax Care Home E53 S4354 Pax Care Home V234029 080605 Stage 4.doc Version 1.30 Page 22 The inspector was satisfied, having examined a sample of staff records, that existing staff members were properly appointed after completing application forms, satisfactory references, and criminal records checks being made. In regard to how future staff selection might be conducted, the manager is aware of the need to give careful consideration to candidates’ employment history and explanations of any gaps therein. Further, the requirement to consult the Protection of Vulnerable Adults register and to align the Home’s employment policy with the General Social Care Council’s code of practice and conduct copies of which were seen to be available in the Home. The manager is a practising medical doctor and members of his family who assist in the care of service users include a qualified mental health nurse and a pharmacologist. Other staff members are reported by the manager to have had extensive experience in caring for adults on a domiciliary basis. This indicates that staff’s collective experience and training should enable them to respond more than adequately to service users health and physical care needs. Evidence was provided in the form of certificates confirming that staff members have received foundation training in areas such as moving and handling, basic fire safety, protection of vulnerable adults, first aid, medicine management, etc. However, there is no established induction programme and no staff supervision arrangements, which would mean that the development of any new and existing staff is currently left to chance. The manager now recognises 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 needs to be put in place:• • • • • An induction and foundation training programme Equal opportunities training including Disability Awareness training System for assessing staff training needs and to develop a staff development and training 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 In light of service users ethnicity and disabilities, and taking account of the deficits earlier mentioned in regard to establishing their aspirations supporting them towards achieving them, assessment and care planning and equal opportunities are indicated as priority training for staff. Pax Care Home E53 S4354 Pax Care Home V234029 080605 Stage 4.doc Version 1.30 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 and 42 There is a lack of formal review and planning, which has the effect of inhibiting the Home’s development in a number of areas, but particularly in relation to evaluating its performance informed by the views of service users and other stakeholders (e.g. relatives, GPs, CPNs). The lack of planning and review means there is no objective evaluation of the Statement of Purpose, which steers the way the Home is run and establishes the principles on which service users are cared for both individually and as a collective. This might, in part, explain some of the deficits identified such as in addressing more effectively service users’ communication, cultural and personal aspiration needs. Careful thought has been given to matters of health, safety and welfare of service users and staff. Furthermore, the measures that the registered person has put in place in this regard are deemed reasonable. EVIDENCE: It appears that the Home’s Statement of Purpose is being regarded as bureaucratic imperative with which the registered person must conform. Pax Care Home E53 S4354 Pax Care Home V234029 080605 Stage 4.doc Version 1.30 Page 24 This is rather than it being held up as a declaration of the principles and methods by which the Home is run and thus subject to monitoring, review and revision influenced by service users circumstances and the professional and business environment in which it operates. Currently the registered person does not have any formal systems for monitoring the quality of the Home’s work or to assure the quality of service users care. Previously, the Home was part of the Adult Placement Scheme and the manager has continued to monitor quality simply on the basis of observations of areas such as staff performance, the material condition of the Home and the quality of the food. There is nothing wrong with this approach, but it remains subjective unless it is underpinned by a formal system of data collection such as in relation to complaints, whether service users individual and common care objectives are being met, their level of satisfaction with the way the Home is run and the quality of their care. This formal system is of quality monitoring and quality assurance is intended to cause timely intervention when service quality falls below expected standard and contributes to the Home’s annual development plan, which the manager reports is not being done. There was no evidence of annual development for each service user based on the objectives in their individual Plan, which the annual development plan for the Home is intended to influence. Indeed the only review of service users’ development is confined to a six monthly review of their mental health. Being able to demonstrate development, on an annual basis, of each service user in relation to achieving the objectives in his or her individual Plan is one of the ways in which the Home must prove its effectiveness. In taking steps to reduce the risk of fire, the registered person has conducted a fire risk assessment for the home and has introduced the control measures, which the assessment indicates are necessary. For example, the Home is fitted with a fire alarm system, heat and smoke detectors, fire extinguishers and emergency lighting. The Registered Person reported that because so few service users are accommodated, they will not normally be visited by the Fire safety Inspector unless specifically requested by the Commission. This being the case, the Registered Person commissioned the services of a private company to conduct the kind of survey, which would usually be done by the fire service. This and other actions such as ensuring that staff members have been trained in first aid and developing a health and safety policy represents responsible action on the part of the Registered Person in