Inspection on 15/04/08 for Reddown Road (37)

This inspection was carried out on 15th April 2008.

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

Reddown Road (37) 18/03/09

Reddown Road (37) 02/07/07

Reddown Road (37) 23/06/06

Reddown Road (37) 25/10/05

Reddown Road (37) 28/06/05

Reddown Road (37) 02/11/04

Reddown Road (37) 15/04/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Reddown Road (37) 37 Reddown Road Coulsdon Surrey CR5 1AN Lead Inspector Lee Willis Key Unannounced Inspection 15th April 2008 11:10 Reddown Road (37) DS0000025829.V361373.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 Reddown Road (37) DS0000025829.V361373.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. Reddown Road (37) DS0000025829.V361373.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Reddown Road (37) Address 37 Reddown Road Coulsdon Surrey CR5 1AN 01737 559 309 F/P 01737 559 309 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) www.milburycare.com Milbury Care Services Ltd Mr Gavin Ainslie Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Reddown Road (37) DS0000025829.V361373.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 8 2nd July 2007 Date of last inspection Brief Description of the Service: 37 Reddown Road is a large detached property offering accommodation and personal support for up to eight generally ‘older’ males with learning disabilities and ‘high’ support needs. Six people currently live at the home. Carmel Rees is the homes new acting manager and will be formally taking over the day to day running of the service from Gavin Ainslie (current registered manager) on 1st May 2008. The home is close to some good transport links including, a local train station, and several bus stops. The service also has its own vehicle. A wide variety of good leisure and community facilities are within 15 minutes of the home. The property is built over two floors and comprises of eight single occupancy bedrooms; an open plan ‘L’ shaped main lounge/dinning area; two sensory areas; an activities room; a quiet area; separate kitchen; laundry room; staff sleep-in room; and new ground floor office. There are sufficient numbers of toilet and bathing facilities located throughout the home near service users bedrooms and communal areas. The garden at the rear is relatively well maintained, although it currently lacks furniture. The home ensures people who use the service and their representatives are supplied with all the information they need to know about the home and how much they can expect to be charged for them. Fees currently charged range from £1,250 to £1,300 a week. Reddown Road (37) DS0000025829.V361373.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The new quality rating for this service is 1 star. This means the service is not performing to its potential and therefore the people who live at 37 Reddown Road only experience adequate outcomes. From all the available evidence gathered during the inspection process the Commission for Social Care Inspection (CSCI) has judged the service as having some strengths, but also areas of particular weakness that require urgent improvement through an action plan which we will be monitoring closely. The providers have a relatively good track history of responding well to major shortfalls brought to their attention and we are confident the new manager will be able to improve the homes poor medication handling practices and staff supervision arrangements. We spent four and a half hours at the home. During the site visit we met four people who use the service, the registered manager, the new acting manager, and four support workers, two of whom we informally interviewed in private. We also looked at a variety of records and documents, including the care plans for two people whose cases were chosen for tracking. The remainder of this site visit was spent touring the premises. We only received one comment card about the home, which had been completed by a member of staff. As part of the inspection process the acting manager also completed and returned an Annual Quality Assurance Assessment (AQAA) to tell us about this service, how it makes sure of good outcomes for the people using it, and any future developments that are being planned. What the service does well: It is evident from the excellent mix of the people currently living at Reddown Road that the service has been particularly good in recent years at giving careful consideration to whether or not a prospective service user would be compatible with those already living there. Over the years the former registered manager has continued to improve the soft furnishings and fittings in communal areas ensuring the place looked more homely and welcoming. He is also commended for improving the number of opportunities people who use the service had to engage in activities while at home, which culminated in the creation of sensory/activity rooms. Staff on duty at the time of this inspection, which included the new acting manager and some other new members of staff, all demonstrated a thorough Reddown Road (37) DS0000025829.V361373.R01.S.doc Version 5.2 Page 6 understanding of the particular needs of the people who use the service and what person centred care was. What has improved since the last inspection? What they could do better: All the positive comments made above notwithstanding their remains a number of areas of practice that the home must take urgent action to address in order to improve the lives of the people who use the service as well as keep them safe: All the people who use the service must have an up to date and detailed record of any appointments they attend with health care professionals including, dentists. This will ensure they receive the correct levels of health care support to meet their needs. The way in which the service records medicines received into the home must be reviewed as a matter of urgency. This will ensure there is a clear audit trail Reddown Road (37) DS0000025829.V361373.R01.S.doc Version 5.2 Page 7 to track all medicines handled by staff on behalf of the people who use the service can be accounted for. This is necessary to keep the people who use the service safe from potential risk of harm and/or abuse. The way in which the service quality controls its medication handling procedures should also be reviewed as a matter of urgency. This will ensure poor medication handling practices are identified and a much earlier stage thus minimising the risk of medication recording errors, abuse, and/or theft recurring. The home must ensure all support workers who are currently authorised to handle medication on behalf of the people who use the service receive refreshing training in the safe handling of medication in a residential care setting. In order to keep the people who use the service safe it is also recommended all staff ‘authorised’ to handle medication in the home should always write the reason why they decided to administer ‘as required’ (PRN) medication in the space provided on the reverse side of medication administration (MAR) sheets. The practice of stock piling ‘as required’ medication and taking the same medication from several different blister packs at once should cease immediately. And finally, the way in which medication is handled on behalf of the people who use the service should be reviewed as a matter of urgency and tighter monitoring arrangements established. The way in which the service controls the temperature of water used in baths should be reviewed to ensure it is sufficiently hot to meet the personal care needs of the people who use the service. All staff authorised to use British Institute of Learning Disability approved physical intervention techniques must be appropriately trained in their use and up their existing knowledge and skills at regular intervals. This will minimise the risk of people who use the service being harmed or suffering abuse. All staff who provide personal care in the home must be appropriately trained to promote continence in a dignified manner. The way in which the registered provider obtains all the relevant information and carries out all the appropriate checks when recruiting new members of staff should be reviewed to ensure the system is far more open and transparent. This will ensure the risk of employing people whom are not ‘fit’ to work with vulnerable adults is minimised. Reddown Road (37) DS0000025829.V361373.R01.S.doc Version 5.2 Page 8 The way in which the service appraises the performance and training needs of the staff team should be reviewed to ensure this is undertaken on an annual basis. This will help the manager plan staff development programmes and ensure her staff team are suitably qualified and competent to meet the needs of the people who use the service. Finally, the new person in operational day-to-day control of the home should be registered with the Commission as soon as reasonably practicable. This will enable the Commission to determine whether or not the current acting manager is ‘fit’ to run a residential care home for adults with learning disabilities. 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. Reddown Road (37) DS0000025829.V361373.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Reddown Road (37) DS0000025829.V361373.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If they decide to stay in the home they and people close to them know about their rights and responsibilities because the service has produced a Statement of purpose and Guide that are easy to understand. People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. EVIDENCE: The home has developed a comprehensive Statement of Purpose and Service User Guide that include all the information people who use the service and their representatives need to know about the services and facilities provided. All this information is available in an easy to understand format that people who use the service, and their families can access. For example, the Guide is written in plain English and is illustrated with all manner of coloured photographs, pictures, and symbols. Reddown Road (37) DS0000025829.V361373.R01.S.doc Version 5.2 Page 11 The new acting manager told us she intended to review these documents on an annual basis and up date them accordingly to reflect any changes in provision. These documents are now due a review and should be updated to make it clearer the age range of the people the service is intended for i.e. 40 . The service has not received any new referrals in the past twelve months and the registered manager told they were not planning to fill the homes two vacant places in the near future. The new acting manager told us before accepting a referral she would give careful consideration to whether or not the home was capable of meeting an individuals needs and how compatible they would be with the existing service user group. The service is commended for ensuring the current group of people living at Reddown Road are well matched. A track record the new acting manager told us she was very keen to sustain. Reddown Road (37) DS0000025829.V361373.