Inspection on 23/08/06 for Phoenix House

This inspection was carried out on 23rd August 2006.

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 no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Phoenix House 03/04/08

Phoenix House 26/04/07

Phoenix House 02/12/05

Phoenix House 13/06/05

Phoenix House 09/12/04

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

CARE HOME ADULTS 18-65 Phoenix House 1 The Drove Northbourne Kent Lead Inspector Mark Hemmings Unannounced Inspection 23rd August 2006 09:30 Phoenix House DS0000043898.V305377.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 Phoenix House DS0000043898.V305377.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. Phoenix House DS0000043898.V305377.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Phoenix House Address 1 The Drove Northbourne Kent 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) 01304 379917 Phoenix Care Homes Ltd Mrs Karen Christine Moss Care Home 20 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (20) of places Phoenix House DS0000043898.V305377.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd December 2005 Brief Description of the Service: Phoenix House is a newly renovated service catering for up to 20 people with mental health problems. The home is set in the small rural village of Northbourne, which is approximately 5 miles from the town of Deal. The village has a public house, post office and local shop. There is a bus service that links the village with local towns. The house is located within large grounds with ample parking spaces. The home benefits from a good range of communal spaces including a large conservatory, a games room, comfortable lounges and a substantial dining area. There is also a semi-independent flat with its own kitchen and lounge available for up to 4 service users. All bedrooms are single occupancy and have en suite facilities. The home has recently purchased a vehicle to enable staff to support service users in the community and to access local amenities. Phoenix House (the Home) is registered to provide accommodation and personal care for 20 adults (service users) who experience difficulties with maintaining aspects of their mental health. The property is a detached three storey building. There is provision for all of the service users to have their own bedroom, each of which has a private wash hand basin and toilet. The Home is located in Northbourne. This is a village that is approximately five miles from the town of Deal. The village has a public house, post office and local shop. There is a bus service that links the village with local towns. The Registered Provider is understood to supply information to prospective service users through a variety of routes. These include the provision of a Service Users’ Guide. This is a brochure which outlines the principal features of the facilities and services available in the Home. Also, the Registered Provider ensures that a copy of the most recent Inspection Report from the Commission, is available for reference in the Home. The Registered Provider has informed the Commission that the current range of fees it charges for residence in Phoenix House, runs from £512.50 to £659.84 per week. Phoenix House DS0000043898.V305377.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Report has been based upon a number of sources of evidence. These included a review of the correspondence in relation to the Home received by the Commission since the last inspection. Another source of evidence involved any written information received from service users, from their relatives and from care managers (social workers). Also, the Inspector completed an unannounced site visit to the Home. This took about seven hours to complete. During this time, the Inspector spoke in some detail with five of the service users. Some of these discussions were in private. The Inspector also joined a number of the service users for lunch. The Inspector spoke with the Registered Manager and with the Senior Support Worker. The Inspector examined various parts of the accommodation and he reviewed a selection of the key records and documents. The Inspector concludes that the Registered Provider generally operates the Home so as to provide the service users with access to the resources they need to enable them to lead normal everyday lives. However, there is a number of omissions which might detract from the adequacy of the support received by some of the service users. These now need to be addressed. There are six Required Developments at the end of this Report. With respect both to these and to other developments identified for action in the main body of this Report, the Registered Provider should submit to the Commission a written Action Plan. This should state what has been done and what will be done to ensure that the Registered Provider complies fully with developments in question. The Commission should receive this Action Plan by 1 November 2006. What the service does well: Service users said that the Home provides them with a relaxed and generally comfortable setting within which to make their home. They observed that in general they receive all the assistance they need. Also, they said that the support workers are attentive and kind in their manner. The Inspector was impressed with the confident informality which characterised the interactions he observed between the support workers and the service users. The catering arrangements were noted to be adequate. Suitable systems were in place to ensure that the service users take medication in the correct manner. Phoenix House DS0000043898.V305377.