Inspection on 03/05/07 for Penang

This inspection was carried out on 3rd May 2007.

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 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Penang 25/04/08

Penang 22/05/06

Penang 20/10/05

Penang 14/04/05

Penang 06/12/04

Penang 20/07/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Penang 35 Charles Road St Leonards on Sea East Sussex TN38 0QX Lead Inspector Jason Denny Key Unannounced Inspection 3rd May 2007 09:30 Penang DS0000036588.V337722.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Penang DS0000036588.V337722.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Penang DS0000036588.V337722.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Penang Address 35 Charles Road St Leonards on Sea East Sussex TN38 0QX 01424 420484 01424 429102 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) Evesleigh (East Sussex) Ltd Mr Nicholas Harmer Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Penang DS0000036588.V337722.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of residents to be accommodated is six (6) Residents must be aged between eighteen (18) and sixty-five (65) years on admission Residents with a learning disability only to be accommodated Date of last inspection 22nd May 2006 Brief Description of the Service: Penang is a care home registered to provide services for 6 adults with learning disabilities. The home is located in a residential area of St Leonards-on-Sea, close to local transport and amenities. The sea front is approximately 2 miles away. The home is large with mainly spacious rooms. The home has three floors although the registered service user accommodation is set over the ground and first floor only. There is a front and rear garden. All bedrooms are single. There are sufficient toilet and bathing facilities, including a walk-in-shower on the ground floor. The organisation’s area manager uses the top floor of the home, which is unregistered, as an office and meeting room. The fees charged are at a flat rate of £990.84 per week for each person with socials services not paying any individual variation due to this being a block contract. Inspection reports are not routinely sent out to families and advocates after each publication although a copy is kept on display in the reception area of the home and can be obtained via the manager. Minster Pathways managed the service since July 1, 2005 on behalf of the new purchasers of Communitas Ltd. The company then underwent a name change to Evesleigh [East Sussex] in mid 2006. Shares in the company were then transferred in December 2006 to Hermes Equity with a new board of directors including the existing operations director. The overall Regional management team in the organisation is unchanged with some switches of Responsible Individual and Area manager in January 2007. The home has its own MPV type vehicle. Penang DS0000036588.V337722.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an Unannounced key Inspection, which included a visit to the home which took place between 9.30am and 1.30pm on 3 May 2007. The focus of the inspection was twofold, which involved looking at how the home is meeting outstanding requirements. Secondly, looking at the two newer residents, those over 65 years old, and those who have specialist needs. Some diversity and equality areas were explored in relation to lifestyles to test what opportunities are provided for Residents. The inspectors spoke with and observed all 5 Residents, staff on duty, and looked at records. This inspection looked at key areas such as the management, who the home intends to provide care for, how care is planned and delivered, activities, lifestyles, the environment, staffing of the home, along with how concerns are dealt with. Discussions with management looked at the future purpose of the home, the admittance process, and staff training plans. All communal areas were toured. Meals, along with quality measures for Residents, were looked at. The inspector, following the home visit, spoke with those relatives, advocates, and social services care managers involved with the home The planning of this visit was unable to take account of the home’s Annual Quality Assurance Assessment [AQAA]. This was received and completed by the manager after the inspection visit. This will be used to inform the next inspection with any immediate or essential items included in this report. This report also takes into account a shorter Random inspection visit of 17 January 2007 which was based on following up requirements from the last key Inspection of May 2006. That visit indicated steady progress, maintenance of some good practice, along with some delays in addressing other shortfalls. Two [2] outcome areas are assessed as Good, and the other six [6] Adequate [ok] and in need of some improvement. What the service does well: Staff are clear about how to both identify possible abuse and report it with no recent issues of Residents being at risk. The home deals well with concerns, which in turn are much reduced. Staff have benefited from a good range of basic training. The home is good at ensuring that any new resident has a number of chances to visit the home before deciding to move in. links with advocacy projects have been maintained for several years which enables residents to have someone outside the home speaking on their behalf. Annual holidays for residents continue to be organised. The atmosphere of the home is relaxed with all Residents protected by living with people who do not Penang DS0000036588.V337722.R01.S.doc Version 5.2 Page 6 interfere with their needs. Basic Personal care is good. Residents benefit from well appointed bedrooms and good communal space and modern fittings. What has improved since the last inspection? What they could do better: The home is catering for a wide range of needs, including some with specialist sensory or mobility needs, and is required to confirm it can meet the specialist needs of some residents including two over 65 years of age in a home for