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 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. EVIDENCE: It was evident from the two care plans being case tracked that these documents have been improved in the past year to make them far more person centred. The plans include information about every aspect of an individual’s life and easy to read. The two support workers spoken with at Reddown Road (37) DS0000025829.V361373.R01.S.doc Version 5.2 Page 13 length believed the new care plans were easier to follow than the format they previously used. The home continues to work a keyworker system with each person who uses the service allocated a named member of staff who works closely with that individual. Two keyworkers met told us they are responsible for reviewing care plans for the individuals they keywork on a monthly basis and for keeping a record of these reviews. An information board is available in the dinning area which staff pin photographs and/or pictures too to let the people who use the service know who is on duty, what activities are on offer, and what choices of meals there are on any given day. Unfortunately, the photos pinned to the board at the time of this site visit did not accurately reflect who was duty that day, and what choices people had regarding lunch or activities that morning. As required in the home last inspection both the care plans look at in detail contained a far more comprehensive set of risk assessments that covered every aspect of peoples lives including, risk management plans that staff needed to follow when supporting people in the wider community. Documentary evidence was produced on request to show that following a recent unplanned absence of someone who used the service a new risk assessment had been carried out, their care plan updated to reflect a new risk management strategy, and a ‘significant’ incident form completed. These assessments are reviewed at regular intervals. It was evident from comments made by the new acting manager that she has a positive approach to managing risk and is keen to enable people who use the service to take ‘calculated’ risks in order to help people maintain their independence (so far as reasonably practical). Reddown Road (37) DS0000025829.V361373.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person is treated as an individual and the care home is responsive to people’s culture, religion, age, disability, and gender. People can take part in age appropriate activities in the local community and staff support them to follow their personal interests. People are able to keep in touch with family, friends, and representatives and the home supports them to have appropriate personal and family relationships. Dietary needs and preferences are well catered ensuring the people who use the service are provided with daily variation, choice, and nutritionally wellbalanced meals. Reddown Road (37) DS0000025829.V361373.R01.S.doc Version 5.2 Page 15 EVIDENCE: We saw a number of instances over the course of this inspection where people who used the service were supported by staff to engage in various social activities, both at home and in the wider community. For example, one person whom used the service went into a sensory room with a member of staff, while another went out shopping. The manager told us a number of the people who use the service are now season ticket holders with a local football team and regular attend home games. It was evident from records sampled at random including, the staff duty rosters, care plans, and daily diary notes that staff roles, shift patterns, and weekly activity schedules all take the social needs and wishes of the people who use the service into account. For example daily diary notes examined for two people who use the service revealed these individuals had participated in a wide variety of leisure activities in the past month that included, walks in the park, drives, shopping trips, attending football matches, art, and using both the homes sensory rooms. The manager told us that service users are actively encouraged to participate in household chores and a section to include this expectation is contained in the new care plan format. The manager told us the home continues to operate an open visitors policy without restrictions. People who use the service have the opportunity to develop and maintain important personal and family relationships. On arrival staff ask to see proof of my identity and in line with the homes visitors policy the acting manager asked me to sign the visitors book as an additional security measure. The manager told us the people who use the service are actively encouraged by staff to help them plan the weekly menu seven days in advance every Sunday. A record of the food actually eaten showed people who use the service have the opportunity to choose an alternative meal if they don’t fancy any of the options displayed on the published menu. The lunchtime meal served on the day of this inspection looked and smelt relatively appetising and seemed to ‘go down well’ with the people who use the service. All the people who were at home at this time sat together around a large wooden table in the open plan dinning area with staff and where assistance was required this was appropriately provided. The atmosphere during lunch remained very congenial and relaxed throughout. Reddown Road (37) DS0000025829.V361373.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 & 21 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. The recording of health care appointments is variable and needs to be improved to enable anyone authorised to view this confidential information to determine whether or not people’s health care requirements are being met. The homes medication handling arrangements need to be significantly improved to ensure the people who use the service are kept safe. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. Reddown Road (37) DS0000025829.V361373.R01.S.doc Version 5.2 Page 17 EVIDENCE: All the people who use the service met during this visit were suitably dressed in well-maintained clothes that were appropriate for the time of year. A member of staff told us they actively encourage the people who use the service to choose what clothes they wear each day. Information contained in the two care plans being case tracked showed people’s personal healthcare needs are clearly identified and action plans are in place to meet them. Staff maintain records of all the appointments people who use the service attend with various health care professionals, although information about the outcome of these meetings is often variable. For example, no record of a recent house call made by a community-based dentist could be located on request. Staff maintain detailed records of all the accidents and significant incidents involving the