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The Registered Provider should in consultation with the service user concerned, make suitable arrangements to ensure that she can access appropriately her entitlements from the Benefits Agency. This is important because at the moment, the person concerned is having to economise, or having to rely upon loans from the Home. This should not be necessary. The Registered Provider should review fully the adequacy of the activity calendar in place for each of the service users. As necessary, the calendars should be extended and the implementation of these developments should be monitored. This is important because service users need to have access to a suitable range of opportunities, if they are to be enabled to lead ordinary and engaging lives. The Registered Provider in consultation with the service user concerned, should ensure that suitable arrangements are made to enable her to access the bath safely and in comfort. The Registered Provider should submit to the Kent Fire and Rescue Service the assessment it has completed recently of the adequacy of the fire safety regime operated in the Home. This is important because the assessment will help the Service to determine what (if any) additional measures are needed in order to protect everyone who lives and works in the Home from the danger of a fire safety emergency. The Registered Provider should ensure that suitably detailed employment histories are obtained for all prospective support workers. This is necessary so that appropriate references then can be sought. These are important because they are one of the means available to the Registered Provider, by which to ensure that only trustworthy people are allowed to have unsupervised access to the service users. The Registered Provider should develop further the systems used to confirm the adequacy of the knowledge and skills which new and existing support workers can invest in the completion of their duties. This is important because Phoenix House DS0000043898.V305377.R01.S.doc Version 5.2 Page 7 these competencies relate directly the quality of the care which can be provided for the service users. The Registered Provider should develop further the arrangements used to consult and to liaise with the service users. After all, it is the service users who are the experts on what it is like to live in Phoenix House. The Registered Provider should ensure that all of the checks specified for completion by the Kent Fire and Rescue Service are undertaken. This is important because the checks are designed to ensure that key items of the Home’s fire safety regime remain in good working order. The Registered Provider should develop further the systems used to ensure that all members of staff are aware of how to help to avoid the occurrence of a fire safety emergency. Also, that they know what to do should the need arise. This very important because the actions taken by members of staff determine largely the degree of protection provided by the Home’s fire safety regime. 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. Phoenix House DS0000043898.V305377.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 Phoenix House DS0000043898.V305377.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 at least once during a 12 month period. 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. There are systems in place to ensure that prospective service users and their representatives have their needs assessed. EVIDENCE: As noted above, the Registered Provider has prepared a Service User’s Guide or a brochure. This document in combination with another document called the Statement of Purpose, should be a useful introduction to prospective service users who want to find out about the facilities and services available in the Home. The Registered Manager said that the needs for support of all prospective service users, are assessed carefully. This is done so that she can be sure that the Home has the resources necessary to meet reliably the person’s needs for assistance. The Inspector reviewed the arrangements made in relation to someone who was about to be admitted to the Home. He concluded that these were sufficient to enable the support workers to meet the person’s needs, should the admission proceed. The service users who mentioned this matter to the Inspector, considered that their needs for assistance had been met adequately from the point of their admission into the Home. Phoenix House DS0000043898.V305377.R01.S.doc Version 5.2 Page 10 The Registered Manager said that she is confident that the current team of support workers based in the Home, has the range of skills and knowledge necessary for it to support the service users in residence. The Inspector noted evidence which was consistent with this account. The Registered Manager was noted to be aware of the various sources external to the Home from which specialist advice can be sought, should the need arise. The Inspector reviewed evidence which showed that some of this advice had been accessed by the Registered Manager in a timely manner since the last inspection visit. The Commission has not received since the last inspection visit, any expressions of concern from the various local mental health services about any aspect of their working relationships with the Home. Phoenix House DS0000043898.V305377.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this Service. The health and personal care which service users receive, is based upon their individual needs and is appropriate. The principles of respect, dignity and privacy are put into practice. EVIDENCE: The Inspector noted there to be various systems in place to enable each service user to liaise with support workers in order to identify and to plan for the provision of the assistance they need. These measures include the preparation for each person of a written individual plan of care. The service users said that they had been involved adequately in the preparation of their individual plans. Also, they observed that they had been invited to contribute to their occasional review. The Inspector examined selected elements of several of the plans to see if particular items had been considered in adequate detail. He concluded that the level of detail was adequate generally, given how the Home works in