younger adults, The home is demonstrating that after years of poor outcomes that it can make the service work especially in relation to activities and those areas within its expertise. However the service needs to make improved efforts to access specialist services such as an occupational theory assessment of the premises to ensure it meet specialist needs. There is an opportunity to make this a home for life for Residents subject to these inputs. The service needs to significantly improve their quality assurance practices to specifically show how the service will develop. More attention to detail is needed to reassure that the service knows what to improve and how this will be achieved. The manager is caring but will benefit the home by undertaking the necessary management course, which will also assist the their ongoing professional development and awareness of best practice. The communication needs of residents are not being fully addressed which affects outcomes for them in terms of choice. Staff are still awaiting a range of training to help them support the complex communication needs of Residents. The staff team though more motivated are inexperienced at some levels and need a lot of support and development to be able to meet all needs and fully function without the manager. Although well meaning some staffing practices are compromising Resident’s privacy and dignity such as security of records Care planning is improving but needs to be more pro-active and requires finetuning to ensure that all information is recorded, and up to date. All staff need to be encouraged to play a fuller role in this so that progress does not slip when key staff are absent. The home has improved how it collects information from Residents and their advocates but needs to show how this is affecting Penang DS0000036588.V337722.R01.S.doc Version 5.2 Page 7 practice and how the home is meeting its aims. Basic health care is good but can improve in terms of demonstrating how needs are met. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Penang DS0000036588.V337722.R01.S.doc Version 5.2 Page 8 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 Penang DS0000036588.V337722.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, & 3. Quality in this outcome area is Adequate This judgement has been made using available evidence including a visit to this service. Information about the service has improved with just minor areas now needing attention. Residents benefit from living in the home, which has significantly improved in the last 2 years but where more input for there specialist needs is required to give them confidence that all needs are being met. EVIDENCE: The inspector looked at the home’s [service user/ Resident’s] guide, which also contains the statement of purpose, which is on display in the home’s reception area. The Statement of Purpose has been written several times since the last inspection. On the day of the visit some areas in the revised Statement of Purpose were confused. Main pints of confusion were on page 2 and 6 in relation to the home’s registration category, the age of Residents on admissions, current Residents, and admissions policy. Other areas lacked important information such as staffing for instance. None of these shortfalls were found to be affecting outcomes and within a week of the inspection the manager forwarded the inspector a revised Penang DS0000036588.V337722.R01.S.doc Version 5.2 Page 10 Statement of Purpose, which resolved the main concerns. This clarity has been important to ensure that service has clear aims and does not repeat previous mistakes regarding admissions, which has created issues in the home around compatibility of Residents and the meeting of diverse needs. The requirement for a clear Statement of Purpose was therefore dropped with it recommended that some minor areas of the Statement of Purpose are expanded upon to ensure that it presents good information to prospective new Residents and their advocates. The current Statement of Purpose has a good use of photographs of the home, which should extend to those who work in the home. The inspector and manager discussed ways in which the Statement of Purpose combined within the Residents’ guide could be made more accessible to Residents most of which do not comprehend symbols, picture bank or Makaton The manager agreed to explore ways of making current inspection reports more accessible such as videoing himself presenting the summary of the report on talking tape or DVD. The home Residents guide is a shorter document summarising the Statement of Purpose in symbol form which 2 of the 5 Residents can follow. Two Residents are well over 65 years of age in a home registered for younger adults. Social services reassessed them in 2004 and deemed that the home could be suitable subject to a range of improvements to the environment and staff training. These recommendations have not yet been fully acted upon. The home are again advised to confirm in writing that they can meet needs, subject to a review with relevant specialists such as occupational therapists and visual impairment services. Evidence in the home since the last two inspections showed that the home has made some effort to get social services to carry out an occupational therapist assessment with social services requested more information. The home was advised during the inspection to organise a private assessment to urgently address this long-standing issue. In addition the recommendation of one of the Residents care managers at his last review 10 July 2006 that medication [PRN] is explored to assist the Resident tolerate a medical examination of his eyes in relation to cataracts which have create blindness or visual impairment. This along with ensuring the environment fully meets needs can improve outcomes further. A range of observational evidence and records shows the home’s improvement in meeting diverse needs however it was agreed with the manager that until specialist interventions are fully explored than demonstrating