people who use the service. In the past year there has been a low number of referrals made as a result of lack of incidents, rather than a lack of understanding about when incidents should be reported. Staff spoken with demonstrated a good understanding of what constituted a ‘significant’ incident and knew how to record such an incident, when it needed external input, and who to refer it too. Incidents and accident sheets sampled at random showed that all those involving the people when use the service had been well managed by staff on duty at the time. As required in the homes last inspection report staff authorised to handle medication are more vigilant when it comes administering oral medicines and no ‘unwanted’ tablets were found during a tour of the premises. However, having carried out an audit of all the homes ‘as required’ (PRN) medication it was evident that the system that was in place to quality control this type of medication was ineffectual. For example, no record of one ‘as required’ medication recently received into the home and held on behalf of some one who uses the service. Staff signatures on medication administration sheets did not always match stocks of medication currently held in the home on service users behalves. Consequently, a number of tablets could not be accounted for. Furthermore, no written record of the rationale behind one ‘as required’ medication being used more frequently in recent months could be produced on request, despite this good practice recommendation being made at the homes last inspection. Protocols for the use of ‘as required’ medication were not particularly detailed and staff spoken with did not always seem clear when they should administered it, and who was ultimately responsible for ‘authorising’ its use. Finally, ‘as required’ medication on a repeat prescription had begun to be stocked piled in the home. This had lead to some confusion amongst staff who had begun using three separate packets of this medication at once. Reddown Road (37) DS0000025829.V361373.R01.S.doc Version 5.2 Page 18 The manager told us a system is in place for suitably experienced and qualified senior member of staff to monitor the homes medication practices on a weekly basis. It was clear from the poor practice examples outlined above that the homes quality monitoring of its medication handling practices was not a particularly effective one. All the staff who handle medicines on behalf of people who use the service will also require further training to up date their existing knowledge and skills in this important area of practice. NB. These failings represent a serious breach of the care homes regulations (2001) and have placed one or more of the people who live at Reddown Road at risk of harm and/or abuse. The registered providers have therefore been issued with a warning letter reminding them of their responsibilities with regards the handling of medication in a residential care setting. We have requested they send us an improvement plan that sets out how they intend to minimise the risk of similar incidents reoccurring in the future. The wishes of individuals about arrangements after death is not always recorded, but the manager assured us he is still in the process of obtaining this highly sensitive information from the relevant people and was also able to give a good account of what the arrangements would be for all the people currently residing at the home. Reddown Road (37) DS0000025829.V361373.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 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations, although staff training in the use of physical intervention techniques needs to be improved. EVIDENCE: The service has a complaints procedure that is clearly written and easy to understand. It is available on request in an easy to read format that is illustrated with coloured pictures and symbols to help anyone living at, or involved with, the service to complain or make suggestions for improvement. The procedure is conspicuously displayed in the home. The acting manager told us she would keep a full record of any complaints made about the home, including details of the investigation and any actions taken. The home has not received any complaints about it operation since it was last inspected. Reddown Road (37) DS0000025829.V361373.R01.S.doc Version 5.2 Page 20 The policies and procedures for Safeguarding Adults are available and give clear specific guidance to those using them. The acting manager was able to demonstrate she understood the local authorities procedures for Safeguarding Adults and said she would always attend meetings or provide information to external agencies as and when requested. In the last three years there has been four separate allegations of abuse made by a small group of staff about the conduct of their fellow co-workers. Apart from the latest allegation of abuse, which is still under investigation, insufficient evidence was found to substantiate claims made by certain members of staff about their colleagues following numerous investigations carried out under the Local Authorities safeguarding adult’s protocols. The service clearly understands its role with regards safeguarding adults procedures as all the aforementioned allegations of abuse were reported to the relevant external agencies, including the local authorities safeguarding adult’s team and the Commission. However, this unusually high number of unfounded allegations of abuse made by certain members of staff about their fellow workers would suggest large divisions in the team. The manager told us the half a dozen or so members of staff who had been accused of abusing the people who used the service along with all the recent whistle blowers no longer worked at the home for a variety of reasons. All the staff interviewed which included, the registered manager, and the new acting manager, and two support workers all told us they were confident that all the recent changes in the composition of the staff team would help improve staff morale. The acting manager also told us she was very keen to get staff working as a team again. Training of staff in the area of protection is regularly arranged by the Home. Other training around dealing with physical and verbal aggression is also made available to staff, but the manager told us a number of the staff authorised to use physical intervention techniques in the home were overdue their refresher training in BILD approved Non Violent Crisis Intervention (NVCI). Reddown Road (37) DS0000025829.V361373.