practice. Phoenix House DS0000043898.V305377.R01.S.doc Version 5.2 Page 12 The Inspector noted that the support workers keep diary records of how things are going in the Home. These records are important because they can reveal patterns in how someone is doing. This can be useful both for the person concerned and for the support workers. The Inspector examined a selection of the entries and he noted them to be detailed adequately. In addition to this, he noted that the Senior Support Worker with whom he spoke, was able to give a detailed account of aspects of the service users’ needs for assistance. There is a balance to be struck about how much information needs to be recorded and how much can and should be held in peoples’ heads. The Inspector in general thinks that at the moment the balance is about right in Phoenix House. The Inspector observed episodes when support workers assisted some of the service users. Their practice was noted to be appropriate and to be consistent with the Registered Provider’s assessment of the needs to be met. The Registered Manager said that she has been asked by some of the service users to retain and disburse their weekly personal spending allowance. The Inspector examined the records of the various transactions in question and found things to be in order. The service users who spoke to the Inspector about this matter, said that they remain satisfied with the arrangement. The Inspector was concerned to note that there were no funds at all in the Home in relation to Service User A. The Registered Manager said that this was because of a delay in the payment of her statutory benefits. She said that repeated attempts had been made to resolve this issue. The Inspector understands that the necessary steps will continued to be taken in order to ensure that the matter is resolved as quickly as is possible. The Registered Provider is responsible for assisting the service users to avoid undue risks to their wellbeing. The Inspector noted that the Registered Manager uses a system which involves each service user liaising with support workers in order to identify potential risks. This is done so that they can be managed effectively. The Inspector examined a selection of the written records which summarise this process. They were found to describe an adequate arrangement. This, in that particular risk situations were identified and in that basic information was given about the response to be provided. The Inspector noted that the Senior Support Worker was conversant with the information in question. Phoenix House DS0000043898.V305377.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is adequate. This judgement is made using available evidence including a visit to this Service. With some exceptions, service users are able to choose their life style, social activities and to keep in touch with family and friends. Service users receive a healthy and varied diet according to their requirements and choice. EVIDENCE: The Registered Manager said that most of the service users undertake some activities each week, a small number of which have a vocational element to them. The Inspector noted there to be a written calendar describing some of these events. However, it was hard to tell which of these events actually take place. On the day of the inspection visit, the Inspector observed some of the service users sitting around and generally not doing that much. One of the service users indicated to the Inspector that he could become bored in the Home. He said that he spent days, “just hanging around really”. Others said that they were satisfied in general with their respective calendars of activities, although several did reflect on the disadvantages of living in a rural setting because getting to places could be difficult. Phoenix House DS0000043898.V305377.R01.S.doc Version 5.2 Page 14 The Inspector is not wholly confident that some of the service users are being offered a suitably varied range of vocational and recreational activities. Therefore, he has asked the Registered Provide to review each person’s calendar of activities and to implement any necessary developments within the timescale established in the relevant Required Development listed and the end of this Report. The Inspector noted that some of the service users do leave the Home regularly in order to do various things, such as going to shops. On the day of the inspection visit, this turned into something of an expedition. This was because the people carrier vehicle could not be used due to there not being a driver on duty. This meant that a taxi had to be ordered and then people had to wait around for it to arrive. When reviewing the resources which might need to be made available to implement any extensions to the existing calendars, the Registered Provider will need to give careful consideration to this matter. Plainly, there is not much point to providing a vehicle and then not having enough members of staff present who can drive it. The service users said that support workers assist them to keep in touch with members of their families. This includes helping them to use the telephone and to engage in written correspondence. The Inspector reviewed the circumstances of some of the service users who have presently the least such contact. He is satisfied that the Registered Manager has kept the matter under review. Also, that the service users in question remain content with the contacts that are available to them at the moment. The service users said that the support workers are kind and approachable in their manner. Also, they observed that support workers are not intrusive and that they respect their needs for private space. During the course of the inspection visit, the Inspector had the opportunity to observe a number of instances when support workers interacted with service users. He noted these events to be characterised by a quiet, but confident, informality. The Inspector recognises this to constitute good care