that all needs are being met is not possible. Some initial work was found to have started on communication aids although it was observed that no aids were being used to communicate with service users during the inspection. The manager explained that he had hoped that a previous member of staff was going to develop photographic aids. In addition Penang DS0000036588.V337722.R01.S.doc Version 5.2 Page 11 none of the three staff on duty were observed using Makaton or other methods than verbal prompts. One Resident had an aid in their room. No new Residents have moved into the home since the last inspection with the home still having one vacancy. The home’s clarity within it admissions policy contained in the Statement of Purpose is designed to ensure that any prospective new Residents will be compatible with current Residents / users of the service who were again observed to get on well together with no-one interfering with the meeting of individual needs. Penang DS0000036588.V337722.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9, & 10. Quality in this outcome area is Adequate This judgement has been made using available evidence including a visit to this service. Care planning and recording is inconsistent and needs to be updated and acted upon in practice. Residents benefit from good advocacy arrangements, which enable them to have people speaking on their behalf. EVIDENCE: The Inspectors examined three care plans, which were found to be accessible, clear and in one case frequently reviewed. The plans showed clear evidence of key worker involvement and staff were found to have basic working knowledge of these plans. Guidelines for each Resident user were good in many respects although not always up to date. Plans have realistic short and long-term goals although there is no mechanism on a regular basis of assessing whether these goals are being achieved apart from reference at annual reviews. Protocols due for review in November/December 2006 for one Resident had not been Penang DS0000036588.V337722.R01.S.doc Version 5.2 Page 13 reviewed. A Key support needs section which forms the basis of the plan was based on advice of 2004 and March 2005 and needs updating in light of further reviews such as one with his care manager on July 10, 2006 which discussed exploring equipment from RNIB and reassessment by sensory impairment team staff to have training in sight loss. The social services Care manager advised exploring a PRN medication so that the Resident could tolerate a medical exanimation in reference to cataracts whose removal would improve quality of life. It was agreed with the manager and on talking with the social services care manager that the home has yet to evidence despite some progress that it has taken all reasonable steps to ensure that all assessed needs are being met. This will involve staff having the necessary training and all steps taken to see how the Residents blindness or visual impairment can be assisted such as visiting medical specialists and having a full assessment of the home’s facilities The social services care manager indicated that the service has improved especially in regard to activities and that there is openness to suggestions. A range of sources such as records and discussions indicates that the home needs to be more proactive and develop it own expertise in addressing areas of improvement in a timelier manner. One resident has had a successful OT assessment in her previous home but the current home’s referral has been turned down as being non-specific. The care-plan discusses detailed protocols, which are focused on staff knowing Makaton although staff were not observed to be using this during inspection visit. Risk assessments such as kitchen access were found to be good with the exception of one Resident whose assessments were due to be reviewed in November 2006. The manager explained how he had missed the input of a particular senior who was good with care plan administration and who would be addressing shortfalls now they had returned after maternity leave. Daily recording notes are generally complete and informative and linked to care-planning goals and guidance as well as activity schedules such as church on Sundays where there is an opportunity as seen in records of April 2007 of this opportunity occurring on a weekly basis meeting the diverse spiritual needs of up to 4 Residents. All Residents were found to be well-presented and wearing clean new clothes with clear time allocated to meeting basic care needs. All Residents have fortnightly visits from their designated external advocate with all having written records of the outcome of these visits. More recently the advocate has been supporting service users to understand and sign their contracts as well as discussing how activities are meeting needs. This is especially important as only one service user has any family involvement. Penang DS0000036588.V337722.R01.S.doc Version 5.2 Page 14 A care-plan for one Resident showed a good focus on increasing independence such as in the kitchen with supporting “boisterous” behaviour to ensure safety. Written evidence of Inputs from the persons advocates showed how the person had been supported to answer 5 questions recently from the home’s Quality Assurance survey in February 2007. The inspector spoke with the advocate who indicated how the home was continuing to make progress with Residents much “busier” and better occupied and staff developing their communication skills who were described as treating the Residents with respect and being open to suggestions. Shortly after arrival at the home 9.30 am the inspector used a communal toilet and found bowel records clearly on display for two named Residents. This continued to be the case at the end of the visit at 1.30pm when the inspector showed the manager who agreed that such records should be secured. Although this was immediately rectified a requirement was made as the same practices were identified on a previous inspection and is an area where staff need to consider there overall practices in respect of promoting Residents privacy and dignity. Penang DS0000036588.V337722.