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, 27, 28 & 30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe and well-maintained home that is homely, clean, comfortable, pleasant, and hygienic. People live in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. Their bedroom feels like their own, are comfortable, and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. Reddown Road (37) DS0000025829.V361373.R01.S.doc Version 5.2 Page 22 EVIDENCE: The living environment of the home is appropriate for the particular lifestyle and needs of the people who use the service and is homely, comfortable, and well maintained. The home is also adequately lit, clean, and smells fresh. As required in the homes last inspection report new sofas have been purchased for the lounge. Other changes made to the physical layout of the home include the office being moved downstairs to enable the manager to be far more hands on in light of staffing issues mentioned earlier in this report. Furthermore, the communal lounge looks far more homely and welcoming with the addition of shelving displaying various ornaments, books, and flowers. There is also a number of new age and gender appropriate posters and pictures hung on the walls in the lounge. The manager told despite being some distance from the providers headquarters where the maintenance team are based there has not been no repeat of the problems experienced a few years ago when there was clearly no programmes in place for the routine repair and redecoration of the home. Records are appropriately maintained of the temperature of hot water emanating from all the homes water outlets, which are tested at regular intervals. However, the temperature of hot water emanating from the first floor bath was found to be an unacceptably low 36 degrees Celsius when tested at 13.30. The thermostatic mixer valve needs to be adjusted to ensure the temperature of water emanating from this bath is at least 40, but not above 43 degrees Celsius. Furthermore, written comments received from a member of staff suggested the home was frequently cold. The home was pleasantly warm on arrival and the manager told us all staff are authorised to adjust the heating system as needed. Two members of staff interviewed told us the home was always pleasantly warm, and knew how to adjust the heating system if required. There is currently no place for the people who use the service, their guests and staff to sit and enjoy the relatively recently re-landscaped garden. Exterior paint on the majority of the homes window frames and sills is also ‘flaking’ off. Staff interviewed demonstrated a good understanding of the homes arrangements for controlling infection in the home. In line with environmental health guidelines the homes laundry room is located in an area where food is prepared, eaten, or stored. The laundry room contains a wash hand basin, plentiful stocks of latex gloves and plastic aprons, and the walls and floor are readily cleanable. Reddown Road (37) DS0000025829.V361373.R01.S.doc Version 5.2 Page 23 Reddown Road (37) DS0000025829.V361373.R01.S.doc Version 5.2 Page 24 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 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are kept safe because there are enough competent and qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. The people who use the service would benefit from being supported by staff whose performance was appraised on an annual basis. EVIDENCE: Throughout the course of the morning staff on duty were all observed interacting with the people who used the service in a very kind and professional manner. Staff duty rosters sampled at random and the numbers of staff noted to be working on both the early and late shifts on the day of this inspection seemed to be adequate to meet the needs, activities and aspirations of the people using the service in an individualised and person centred way. The manager Reddown Road (37) DS0000025829.V361373.R01.S.doc Version 5.2 Page 25 told us additional staffing has been secured to enable one person who uses the service to receive one to one support for seven hours a day. This additional support was in place at the time of this site visit. The acting manager told she believed the recruitment of good quality carers was the cornerstone of delivering good outcomes for the people who use the service and was very keen to ensure the right people for the job are employed, especially in light of recent staffing problems experienced by this service. The acting manager also understood the importance of asking appropriate questions at face-to-face interviews when recruiting prospective support workers. The providers continue to operate a centralised recruitment procedures with all the original documents obtained in the process held at a centrally located office. Information held on the personal files in respect of the homes two most recent recruits indicated that most of the relevant checks had been carried out by Milbury Care before allowing these individuals to commence working at the home, although it was not always clear if two written references had been supplied and where or not a Protection of vulnerable adults check had been carried out. Furthermore, the manager told us he had not read any references obtained in respect of the homes newest recruit as part of the selection process contrary to good practice. The service sees induction and any probation