practice. This is because it acknowledges that service users at the same time, need both independence and support. Getting this balance right can be tricky, but the Inspector thinks that this largely has been achieved in Phoenix House. The service users said that they are provided with suitable meals. The Inspector joined some of them for lunch. He noted that the meal served was adequate both in quantity and quality. The meal time itself was a relaxed affair with service users dining at their own pace. There was no sense of them being rushed along, or being overly organised. The Registered Manager said that the Registered Provider gives the Home sufficient funds to purchase the necessary supplies. The record of food provided in the Home was consistent with the Registered Manager’s account to the effect that the service users are offered the opportunity to have a normally balanced diet. Phoenix House DS0000043898.V305377.R01.S.doc Version 5.2 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 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. Service users’ emotional, physical and health care needs are met. Service users are assisted to take medicines in the correct manner. EVIDENCE: The service users said that the pace of daily life in the Home is relaxed without there being any unnecessary rules to disturb their experience of a normal domestic setting. They observed that within reason, they can decide on the pattern of their day. They spoke about things such as them being free to decide when to retire to their bedroom and choosing what clothes to wear. The Registered Manager said that the support workers keep a tactful eye open so that service users can be assisted to seek and to follow medical advice should it be needed. The Inspector reviewed the arrangements which had been implemented since the last site visit, to assist several of the service users to access medical attention. He noted that suitable provision had been made available to ensure that the people concerned attended various medical appointments. Also noted, was the way in which support workers had monitored discreetly their health in-between times. The Inspector noted that the Commission has not received since the last inspection visit, any Phoenix House DS0000043898.V305377.R01.S.doc Version 5.2 Page 16 expressions of concern from the local primary health care team about its working relationship with the Home. The Inspector noted that all of the service users have elected to have support workers retain and dispense their medication. The Inspector thinks that this is a sensible arrangement, given the interests of the people concerned. The Inspector examined a selection of the administrative arrangements operated by the Registered Manager in relation to this task. They were noted to work well, so as to ensure that service users take medicines in the manner intended. Phoenix House DS0000043898.V305377.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this Service. Service users have an effective complaints procedure and they are protected from abuse. EVIDENCE: There is a complaints procedure which explains how service users and other stakeholders can make a complaint about any aspect of the facilities and services provided in the Home. The Registered Manager said that the Registered Provider operates various systems which should enable all complaints to be investigated promptly and fully. The Inspector noted that the Registered Provider had not received a formal complaint since the last site visit. Therefore, he was not in a position to determine how well these systems will work in practice. The Commission has not received any complaints in relation to the Home, since the date of the last inspection visit. The Senior Support Worker was noted to have a good understanding of what constitutes good care practice. As part of this, she was aware of the need to be alert to instances which might jeopardise the well-being of a service user. She said that she had not witnessed anything in the Home since the last inspection visit, which had given her cause for concern. Also, none of the service users said that they had come across anything which had worried them. More generally, the service users said that they feel safe living in Phoenix House. They observed that they are confident that support workers will act in their best interests. Phoenix House DS0000043898.V305377.R01.S.doc Version 5.2 Page 18 Phoenix House DS0000043898.V305377.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. 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. The physical layout of the Home enables service users to live in a generally well-maintained and comfortable environment, which promotes independence. EVIDENCE: Service users said that they are comfortable living in Phoenix House. The Inspector noted that in general the accommodation was adequate. Having said this, some of the shared-use areas did not feel to be particularly welcoming. This was due to the extensive use of painted plaster walls and to the absence of finishing touches, such as pictures and plants. The bathrooms felt to be particularly stark. The Inspector noted that some of the light bulbs in the corridors were not dressed with shades and this contributed to the place having something of an institutional feel to it. The Registered Manager said that these matter were in the process of being addressed. Consequently, the Inspector looks forward to reviewing the progress made when he next calls to the Home. The Inspector examined selected areas of the kitchen and he noted them to be clean and organised. Also, he observed a selection of food management Phoenix House DS0000043898.V305377.R01.S.doc Version 5.2 Page 20 practices. These were noted to be satisfactory. The Inspector understands that the Registered Provider complies with the principal requirements of the local Department of Environmental Health. The Inspector understands that the Kent Fire and Rescue Service has said that the