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 15, 16, & 17. Quality in this outcome area is Good, This judgement has been made using available evidence including a visit to this service. Residents benefit from good active lifestyles and clear routines, which meets their needs and preferences. Meal arrangements suit Residents’ needs. EVIDENCE: The Inspector purposely arrived at 9.30am and found that 4 of the 5 Residents [one was due to have a house morning] was in the final stages of being supported to go out with clear routines and plans in place based on service user choice. This observation supports the findings of the previous two visits over the last year which indicated how the home has improved activity provision after several years where less able Residents were unoccupied and lacked clear routines and stimulating lifestyles. One of these Residents has been attending a new day centre 4 times a week as seen in records. This new Penang DS0000036588.V337722.R01.S.doc Version 5.2 Page 16 centre was found to be meeting his needs as confirmed in discussions with the person, his advocate, care manager and staff. Another person that attends day centres less frequently than the other Residents was found to now go swimming twice a week. It was positive to find that the diverse wish for three Residents to attend church was now occurring as confirmed by records every Sunday. All Residents were found to have clear activity programmes which were being followed now that staffing levels are more consistent with staff more closely supervised by the manager. The manager was made aware of continuing this recent progress and exploring further evening and weekend opportunities based on service user preferences and ensuring that all staff are led by agreed programmes. The home’s Annual Quality Assurance Assessment completed by the manager identified that aspirational goals for each Resident are gradually improving. Visitors confirmed that they are treated with courtesy and respect. The advocate and records show that Residents are playing a greater role in the running of the home as seen in regular Residents meetings. The manager confirmed in discussion how he is promoting further choice by widening the choice of holiday destinations due to a concern that one Resident’s may just be indicating Butlins due to being the only destination that they know. Two alternative destinations are planned with two peers due to go to Blackpool. Meal arrangements were again found to be good and based on choice with these recorded and additional alternatives offered. The home was found to have good supply of fresh food including fruit and vegetables. One Resident has over the last year increased their independence in relation to meal preparation with clear risk assessments and strategies to ensure safety. Penang DS0000036588.V337722.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, & 20. Quality in this outcome area is Adequate This judgement has been made using available evidence including a visit to this service. Residents receive a basic, and in many respects good level of care, which can improve further with more attention to care planning. EVIDENCE: The medication cabinet was examined along with all records. All aspects of storage and administration were found to meet the standard and best practice. All homely remedies were labelled and accounted for on recording sheets. Staff interviewed was found to be knowledgeable about all aspects of medication including what each drug is for. All staff receive appropriate training before being assessed to be able to dispense medication. A previous requirement linked to staff signing for the medication they give has been addressed. Health needs such as medication reviews, and dental check ups where found to be recorded and regularly reviewed with two exceptions. The Inspector observed one Resident who has bitten their fingernails down to the flesh with each finger red around nail area. An Accident report of January 2006 described Penang DS0000036588.V337722.R01.S.doc Version 5.2 Page 18 the Resident as biting their nails causing bleeding. There was no evidence in the care-plan of a medical follow up or change in guidelines with the manager unable to confirm what action was taken. The manager agreed in light of the inspector’s observations to organise a medical follow up in case any additional support can be offered. Another Resident who has had some useful alterations to their activity programme due to older age [79] and a link to be being too busy and becoming irritable with occasional “lashing out” was found to be well. Staff indicated that since the person has reduced from 4 to 3 days at a work centre that they have become more relaxed with the Resident spending the morning in the home knitting and watching television before going out for lunch. A recent Well- woman check was evidenced in records but no review of her behavioural medication with the manager asked to organise this as one of these drugs can lead to lethargy from long term use, and to verify whether it is still essential as the care plan does not specify exactly why it is prescribed for the individual. The manager indicated that some Residents have been on the same medication for many years hence the need for review. No Residents were found to be on PRN or controlled medication with the overall use of medication low. Accident records showed a low rate and an improvement for a blind Resident who needs support from staff as they decline to use any walking aid. Admittances to accident and emergency are low with none reported over the last year. Overall staff support to Residents was seen to be unhurried, warm, and respectful with all Residents exhibiting good evidence of well-being and no anxiety. Visitors to the home indicated to the Inspector that they find a “happy home”. One relative indicted in discussion how much settled a particular Residents is since moving in during 2005, and how they are no longer fearful of going back after a social leave visit unlike a previous home they lived in. Penang DS0000036588.V337722.