Inspection on 09/05/06 for Repton Drive

This inspection was carried out on 9th May 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 18 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Repton Drive 22/11/07

Repton Drive 07/12/06

Repton Drive 28/11/05

Repton Drive 06/09/05

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 09/07/2008.

CARE HOME ADULTS 18-65 Repton Drive 13a Repton Drive Gidea Park Romford Essex RM2 5LP Lead Inspector Jackie Date Unannounced Inspection 9 May to 26th June 2006 10:00 th Repton Drive DS0000060783.V292692.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Repton Drive DS0000060783.V292692.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Repton Drive DS0000060783.V292692.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Repton Drive Address 13a Repton Drive Gidea Park Romford Essex RM2 5LP 020 8308 2900 020 8308 2999 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) The Avenues Trust Limited Miss Ruth Wilcox Care Home 6 Category(ies) of Learning disability (6), Physical disability (6) registration, with number of places Repton Drive DS0000060783.V292692.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th November 2005 Brief Description of the Service: 13a Repton Drive is a six place care home for adults with severe learning and physical disabilities, situated in a residential part of Romford. Opened in December 2004, it is a purpose built bungalow set behind detached houses, a short walk from bus routes into Romford town centre. There are six, single, bedrooms, each with ensuite toilet, shower, and wash hand basin. There is an additional communal shower, and bathroom. The kitchen/diner is domestic in nature, as is the utility room. A conservatory has been added, which is accessed via the lounge, and this adds to the communal space, which was insufficient for six service users. There is parking to the front of the building, and a small enclosed garden to the rear. The home provides 24-hour personal care, with health needs being met by visiting professionals, or staff accompanying service users to outpatient clinics. All areas of the home have full disabled access, and two bedrooms have fixed overhead tracking for specialist hoists. The Avenues Trust, a private company, which operates other similar homes in the area and in Kent, runs the home. At the time of the visit two ladies and two men were living at the home. The basic charge per week for each service user is £1485-48. This information was provided at the time of the visit. Information about the service provided is contained in the service users guide. Repton Drive DS0000060783.V292692.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit lasted for about seven hours and took place from 10 am. The manager, staff and all of the service users were spoken to. All of the rooms in the house were seen and staff, care and other records were checked. Care staff were asked about the care that service users receive, and were also observed carrying out their duties. Due to the level of their disability the service users were not able to give any direct feedback about the care that they receive and relatives and other professionals were contacted and asked for their opinions of the service. Feedback was received from two relatives. This was a key inspection and all of the key inspection standards were tested. What the service does well: What has improved since the last inspection? The new conservatory has now been finished and furnished. This gives the service users a choice of where to sit and also a quieter area. The same staff have been working at the home recently and are working better together. Staff said, “things have changed here and really got better. Service users are more settled and have been doing more activities in the home and in the community.” The manager in the staff have been working to make the service better for the service users and had been trying to find different things for them to do and also always to help them show what they like and what they want. The service user guide is now available in a format that is easier for service users to understand. Repton Drive DS0000060783.V292692.R01.S.doc Version 5.1 Page 6 The organisation monitors the service each month to check that the service users are getting the help and support that they need. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Repton Drive DS0000060783.V292692.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Repton Drive DS0000060783.V292692.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 4 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. Information is available to enable the staff team to meet service users’ needs. The required information would be gathered on a prospective service user and they and their relatives could spend time in the home to find out what it would be like to live there and to enable the service user to make a choice about living in the home, within their capacity to do so. EVIDENCE: The Statement of Purpose and the Service User Guide were examined. These have both been amended and updated as required by the previous inspection. The Service User Guide contains lots of photographs of the home and the people that live there. The complaints procedure in a pictorial format is also included. As the service users are unable to give informed consent for their photographs to be used their family’s permission has been obtained for this. This was a requirement of the previous inspection. Copies of the service user guide were in