as vital to the success of staff recruitment and retention. The content of the induction and probationary periods are seen to be very robust, detailed, and service specific. Staff spoken with told us they had received a thorough induction before being allowed to commence working at the home. Documentary evidence was produced on request to show the induction process is linked to Skills for care and covered safe working practices, worker role, and the needs of the people using the service. The service ensures that all staff within its organisation receives relevant training that is targeted and focused on improving outcomes for people who use the service. Staff have access to a relatively good programme of training. The manager has carried out a training needs and strengths assessment of his entire staff team, which revealed very few gaps in staffs’ knowledge and skills. Mandatory training has either been provided or arrangements made for it to be completed in the near future that includes, fire safety, manual handling, first aid, food hygiene, safeguarding adults, and understanding autism. The manager told us that with all the recent changes in the composition of his staff team under 50 had achieved a National Vocational Qualification (level 2 or above) in care, although a lot more people were now enrolled on suitable courses. The recommendation made at the homes last inspection is repeated Reddown Road (37) DS0000025829.V361373.R01.S.doc Version 5.2 Page 26 here that a time specific action plan setting out how the providers intend to address this training shortfall and meet National Minimum Standards. It is also recommended that additional workshops are provided in respect of understanding challenging behaviour as a way of communicating needs, preferences, and frustration, and using specialist methods of communication on a daily basis. Sufficient numbers of the homes staff team still need to receive training in promoting continence in a dignified manner. Staff files inspected revealed that it had been well over a year since the manager formally assessed staff’s annual performance and training needs. Furthermore, minutes of staff meetings revealed that none had been held for nearly six months. All the aforementioned failings are particularly concerning given all the staffing problems experienced by this service in recent years. Reddown Road (37) DS0000025829.V361373.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The homes environment is safe for people and staff because health and safety practices are carried out. Reddown Road (37) DS0000025829.V361373.R01.S.doc Version 5.2 Page 28 EVIDENCE: The homes new acting manager, Carmel Rees, does not formally commence working at Reddown Road until 1st May 2008, although she has begun her probationary period of employment. Carmel has well over two years experience working with adults with learning disabilities in both a residential and day centre settings in a management capacity. She has also achieved a National Vocational Qualification Level 4 in both management and care in line with National Minimum Standards for residential care home managers. Carmel was able to describe a clear vision for the home as well as sound understanding and application of ‘best practice’. It was also clear from comments made by all the staff spoken with during the inspection that they had appreciated the open and approachable style of the former manager, but also felt the place might benefit from a change of leadership. The acting manager is aware that her appointment is subject to a fit person interview with the Commission, which she must pass to be registered. Carmel should submit an application to the Commissions Regional Registration Team as soon as reasonably practicable. We will closely monitor progress made on this matter. The quality assurance system the providers have introduced in recent years covers every aspects of life in the home and use the views of major stakeholders to monitor how successful or not the home has been regards achieving its stated goals. An annual quality assurance report for 2007 was produced on request, which contained a lot of feedback from the people who used the service about the standard of care they received at the home. The manager was able to produce Regulation 26 reports on request to show monthly unannounced visits to the home continue to be carried out by the operations manager for the service. In addition to these reports the acting manager had also provided d the Commission with an Annual Quality Assurance Assessment. All the health and fire safety requirements identified in the home last report have all been addressed in full. During a tour of the premises no fire resistant doors were found inappropriately wedged open or COSHH products left out. The homes fire risk assessment for the building has been up dated in the past ten months and the water heating system checked for legionella. The fire alarm system continues to be tested on a weekly basis and fire drills carried out at regular intervals in line with good fire safety guidelines. All the fire doors tested at random on the ground all closed flush into their frames when released. Reddown Road (37) DS0000025829.V361373.R01.S.doc Version 5.2 Page 29 During a tour of the kitchen it was noted that all items of food were correctly stored in line with basic food hygiene standards. A set of multi-coloured chopping boards was also observed being used for the safe preparation of food. Reddown Road (37) DS0000025829.V361373.R01.S.doc Version 5.2 Page 30 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 X 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 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 3 28 3 29 X 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 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 3 3 X 3 X X 3 X Reddown Road (37) DS0000025829.V361373.R01.S.doc Version 5.2 Page 31 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 YA19 Regulation 