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, & 23. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The home operates in an open manner for the benefit of Residents and continues to have a low number of concerns made against it. Graduals improvements in staffing is giving Residents greater protection. EVIDENCE: There have been no formal complaints or concerns made against the home over the last year as confirmed by the manager and by records. The home has improved over the last two years in how it responds to concerns as confirmed by social services who indicated that they were pleased with the openness and skill in which the home dealt with two concerns in 2006 which related to how some Residents were supported in public and spoken too. Staff concerned have since left the service and there was no evidence of Residents being at risk or being harmed. Visitors described the home as open and approachable with a clear complaints procedure in place with some attempt to make this accessible to some of the Residents with the use of symbols. Monthly service user meetings have just started where the manager hopes that service users will develop skills and confidence in airing any views. These meetings along with key worker reviews are attended by the independent advocate who indicated the open way in which the home acts on suggestions in the best interest of Residents Penang DS0000036588.V337722.R01.S.doc Version 5.2 Page 20 All staff have received adult protection and again confirmed through discussions how to both identify and report suspected abuse. The home’s policy in this respect is regularly updated. Despite the diversity within the Resident group it is positively noted that no service users are at an obvious risk of being harmed by others as seen in the continued absence of any such incidents. The inspector spent some time in the home’s vehicle with 4 of the 5 Residents and noted how relaxed and supportive of one another they were. Penang DS0000036588.V337722.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 29, & 30. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from a range of positive improvements to the home, which creates a good impression and made the home more personalised to Residents’ tastes and preferences. The service is unable to confirm that the building meet specialist needs due to a long-standing requirement for a specialist assessment. This delay is potentially affecting outcomes and needs prompt attention. EVIDENCE: The inspector toured communal parts of the home. Residents’ bedrooms were inspected on the previous visit and were found to be highly personalised with new furniture including comfortable chairs, new wardrobes, and audio/visual equipment, with decoration according to resident’s preferences. Some recent attempts to make some bedrooms more suited to needs have been achieved. Visitors remarked positively on these changes to the inspector. The home has Penang DS0000036588.V337722.R01.S.doc Version 5.2 Page 22 put up pictures of Residents along with other homely touches. The new laminated flooring around the ground floor of the home was found to be modern and suited to purpose. The dinning room has been further improved along with new a modern fitted kitchen, which creates a highly positive impression and more space for Residents. The front and rear gardens are large. Since the last visit January 17, 2007 the rear garden used by Residents has been significantly improved by landscaping and a range of creative touches such as central flowerbed. Level access With the add of two ramps created to facilitate wheelchair access to the rear garden has improved in length and smoothness with the manager confirming via his health and safety department that the ramps are fit for use and could be safely accessed by the Resident who use a Zimmer frame. A newly admitted Resident with mobility needs has not had an occupational therapy assessment to ensure that all adaptations are in place despite receiving this in their last home. This also applies to another resident who is blind. The manager confirmed in records that he has applied for a social services assessment with records showing that this department need more evidence from the home of its necessity. Given that this is long standing requirement and that there is need to evidence that this home can meet the specialist needs of particular Residents that a privately funded occupational therapy assessment should be accessed if this is timelier. Once this is carried out and any recommendations acted upon then the environment can be rated as being fully fit for use and rated as Good or Excellent in relation to Residents needs. A fire door leading from the kitchen which was previously a safety risk due to be wedged open now has an auto closing door mechanism fitted. The home was found to be clean, bright, warm, and free from offensive odours. Penang DS0000036588.V337722.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, & 36. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. Staff are gradually improving and have created a more positive and purposeful atmosphere for Residents. Outcomes will further improve once staff are fully trained and have developed the necessary experience and understanding of Residents needs. EVIDENCE: This visit supported the positive findings of the two previous inspections which indicates that the home is now ensuring that there is enough staff [3 on each shift] to meet needs, as seen in observations and rotas. It was also again evident that staff are motivated towards supporting existing routines and activities for Residents. There is no longer an over reliance on flexi staff and those from other home’s to make up staffing numbers. The staff team has now stabilised and reduced the previous high turnover. The staff team do have development needs as acknowledged by the manager but with the right