each persons bedroom. Therefore appropriate information about the home is available to prospective service users and their relatives. A referral has been made for a prospective service user. The paperwork with regard to this individual was examined. A referral form containing basic details has been completed and an assessment made by the referring social worker. In addition to this the manager has completed the organisation’s preRepton Drive DS0000060783.V292692.R01.S.doc Version 5.1 Page 9 assessment. These assessments cover all of required areas and include health, culture and sexuality. In addition to this a copy of the service users care plan has been obtained from his current placement. The manager said that the next step would be to arrange for the individual and their relatives to visit the home. If it were agreed that this person would like to live at the home then a transition plan would be developed. Therefore sufficient information would be gathered on a prospective service user to enable staff team to identify their needs Repton Drive DS0000060783.V292692.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 and 10 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. Service users’ plans contain detailed information so that staff can meet their needs. Risk assessments have been reviewed and therefore contain up to date information about service users needs. Service users’ personal information is safely stored to maintain confidentiality. EVIDENCE: Each service user has an individual plan covering all of the necessary areas. These include health, finance, communication, domestic skills, activities, mobility, diet, personal care, religion and culture. The plans give details of how each person likes and needs to be supported. The degree to which service users can be involved in the development of the plan is very limited due to their profound learning and communication difficulties. Two care plans were examined. These contained a lot of information about the individuals needs, likes and dislikes. From these it was apparent that the staff team know the service users well. The two care plans seen were in different Repton Drive DS0000060783.V292692.R01.S.doc Version 5.1 Page 11 formats. The second of these was very detailed and far more person centred. It clearly described how to support this person and what good support would be like. It also clearly described the person’s behaviours, why they exhibited these behaviours and what to do. It also covered sexual needs and this was sensitively and appropriately recorded. The other care plan contained a lot of information about the individual and what they enjoyed. For example enjoys being pampered. The plan also clarified the service user’s cultural needs and confirmed that they had no specific dress requirements and that they eat traditional English food but no beef. There was sufficient information available for staff to work with the service users and both plans show that staff know the service users well and that they are working to meet individual needs. In the case of one of the service users this has meant that they rarely require additional medication because of their behaviour. However in both cases there were gaps or information had not been fully completed or dated. These issues had also been highlighted as part of the organisations monthly monitoring visits. The information in individuals plans needs to be fully complete, signed and dated. This will ensure that all staff have correct and full information about individuals. Daily recordings are made about what each person has done and support that they have been given. In some cases these recordings were detailed but others did not give a clear picture. For example “participated in an in-house activity”. Daily recordings need to be more specific and detailed and linked to individual plans. This will ensure of that there is detailed information about each service user, which can be used as part of the review process and to identify ongoing and changing needs. There are risk assessments in place. These identify risks for the service users’ and staff and indicate ways in which the risks can be reduced to enable the service users’ needs to be met as safely as possible. The risk assessments have been reviewed and were up to date. Service users’ records and other information are stored in a lockable cabinet in the office and staff are aware of issues of confidentiality. Service users families have given permission for their relatives photograph to be used in the service user guide as required by the previous inspection. Therefore service users personal information is appropriately kept and their confidences maintained. Repton Drive DS0000060783.V292692.R01.S.doc Version 5.1 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. The service users are encouraged to take part in activities and to be part of the local community. Service users are supported to keep in contact with their relatives and relatives are welcomed at the home. Menus do not always contain healthy or low-fat options and therefore service users’ dietary needs are not always being met. EVIDENCE: Service users have severe disabilities but are encouraged and supported to do as much as they are able for themselves. For example one service users care plan says that she can carry her clothes to the laundry on her knee. It also says that she enjoys cooking and baking and on the day of the inspection she was observed to be assisting to prepare the evening meal. Service users are also