12(1)(a) Requirement All the people who use the service must have an up to date and detailed record of any appointments they attend with health care professionals including, dentists. This will ensure they receive the correct levels of health care support to meet their needs. Timescale for action 01/05/08 2. YA20 17(1)(a)(i) The way in which the service 01/05/08 records medicines received into the home must be reviewed as a matter of urgency. This will ensure there is a clear audit trail to track all medicines handled by staff on behalf of the people who use the service can be accounted for. This is necessary to keep the people who use the service safe from potential risk of harm and/or abuse. A warning letter has been issued reminding the providers about their medication handling responsibilities. Reddown Road (37) DS0000025829.V361373.R01.S.doc Version 5.2 Page 32 3. YA20 13(2) The way in which the service 01/05/08 quality controls its medication handling procedures should be reviewed as a matter of urgency. This will ensure poor medication handling practices are identified and a much earlier stage thus minimising the risk of medication recording errors, abuse, and/or theft recurring. This will ensure the people who use the service are kept safe. A warning letter issued - (See Requirement No 2 above). The home must ensure all support workers who are currently authorised to handle medication on behalf of the people who use the service receive refreshing training in the safe handling of medication in a residential care setting. This will ensure the safety of the people using the service. All staff authorised to use British Institute of Learning Disability approved physical intervention techniques must be appropriately trained in their use and refresh their existing knowledge and skills at regular intervals. This will minimise the risk of people who use the service being harmed or suffering abuse. 01/06/08 4. YA20 18(1)(c) 5. YA23 13(6) 15/05/08 6. YA35 12(4)(a) All staff who provide personal & care in the home must be 18(1)(c)(i) appropriately trained in promoting continence. 01/06/08 Reddown Road (37) DS0000025829.V361373.R01.S.doc Version 5.2 Page 33 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations The homes Statement of purpose should be up dated to more accurately reflect the age-range and sex of the people for whom the service is intended (i.e. generally males aged forty and over). The way in which the home keeps the people who use the service informed about what activities and meals are available each day should be reviewed. The notice board should be up dated a regular intervals to ensure the people who use the service have all the information they need to make decisions about what they do and eat each day. Staff authorised to handle medication in the home should always write the reason why they decided to administer ‘as required’ (PRN) medication in the space provided on the reverse side of medication administration (MAR) sheets. This recommendation was made at the homes last key inspection, but was not implemented. The way in which the service stock piles certain ‘as required’ medication and the practice of taking it from several different blister packs at once should be reviewed as a matter of urgency to make the system far more transparent and easier to audit. The way in which the service handles all its Controlled drugs should be reviewed as a matter of urgency and tighter monitoring arrangements established (i.e. Consider storing all Controlled drugs in a separate lockable cabinet, and ensure two suitably trained staff authored to handle medication in the home witness the receipt, administering and disposal of this type of medication, which is clearly recorded. This will ensure the people who use the service are kept safe. The way in which the service controls the temperature of water used in baths should be reviewed to ensure it is sufficiently hot to meet the personal care needs of the DS0000025829.V361373.R01.S.doc Version 5.2 Page 34 2. YA7 3. YA20 4. YA20 5. YA20 6. YA27 Reddown Road (37) people who use the service. 7. YA28 People who use the service should be provided with outside furniture to enable them to sit out and enjoy their garden. The service should establish a time specific rolling programme to repaint all the homes exterior window frames and sills. This will improve the overall appearance of the property. The providers should establish a time specific action plan setting out how they intend to ensure the homes entire staff team achieve an NVQ level 2 or above in care by an agreed date. This recommendation was made at the homes last key inspection, but was not implemented. The way in which the registered provider obtains all the relevant information and carries out all the appropriate checks when recruiting new members of staff should be reviewed to ensure the system is far more open and transparent, and always involves the manager of a particular service. This will ensure the risk of employing people whom are not ‘fit’ to work with vulnerable adults is minimised. The way in which the service appraises the performance and training needs of the staff team should be reviewed to ensure this is undertaken on an annual basis. This will help the manager plan staff development programmes and ensure her staff team are suitably qualified and competent to meet the needs of the people who use the service. The new person in operational day-to-day control of the home should be registered with the Commission as soon as reasonably practicable. This will enable the Commission to determine whether or not the current acting manager is ‘fit’ to run a residential care home for adults with learning disabilities. 8. YA28 9. YA32 10. YA34 11. YA36 12. YA37 Reddown Road (37) DS0000025829.V361373.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Reddown Road (37) DS0000025829.V361373.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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