training, leadership, and with more experience will continue to develop. It is evident that the home is reliant on specialist advice with it hoped Penang DS0000036588.V337722.R01.S.doc Version 5.2 Page 24 that the service will develop its own expertise. It is disappointing that communication training has not taken place and although this was not found to be planed in the home’s AQAA [Annual Quality Assurance Assessment] the manager confirmed that is planned in 2007 and is urgently required as some Residents use Makaton. None of the 3 staff on duty were observed using this during the period when they were observed supporting Residents to leave the home. The manager confirmed that training around supporting a blind Resident was planned. A Makaton stage 1-9 book has been introduced which staff sign. The advocate who visits the home every fortnight confirmed that some staff have good communication skills. Team leaders [seniors] were found to have development needs although since the last inspection one has completed their National Vocational Qualification in Care level 3 and has carried out her first supervision after training from the manager. More than 50 of the full care staff team as confirmed by the manager [5 of 8 staff] now have at least National Vocational Qualification level 2. Tight recruitment procedures are followed with the manager fully aware of what is required. No new staff have been employed since the last KEY inspection when they were last checked [May 2006] and so staffing files were not looked at. The manager confirmed that all staff are now receiving regular written supervision. All staff employed during the last 2 years have experienced a thorough Induction’ which covered TOPSS, all mandatory training such as Moving and handling, food hygiene and First aid, and the foundational course level 2 in Care Practice, which leads to an NVQ 2. An in-house structured written induction is undertaken in the home. Ongoing mandatory training is planned throughout 2007. The manager confirmed awareness of the new Common Induction standards effective from September 2006 for any new staff joining the home. Penang DS0000036588.V337722.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41, & 42. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. The management of the home is improving and provides much needed stability, but will benefit from training and more attention to those areas, which need improvement, in order to further improve outcomes for Residents. EVIDENCE: This manager is experienced and was described in the last report as working towards the required qualification. The manager achieved registration following the last inspection on the basis of ensuring that they attend to their professional development along with completing the necessary qualification as soon as possible. On the day of the visit the manager confirmed that previous work undertaken to achieve a management qualification with another training body needs to be restarted. The manager confirmed that he has a place on a Penang DS0000036588.V337722.R01.S.doc Version 5.2 Page 26 management course for September 2007. The home is clearly benefiting from having a stable manager who has now worked in the home for over a year and who has the support of the staff team. It was evident from the way in which the Annual Quality Assurance Assessment was completed, and some shortfalls at the home in meeting requirements, that the manager will benefit from updating their knowledge and attending in a timelier way to areas for improvement. Regulation 26 monthly reports of inspections of the home by the organisation are sent to the Commission on a monthly basis. These reports are improved in that they make reference to Residents and staff although these need to be more specific in terms of linking this with the overall quality of care being provided. These reports such as the most recent one sent before the inspection dated 27 March 2007 do not show how the home is meeting shortfalls including long standing requirements .It will be useful if such reports show specific progress with meeting any action plan. Evidence was found to show a recent survey of Resident’s views via a symbol form questionnaire, which, the advocate was brought in to help Residents answer questions. The manager was made aware that information, which is collected from Residents, needs to be followed up and form the annual development plan for the home to show Resident’s involvement in the home’s future direction and day to day running. The manager showed written evidence of an annual development plan for 2007[business plan], which contained useful information. The manager was advised to make more specific reference to outstanding requirements such as occupational therapy assessment of the building. Some linkage needs to be made to the four stated aims at the start of the home’s new Statement of Purpose, which is the stated benchmark for service quality. The Commission on May 9 2007, following the inspection visit received an Annual Quality Assurance Assessment. The home are asked to resubmit this as a number of sections are not completed, are vague, not specific, or linked to existing requirements. Examples include the section on service user views where it is left blank in the section concerning, any changes in response to Residents views, or any future changes planned. Equality and Diversity section just states Service Users will attend church without consideration of other aspects of this important area. The section, which deals with identifying barriers to improvements, is left blank. The Section on environment makes no mention of outstanding requirement such as an occupational therapy assessment. The area of staffing just identifies National Vocational Qualification in Care level 2 as an improvement area and not other training needs. The management section was particularly poor as most sections not filled in, such as what the home does well. Penang DS0000036588.V337722.R01.S.doc Version 5.2 Page 27 It is essential that the service