safeguarding the health and safety of service users. Note, accident register is kept at the home, but no incidents have been recorded and none have been notified to the Commission. Pax Care Home E53 S4354 Pax Care Home V234029 080605 Stage 4.doc Version 1.30 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 2 x x x Standard No 22 23 ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 2 x 2 x x 3 Standard No 11 12 13 14 15 16 17 x 2 2 x 3 2 2 Standard No 31 32 33 34 35 36 Score x x x 3 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Pax Care Home Score 3 2 2 x Standard No 37 38 39 40 41 42 43 Score x x 2 x x 3 x E53 S4354 Pax Care Home V234029 080605 Stage 4.doc Version 1.30 Page 26 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 2 and 9 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. This replaces requirements 1 and 2 of the previous inspection report for which the timescales were 01/09/04 and 01/06/05. The Registered Person must, in collaboration with each service user, develop an individual E53 S4354 Pax Care Home V234029 080605 Stage 4.doc Timescale for action 07/10/05 2. 2 and 6 15 07/10/05 Pax Care Home Version 1.30 Page 27 3. 7, 11 and 16 20 and 12 4. 12 12 Service User Plan, which will give effect to the actions needed to address successfully the needs indentified 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 action were 01/09/04 and 1/6/05. Conduct, in collaboration with 07/10/05 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. This supersedes requirements 4 and 5 of the last inspection report, for which the timescales for action were 01/09/04 and 01/06/06; 01/10/04 and 15/04/05, respectively. 07/10/05 The Registered Person must support each service user to become involved in some form of appropriate education, training or meaningful occupation unless there are prohibitive factors that prevent this and, in which case, this is documented in their Version 1.30 Page 28 Pax Care Home E53 S4354 Pax Care Home V234029 080605 Stage 4.doc individual plan. 5. 13 16 The Registered Person must seek to involve service users in community life so as to reduce their isolation. It might be necessary to work in conjunction with the placing authority to achieve this and the introduction of suitable and properly vetted local befrienders might be one way to approach this. Ensure that there is a suffient number of staff on duty who are equipped to prepare meals in the event of the person who normally prepares the meals being absent or delayed. The Registered Person must take steps to seek treatment/therapy for the service user whose emotional difficulty is preventing that individual from journeying out of the Home. The Registered Provider must conduct a risk assessment and take any indicative action in relation to the location and security of the medicine cupboard. If it becomes necessary to store controlled drugs on the premises, install a metal cupboard, which conforms with the current regulations and guidance issued by the Royal Pharmaceutical Society of Great Britain. The Registered Person must maintain a complaints register into which must be entered all complaints. Clean or replac the stained carpet in one of the bedrooms. Fit restrainers to the window openings in service users bedrooms so that there is sufficient ventilation, but a reduced risk of the occupant being at risk from trying to climb E53 S4354 Pax Care Home V234029 080605 Stage 4.doc 07/10/05 6. 17 18 07/10/05 7. 13 and 19 13 07/10/05 8. 20 13 07/10/05 9. 22 17 07/10/05 10. 11. 24 24 16 13 07/10/05 07/10/05 Pax Care Home Version 1.30 Page 29 out or intruders climbing in. 12. 24 16 The registered person must replace the worn items of furniture in service users bedrooms and support them to personalise their rooms, and adorn the bathroom so that it is more homely and inviting. This replaces requirement 7 of the previous inspection report, for which the timescales for action were 01/09/04 and 01/06/05 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 and established induction and foundation programme and, as a priority, equal opportunities including disability awareness and assessment and care management. This replaces requirement 8 of the previous inspection report, for which the timescales for action were 01/10/04 and 01/06/05. Staff must have supervision and an annual appraisal where their training and practice needs are recorded and identified. This is a requirement from the previous inspection, for which the timescales for action were 01/10/04 and 15/04/05. The Registered Person must introduce a quality monitoring and quality assurance system, which actively seeks feedback from service users and others connected to the Home or with an interest in it. This replaces requirement 10 of the previous inspection report, for which the timescales for action were 01/10/04 and 15/04/05. E53 S4354 Pax Care Home V234029 080605 Stage 4.doc 07/10/05 13. 35 18 07/10/05 14. 36 18 07/10/05 15. 39 24 07/10/05 Pax Care Home Version 1.30 Page 30 16. 39 24 17. 12, 17 40 The Registered Person must 07/10/05 prepare an annual development plan, which is informed by a review of the quality of care and the outcome of the quality monitoring mentioned above. The development plan might be structured in the form of a SWOT Analysis, which considers the strengths, weaknesses, opportunities for development and any potential threats to the quality of service users care and the effective operation of the Home. The registered person must put 07/10/05 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 a requirement from the previous inspection report, for which the timescales for action were 01/10/04 and 01/06/05. 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 Good Practice Recommendations The Registered Person is advised to give consideration to whether service users interests are best served by the Homes current category registration. Given that so few service users are accommodated, it might be that the Adult Placement Scheme is more appropriate. Pax Care Home E53 S4354 Pax Care Home V234029 080605 Stage 4.doc Version 1.30 Page 31 Commission for Social Care Inspection 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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