supported to take part in a variety of activities both in the home and in the community. For example going to the theatre, cinema, pubs, local park Repton Drive DS0000060783.V292692.R01.S.doc Version 5.1 Page 13 and shopping. Some service users have aromatherapy and physiotherapy. Staff also said that some of the service users enjoy going to the library and being read to. Some also enjoy watching DVD’s. On the day of the inspection one service user had gone to do the house shopping with staff. In the afternoon two of the other service users went shopping for personal items. Service users have been paying staff expenses for some activities and trips and further information about this is in the section on concerns and complaints. All of the service users have contact with their families in varying degrees. One service users’ parents visit regularly and take her out, and another’s sister visits. The mother, aunt and sister of one service user are picked up and come back to the home for lunch. The staff team supported one of the service users to attend his mothers funeral. Therefore the service users are supported to maintain their contact with their families. There is a varied menu that is developed by staff and it is based on the knowledge of service users likes and dislikes. They are in the process of getting photographs of various foods to assist service users to make choices about what they would like on the menu. Each service users’ plan contained information about their dietary needs and support they need at mealtimes. One service user needs food cut into bite size pieces, another has to have the food put on his plate in small amounts at the time and a third needs to be given her food by the staff. The Inspector joined the service users at lunchtime and staff were observed to give each person the support that they needed. Records are kept of what each person has to eat. Staff have raised concerns about the weight gained by one of the service users and said that they needed to help address this and that a referral has been made to the dietician. However records show that meals provided to her included pizza, chips, toast for breakfast and sandwiches for lunch. Meals provided need to be more balanced and include healthier options. This will ensure that service users receive the nutritious diet that meet their individual needs. Repton Drive DS0000060783.V292692.R01.S.doc Version 5.1 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. Service users receive personal care that meets their individual needs and preferences and the staff team support them to get the healthcare that they need. The administration and recording of medication needs to be improved to ensure that the service users are given prescribed medication safely. EVIDENCE: The service users all require a lot of support with their personal care and details of the help that they need and how they prefer to be supported are in their individual plans. One service users’ care plan clearly states how personal care needs should be met. This includes the fact that she likes to have a shower in the morning. Also that she likes to wear hair bands, jewellery and perfume. The plan also states that she should be checked at five oclock in the morning and changed if necessary to keep her comfortable. The care plan also indicates that this person needs the assistance of two staff and that this should be females when possible. Examination of records shows that in March and April there were three different occasions when a male member of staff had assisted this person, even though other female staff had been on duty. This was discussed with the senior on duty on the day of inspection and they said Repton Drive DS0000060783.V292692.R01.S.doc Version 5.1 Page 15 this issue had been already addressed and that it be made clear to staff that two females should assist this service user with personal care. On the day of the visit service users seen looked clean and well dressed. Service users’ personal care needs are met. All of the service users go to the local doctor and specialist help is received when needed. Staff take service users to all of their medical appointments. Service users’ files have details of health care issues and show that service users have regular access to health care professionals. Records are kept of medical appointments and these show that service users have checks from the optician, dentist and when needed the chiropodist. Therefore service users health care needs are being met. Service users’ files include healthcare profiles and in some cases health-care action plans but these are not always being fully completed although information is available in other places. This is confusing and needs to be in sorted out so that all relevant information is in the appropriate place, not duplicated and easily accessible. This will ensure that correct and up-to-date information is available and can clearly show service users needs’ and how they have been met. None of the service users are able to self medicate and medication is administered by staff that have been trained and deemed capable to do this. This is usually a senior or a shift leader. A specialist pharmacist inspection was carried out in September 2005 and at the time of this inspection medication records and the medication were checked. Medication is stored in an appropriate lockable cabinet in the main office. Examination of the MAR (medication administration record) found that there were several handwritten entries. For accountability