Registered Provider has installed sufficient equipment in the Home. This has been done both to help prevent the occurrence of a fire safety emergency and to respond effectively to one should the need arise. However, this assessment needs to be updated regularly. To do this, the Service needs to receive from the Registered Provider its own evaluation of how potential fire safety risks are to be managed. This is important because the level of fire safety protection available in the Home, depends in part upon how potential hazards are identified and are eliminated or managed. The Registered Provider was noted to have prepared an up-to-date assessment. The Registered Manager said that this now would be submitted to the Service by 1 October 2006. The Inspector noted that Service User A is experiencing real difficulties using the bathroom because the Home is not equipped with a hoist. The Inspector understands that arrangements are in place to address this matter. He will check on the progress of these when next he calls to the Home. The service users said that suitable arrangements are in place to enable their laundry to be done. The Inspector noted that the service users generally were wearing appropriately clean clothes of their own choice. The Inspector examined the laundry facilities. He noted that the washing machine was out of action. The Registered Manager said that the item was due to be repaired in the next few days and that in the interim there was another machine which could be used. All residential care homes now need to comply with revised regulations which have been introduced to help better ensure the purity of drinking water. In particular, the new provisions are intended to prevent used water siphoning back from items such as washing machines into the main pipe-work. The Registered Manager was not sure if this work had been completed. It was agreed that the Registered Provider will seek clarification from its water supply company about what (if any) additional installations are now required. This will be completed by 1 October 2006. Phoenix House DS0000043898.V305377.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,34,35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this Service. Service users are assisted by support workers who are present in sufficient numbers and who are skilled suitably. EVIDENCE: The Registered Manager said that routinely there are two support workers on duty during the day and the evening and that there are two members of staff on the premises at night. The Inspector noted that there no catering or housekeeping staff are employed in the Home. This means that the support workers have to undertake a range of duties additional to the provision of personal care. The Inspector is not convinced that this is a sustainable arrangement. This was so, even given the fact that the Home was not full at the time of the inspection visit. The Registered Provider will need to give this matter careful consideration, once the reviews of the activity calendars have been completed. This is because more and different categories of staff hours may need to be made available in order to implement any necessary developments. The Inspector will return to this matter when next he is in the Home. The Registered Manager said that the Registered Provider completes all of the checks specified in the Regulations. The checks in question are important. This Phoenix House DS0000043898.V305377.R01.S.doc Version 5.2 Page 22 is because they are one of the means by which the Registered Provider can ensure that only suitable people are trusted to have unsupervised access to service users who may be vulnerable. The Inspector examined one set of these records. He noted that there was an error in that there were gaps in the person’s employment history which had not been explored by the Registered Provider. This then meant that the Registered Provider could not have been sure that it had sought the necessary references in relation to the person concerned. The Registered Provider should address this matter within the timescale established in the relevant Required Development listed at the end of this Report. The Registered Provider delivers introductory training for all new support workers. This is done to help to ensure that they have the skills and knowledge they need in order to work without direct supervision. This is important because the competencies possessed by support workers, largely determine how well they are able to assist service users. The Inspector noted that there were some aspects of the arrangements which could usefully be strengthened. This, to better ensure that focused consideration is given to all of the core competencies which a new support worker might reasonably be expected to have to hand. With this in mind, the Inspector has referred the Registered Provider to a new national model of induction which the Commission recognises to constitute good practice. The Registered Manager said that the Registered Provider will review the existing arrangements used in the Home against its provisions, by 1 November 2006. In addition to the introductory training, the Registered Provider arranges for support workers to attend a variety of ongoing training events. These are designed to confirm and to extend the range of skills and knowledge at their disposal. Previously, an Inspector has noted that the Registered Provider has not delivered training material on the general subject of mental health conditions and their respective management regimes. Given the nature of the Home’s provision, this is quite a surprising oversight. The present Inspector noted that the matter remained outstanding. The Registered Provider should now take suitable steps to confirm that each support worker is indeed conversant with the subject matter in question. The Registered Manager said that the necessary exercise will be completed by 1 November 2006. Having said this, the Registered Manager did say that she considers that each of the support workers has the knowledge and the skills they need in order to able to respond to the present service users’ needs for assistance. Also, the Inspector did not identify any practical evidence which contradicted this account. Phoenix House DS0000043898.V305377.