appreciates the importance of this assessment and demonstrates competence in being able to assess and improve its service without guidance from the Commission. Daily entries in to Residents’ daily records are helpfully in bound books however a number of lines are left blank between entries with the home advised to address this to reduce the possibility of such records being amended retrospectively. All regular staff were found to have all the basic health and safety training such as first aid and moving and handling. Fire training recently took place for staff. Fire drill occurs six monthly with an evacuation carried out. No hazards were observed during the visit. The home’s Annual Quality Assurance Assessment confirmed that all health and safety checks continue to take place. During the visit a visiting technician was testing portable appliance equipment. Penang DS0000036588.V337722.R01.S.doc Version 5.2 Page 28 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 2 2 3 3 2 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 2 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 2 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 2 X 1 X 2 3 X Penang DS0000036588.V337722.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Home’s Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA3 Regulation 14 [1][d][2] Requirement That the Registered person must demonstrate that the service is aware of and is meeting all the assessed needs of those Service Users [Residents] over 65 and those who have specialised needs such a mobility or sensory. That evidence is sent to the Commission by the date shown to confirm that relevant Service User [Residents] have had the relevant specialised input and that any recommendations have been acted upon to demonstrate that needs are being met. That the Registered person must ensure That Residents [service users] must have appropriate individualised communication tools to assist them to get their needs met. That such aids are used in practice. Requirement made at the last 5 inspections. Requirement first made April 14, 2005. Penang DS0000036588.V337722.R01.S.doc Version 5.2 Page 30 Timescale for action 03/11/07 2. YA3 12[1] [a] 03/11/07 3 YA6 15[2][b] 4 YA10 12[4][a] 5. YA18 12[1][a] 6 OP29 23 [2][a] That the Registered person must ensure that care-plans are kept under review and updated including evidence to indicate whether recommendations from specialists, or care-planning goals, have been actioned. That the Registered person must ensure that the home is conducted in a way which respects the privacy and dignity of Service Users [Residents] by ensuring that their personal information [continence charts] is not on display for visitors. That the Registered person must ensure that a particular Service User’s ongoing health need is explored to assist their comfort. That evidence is seen of the service promptly accessing health care when such accidents or incidents occur. That the Registered Person must ensure that the premises are assessed by an Occupational Therapist or other suitably qualified person, to advise the home on any necessary adaptations with particular reference to older Service Users [Residents] and those with physical and sensory disabilities. That a copy of this assessment is sent to the Commission by the date shown. Requirement of the last 3 inspections. Requirement first made 22/05/06 That the Registered person must ensure that all staff receive suitable training in DS0000036588.V337722.R01.S.doc 03/09/07 03/05/07 17/06/07 03/10/07 7 YA35 18[1][c] 03/10/07 Penang Version 5.2 Page 31 communication techniques with adults with learning disabilities and help service users [Residents] develop their own appropriate communication aids. Requirement of the last 6 Inspections. Requirement first made December 2004. That the Registered person must ensure that the registered manager confirms they have achieved the necessary management qualification, or are working towards it, by writing to the Commission by the date shown. Requirement of the last 2 Inspections. Requirement first made January 17, 2007. That the Registered Provider must ensure that monthly Regulation 26 reports show sufficient evidence of how the quality of the care has been measured. That these reports make specific reference to the performance of the home in meeting outstanding requirements and how the organisation is supporting the service. Requirement of the last 3 inspections. Requirement first made May 22, 2006. 21 & 24 That the Registered Person amendments must properly complete all to Care sections of the AQAA [Annual Quality Assurance home’s regulations assessment]. Incomplete AQAA 2006 received May 9, 2007. DS0000036588.V337722.R01.S.doc 8. YA37 18[1][c] 03/08/07 9. YA39 26 03/06/07 10 YA39 30/06/07 Penang Version 5.2 Page 32 A new AQAA needs to be received by the Commission by the date shown. 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 YA1 Good Practice Recommendations That a copy of the revised, Statement of Purpose is produced and sent to the Commission which reflects guidance given at the inspection visit and in the text of the report. and which reflects the provisions of the regulation. That the home explores ways of making the findings of inspections accessible to Service Users [Residents] That the home ensures risk assessments are kept up to date and regularly reviewed inn line with stated schedules. That there is clear evidence to indicate timely reviews of Service Users [Residents] in relation to behavioural medication. That the service explores the best and most timely way of ensuring that staff have the full range of skills necessary to meet needs That Quality assurance reviews make reference to how successful the home is in meeting the four aims highlighted in the services Statement of Purpose. That entries into daily records are completed without gaps. 1 2 3 4 5 6 YA1 YA9 YA20 YA32 YA39 YA41 Penang DS0000036588.V337722.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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