any handwritten amendments or additions to Medication Administration Records (MAR) sheets must be signed and dated by the person making the entry. One service user’s medication record stated that they should be given between 1 or 2 5ml spoons of the medication but there was no record of how much the person is actually given. There were other examples where the amount of medication was variable but the exact amount given was not recorded. In addition there were not any guidelines available to enable staff to identify which dosage was required. When directions for administration are variable the dose given must be entered on the medication administration record. In addition there must be clear guidelines to identify how much medication is needed. These issues were discussed with the manager at the time of the visit and in addition these were requirements of the specialist pharmacy inspection in September 2005 and must be addressed. Medication must be safely administered to ensure that service users receive the correct medication and to minimise the risk of an error. Repton Drive DS0000060783.V292692.R01.S.doc Version 5.1 Page 16 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 judgment has been made using available evidence including a visit to the service. There is a complaints procedure, available in a user-friendly format that would be followed in the event of any complaints being made. However the organisation have not addressed a complaint within a reasonable timescale and has therefore possibly jeopardised relationships with neighbours. All staff have now received adult protection training to ensure that they are clear about what constitutes abuse and what to do if abuse is seen or suspected. This will give service users a greater protection from abuse. Service users’ finances have not been adequately managed or monitored and this places them at risk of financial abuse. EVIDENCE: Repton Drive DS0000060783.V292692.R01.S.doc Version 5.1 Page 17 Service users are not able to realistically make a complaint due to their profound learning and communication difficulties. The organisation has an appropriate complaints procedure and is available in a user-friendly format. This is included in the service user guide. There was one complaint recorded and that was from the next-door neighbour about poor fencing in the garden. (See section on the environment for the requirement with regard to the fence.) This complaint was made several months ago and at the time of the visit the fence had not been fixed. However this was not within the control of the manager or the staff team as this had been reported but the work not been carried out. The delay in dealing with this complaint had affected relationships with neighbours and will not assist the service users or the service being accepted in the local community. The registered person must ensure that there is a system in place to address all complaints within a reasonable timescale. At the time of the last inspection there was an adult protection investigation in progress and four members of staff were suspended without prejudice. As result of this an action plan was put in place to support the service, provide management support and additional protection for service users. The Commission has been unable to obtain full details of the outcome of the investigation from the local authority investigating officer but the organisation has been able to confirm that their disciplinary processes have not yet been fully completed. This will continue to be monitored by the Commission. The previous inspection required that the staff team were equipped to recognise potential abuse and that they were clear about their responsibilities. Also that the staff must have training on the protection of vulnerable adults. In response to the first requirement a senior manager from the organisation attended regular meetings at the home and went through various policies and procedures including whistleblowing. Staff spoken to were aware of issues of abuse and all said they had no concerns about the way service users were treated and cared for. In response to the second requirement the staff have now all received protection of vulnerable adults training. This offers more protection to service users who are unlikely to be able to indicate that they have not been treated appropriately and are relying on other people to keep them safe. A random selection of service users’ finances was checked and cash amounts held agreed with records. Receipts were on file. Service users monies are securely stored and checks are made at each handover. However examination of records found that service users are routinely paying for staff meals and other staff expenses. This is not acceptable and must be stopped, as service users do not have the capacity to make informed decisions about how their money is spent. There should be a service budget to pay for staff expenses. In addition service users must be reimbursed for any expenditure on staff expenses. Representatives of the organisation have stated that there is a separate budget for staff expenses and that service users should not have been paying. They also said that service users would be reimbursed. This will Repton Drive DS0000060783.V292692.R01.S.doc Version 5.1 Page 18 be monitored during future visits to ensure that service users’ finances are being appropriately managed and safeguarded. Repton Drive DS0000060783.V292692.R01.S.doc Version 5.1 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, 