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this Service. There are some omissions in the arrangements used to promote health and safety in the Home. There is a basic quality assurance system. EVIDENCE: The Inspector noted that the Registered Manager has begun a course of study which should enable her to acquire the formal management qualifications which have been designed to confirm good practice in the administration of residential care services. However and in the interim, the Inspector noted that she administers the Home in an appropriate manner, so as to help the support workers to coordinate their efforts in a reliable manner. This is very important because it means that service users can experience consistent support regardless of who happens to be on duty in the Home. As noted earlier in this Report, the service users said that the support workers consult them about various aspects of the day to day running of the Home. The Inspector saw this in action as support workers asked service users about Phoenix House DS0000043898.V305377.R01.S.doc Version 5.2 Page 24 all sorts of things which go to make up everyday life. The Senior Support Worker said that there are occasional house meetings at which service users can and do make suggestions about things which can be improved. The Inspector reviewed some of the records of these meetings. He noted that little seemed to have been done to respond to some of the comments made by service users. The Inspector was informed that in the past, the Registered Provider has asked service users to complete questionnaires telling it what they think of their home. The Inspector could not identify when these were last used. Also, there appeared not to a system to gather the results together so that the Registered Provider could explain to the service users what was going to be done to implement their suggestions. The Registered Provider should address these omissions within the timescale established in the relevant Required Development listed at the end of this Report. The Inspector noted that the Registered Provider had not arranged for the completion of all the routine checks which are designed to ensure the continued serviceability of the Home’s fire safety equipment. The Inspector noted also that the programme of fire drills had become overdue significantly. Also, that the Registered Provider does not operate a system which is designed to confirm that all members of staff know how to operate safely all parts of the Home’s fire safety regime. The Registered Provider should address these oversights within the timescales established in the relevant Required Developments listed at the end of this Report. The Registered Manager said that all items of equipment in use in the Home remain in good working order. The Inspector sample checked some of the paperwork relating to this matter and he found it to confirm the Registered Manager’s account. The Registered Manager said that there were not any significant risks to health and safety in the Home. The Inspector did not notice any obvious hazards with which to contradict this account. The Registered Manager said that the Area Manager calls to the Home regularly in order to oversee its operation. Part of this, involves meeting with the Registered Manager in order to review her work and to help her to resolve any problems should there be any. Phoenix House DS0000043898.V305377.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 2 30 X STAFFING Standard No Score 31 X 32 X 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 2 X X 1 3 Phoenix House DS0000043898.V305377.R01.S.doc Version 5.2 Page 26 No 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 YA12 Regulation 16 Requirement The Registered Provider should review and as necessary should strengthen the Activity Calendar for each of the service users The Registered Provider should strengthen aspects of the internal quality assurance system used in the home. In particular, the following points should be actioned 1. appropriate methods should be introduced to enable all of the service users to comment meaningfully on the adequacy of their home 2.an Annual Quality Report should be prepared which summarises the service users’ opinions and which gives the Registered Provider’s response to any suggested improvements 3. the Quality Report should be fed back to the service users so that they know what is going to be done to implement their suggestions. The Registered Provider should ensure that the continued serviceability of the Home’s emergency lights and of the Timescale for action 01/11/06 2 YA39 12 01/02/07 3 YA42 23 23/08/06 Phoenix House DS0000043898.V305377.R01.S.doc Version 5.2 Page 27 4 YA42 23 5 YA42 23 6 YA34 18 Home’s fire extinguishers, is checked regularly The Registered Provider should ensure that a suitably frequent programme of unannounced fire drills is re-commenced The Registered Provider should introduce a suitable system to confirm that all members of staff are aware of how to help avoid the occurrence of a fire safety emergency and that they are aware of how to respond effectively to one should the need arise The Registered Provider should ensure that suitably detailed employment histories are obtained for all prospective support workers, so that appropriate decisions can be made about the personal references which need to be sought. 23/08/06 01/10/06 23/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Phoenix House DS0000043898.V305377.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. Extracts may not be used or reproduced without the express permission of CSCI Phoenix House DS0000043898.V305377.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!