25, 26, 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. The service users live in a purpose built home that is suitable for their needs. However the service users cannot use the garden as necessary maintenance work has not been carried out and it is not a safe or nice area. EVIDENCE: The home is purpose built, and was opened in late December 2004. The communal space consists of a large kitchen/diner, small lounge, laundry room and a garden. Recently a conservatory has been added to increase the communal area. The conservatory had been furnished and service users have just started to use the additional space. The building is accessible for wheelchair users throughout. Each service user has a single bedroom that is suitable for his or her needs. All of these have an ensuite toilet, shower and washbasin. Two have overhead tracking for specialist hoists. Bedrooms are personalised according to individuals likes and one service user’s room has been fitted with sensory equipment. Repton Drive DS0000060783.V292692.R01.S.doc Version 5.1 Page 20 There is a separate bathroom, with an assisted bath, and a separate toilet and shower and these are suitable for the service users needs. However the garden area has not been developed and is not really usable. This restricts the option for service users to use the garden. It is also prone to flooding. The neighbour has complained about the condition of the fence, which was damaged during the building of the conservatory. This was some time ago and it had still not been repaired. The family of a service user that lived in the home before her death last year wish to landscape the garden in memory of their daughter but as other work has not been carried out to remedy the problems in the garden they cannot arrange for the landscaping to be done. One of the service users in particular likes to be outside but due to the condition of the garden is prevented from doing so. This issue has been outstanding for sometime and must to be addressed by the registered persons. External grounds must be appropriately maintained so that they are suitable and safe for use by the service users. The previous inspection required that there must be an annual programme of repair, maintenance and decoration, which takes into account the level of wear and tear that arises with this service user group. The manager drew this up as required but it is not clear how this has been implemented. Some areas have been decorated but there were areas with broken plaster that required repair and redecoration. Overall the system for maintaining the building is not adequate as demonstrated by the issues with the garden. This needs to be addressed by the registered person and all areas must be kept in a good state of repair and decoration. Staff spoken to said that the house is becoming more homely as everyone settles in and that pictures have been put up and new covers purchased for the suite. One relative said, “the bungalow is always clean and tidy” Repton Drive DS0000060783.V292692.R01.S.doc Version 5.1 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): 31, 32, 33, 34, 35 & 36 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. Staff are receiving the necessary training to give them the skills to meet service users’ current needs and provide an appropriate service for them. Staffing levels are sufficient to allow for this. Staff are properly recruited and the necessary checks carried out. This helps to protect service users and keep them safe. Staff need to receive regular formal supervision and regular staff meetings are needed to ensure that they have the opportunity both individually and collectively to discuss problems and developments within the service. EVIDENCE: The staffing situation was discussed in depth with The Avenues Trust just prior to the last inspection and it was agreed that experienced shift leaders from other projects would be drafted in. Since then a fairly stable staff team has supported users. Two regular long-term agency workers who are now very familiar with the running of the home and know the service users cover vacancies in the main. Therefore the service users are receiving a service from a consistent group of staff. Recruitment has been taking place and three new Repton Drive DS0000060783.V292692.R01.S.doc Version 5.1 Page 22 staff are due to start work in July and this will lessen the dependency on agency staff. The senior spoken to at the time of the visit was quite clear as to their role and responsibilities. However this person was returning to their permanent place of work the following week. In addition the manager was leaving at the end of the week. The section on management gives more information and requirements about this. Staff spoken to said that things had changed at the home and that staff are working as a team. They also said that as a result of this service users were more settled and were doing more. All staff spoken to felt that service users were well looked after and that they did not have any concerns about the way that service users were being treated. One of the relatives said that she was really satisfied with the way that her son was looked after. During the visit staff were observed to spend time with service users, talking to them, reading to them and giving them the support that they needed. They were also observed to deal appropriately and patiently with a service user that was exhibiting some challenging behaviour in the kitchen. There are usually three staff on duty during the daytime shift and two staff during the night. Staff spoken to said that they felt that the staffing levels were sufficient to meet the needs of the service users. The staff team all have experience of working with people with learning disabilities. Staff on duty said that they had received training since they started work in the home. This has included induction, adult protection, manual handling, food hygiene and understanding challenging behaviour. They also said that the training programme for the coming year was available and that they have been booked on other courses. A staff training record was available and this showed courses completed and those that staff were booked to attend in the coming months. Staff were clear about their duties and responsibilities towards the service users. One staff has NVQ level 2 and one senior staff has NVQ level 3. Another staff is studying for NVQ level 3. Therefore the staff team are receiving ongoing training to enable them to meet service users needs appropriately as required by the previous inspection. The organisation operates an appropriate recruitment procedure. Jobs are advertised, application forms completed and interviews held. The necessary checks are undertaken prior to staff commencing employment. Staff records are held centrally at the organisations head office in line with an agreement made with the Commission. Staff meetings have not been taking place regularly. It is important that staff meetings do take place and that all of the staff team are involved in these. Regular staff meetings must take place, a minimum of six per year. Staff spoken to also said that although they had been receiving supervision this was not always happening regularly. Representatives of the organisation also confirmed that supervision had been “ad hoc”. All staff must receive regular recorded supervision at least six times a year with a senior/manager in Repton Drive DS0000060783.V292692.R01.S.doc Version 5.1 Page 23 addition to regular contact on day-to-day practice. This will ensure that staff have an opportunity individually and collectively to discuss issues, concerns and the development of the service. Repton Drive DS0000060783.V292692.R01.S.doc Version 5.1 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 42 and 43 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. The organisation has not robustly supported the manager and staff team to develop and improve the service. A safe service is provided to service users. EVIDENCE: At the time of the last inspection there was a new manager at the home. The Commission subsequently registered this manager. However the new manager left the employment of the organisation during the course of the inspection. Interim management arrangements were put in place with a service manager being seconded to the home. In addition to this a member of staff on the fast track management programme is also supporting the service. At the time of completion of this inspection the service manager was on leave and the member of staff on the fast track management programme was taking day-today responsibility for the service and being supported by an experienced registered manager from another service. It was anticipated that these Repton Drive DS0000060783.V292692.R01.S.doc Version 5.1 Page 25 arrangements would be in place at least until the end of July. Previously the Commission had been told that attempts would be made to fast track the recruitment of a new manager using the recruitment agency. The organisation were asked to provide up-to-date information about the management arrangements for the home. This is a service that experienced a lot of difficulties last year and these included the suspension of four staff pending an adult protection investigation. During the feedback visit it was apparent that the service had already started to address some of the issues raised during the inspection. However it is extremely important that the staff team receive appropriate and consistent support and the new manager is in post as soon as possible. Robust and consistent interim management arrangements must be in place until a permanent manager is recruited. This is to ensure that improvements in the service continue and that service users receive a safe service. The previous inspection required that the registered person must ensure that the manager of the home receives consistent and appropriate support to make the changes that were required in the service and also that there must be effective quality monitoring systems in place. Unfortunately in the period of time the manager was in post there were three different line managers and supervision was not regular. Regular monthly monitoring visits have been taking place and reports of these visits have been sent to the Commission. These reports are now far more detailed and cover all of the necessary areas and show that monitoring of the home has improved. However feedback from a number of staff was that they did not feel that the organisation had given adequate support and that “they visit every month and tell you whats wrong and then go away, they dont offer support and help”. The requirement that the registered person must ensure that the manager of the home receives consistent and appropriate support so that the necessary changes can be made remains outstanding and needs to be addressed to ensure that both manager and the staff team are able to develop a good quality service for the service users. The organisation’s policies and procedures were readily accessible in the office and these were discussed with the staff team as required by the previous inspection. Staff spoken to were aware of where policies and procedures and other information was stored and confirmed a selection of these had been discussed. The majority of the necessary health and safety checks are carried out and a safe environment is provided for the residents. A food safety inspection was carried out in 2005 and stated that there were excellent standards in the home with regards to food safety. Three fire drills have been held since December as required by the previous inspection. The organisations procedure is that fire drills are carried out monthly and this started in the home in May. It is recommended that the fire drill record sheet includes information about the time of the fire drill and who was present. This information can then be used Repton Drive DS0000060783.V292692.R01.S.doc Version 5.1 Page 26 to check that fire drills are being carried out at different times of the day and night and also that all staff and residents have taken part in fire drills over a period of time. There is a fire procedure but this does not cover the action that should be taken in the event of a fire during the night. A fire procedure must be developed to ensure to all staff are aware of the correct action to be taken in the event of a fire at night when all the residents are in bed and less staff are on duty. Hot water temperatures are tested each month but must be checked each week to ensure that they do not exceed the specified 43°C. The most recent monitoring visit by the organisation had also highlighted this. It is recommended that the prescribed maximum temperature for the hot water brief guidelines on what staff should do if the temperature is above 43° C. be on the record sheet. This will ensure that staff are clear about this and will further lessen the risk of scalding to service users. Repton Drive DS0000060783.V292692.R01.S.doc Version 5.1 Page 27 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 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 2 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 2 3 3 X 2 X Repton Drive DS0000060783.V292692.R01.S.doc Version 5.1 Page 28 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. 4. Standard YA6 YA6 YA17 YA19 Regulation 15 15 13 13,16 Requirement The information in individuals care plans need to be fully complete, signed and dated. Daily recordings need to be more specific and detailed and linked to individual plans. Meals provided need to be more balanced and include healthier options. All relevant service user health care information must be in the appropriate place, not duplicated and easily accessible. Any handwritten amendments or additions to Medication Administration Records (MAR) sheets must be signed and dated by the person making the entry. When directions for administration are variable the dose given must be entered on the medication administration record. In addition there must be clear guidelines to identify how much medication is needed. The registered person must ensure that there is a system in place to address all complaints DS0000060783.V292692.R01.S.doc Timescale for action 31/08/06 31/08/06 31/08/06 31/08/06 5. YA20 13 31/07/06 6. YA20 13 31/07/06 7. YA22 22 31/08/06 Repton Drive Version 5.1 Page 29 within a reasonable timescale. 8. 9. YA23 YA23 13 13 Staff expenses must be paid for by the organisation. Service users must be reimbursed for any staff expenses that they have financed. All areas must be kept in a good state of repair and decoration. External grounds must be appropriately maintained so that they are suitable and safe for use by the service users. Regular staff meetings must take place, a minimum of six per year. All staff must have regular, recorded supervision meetings at least six times per year in addition to regular contact on day-to-day practice. Robust and consistent interim management arrangements must be in place until a permanent manager is recruited A permanent manager must be recruited The Registered Person must ensure that the manager of the home receives consistent and appropriate support so that she can make the changes that are necessary in order to ensure that it becomes a well-run home, where the best interests of service users are put first. (Previous timescale of 28/11/05 not met). A night time fire procedure must be developed. Hot water temperatures must be tested each week to ensure that they do not exceed the prescribed safe temperature. DS0000060783.V292692.R01.S.doc 31/07/06 31/08/06 10. 11. YA24 YA28 23 23 30/09/06 30/09/06 12. 13. YA36 YA36 18 18 30/09/06 30/09/06 14. YA37 8 31/07/06 15. 16. YA37 YA38 8 12 30/09/06 30/09/06 17 18 YA42 YA42 23 13 31/07/06 31/07/06 Repton Drive Version 5.1 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA42 YA42 Good Practice Recommendations It is recommended that the fire drill record sheet includes information about the time of the fire drill and who was present. It is recommended that the prescribed maximum temperature for the hot water and brief guidelines on what staff should do if the temperature is above 43° C. be on the record sheet. Repton Drive DS0000060783.V292692.R01.S.doc Version 5.1 Page 31 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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 Repton Drive DS0000060783.V292692.R01.S.doc Version 5.1 Page 32 - 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. 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