Inspection on 23/10/07 for Roundtrees

This inspection was carried out on 23rd October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 31 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Roundtrees 29/10/08

Roundtrees 15/04/08

Roundtrees 21/06/06

Roundtrees 17/11/05

Roundtrees 26/05/05

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

Pennine Camphill

Muston Road (70)

Grayling

The Cornerstone

John Street Nursing Home

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

CARE HOME ADULTS 18-65 Roundtrees Roundtrees 340 Beverley Road Kingston upon Hull East Yorkshire HU5 1LH Lead Inspector Christina Bettison Key Unannounced Inspection 23rd October 2007 09:15 Roundtrees DS0000062842.V353453.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 Roundtrees DS0000062842.V353453.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. Roundtrees DS0000062842.V353453.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Roundtrees Address Roundtrees 340 Beverley Road Kingston upon Hull East Yorkshire HU5 1LH 01482 342404 F/P 01482 342404 vivian.bone@milewood.co.uk 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) Milewood Healthcare Limited Mrs Vivian Esther Bone Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Roundtrees DS0000062842.V353453.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. That the Residential Staffing Forum hours are adhered to. The home should ensure that there is a person on duty at all times with experience in Learning Disability, this condition will be reviewed after three months of registration. That the home do not admit people who have physical disabilities or conditions which affect their mobility. 21st June 2006 Date of last inspection Brief Description of the Service: Milewood Healthcare own Roundtrees, one of a number of homes the company owns in the area. It is registered to provide personal care and accommodation for up to 9 adults aged 18 to 65, of either gender and with a learning disability. The home is on Beverley Road, a main bus route into the city centre. There is a range of local shops and amenities close by. There is an enclosed rear garden and parking is limited to nearby street parking. On the ground floor is a large through lounge and dining room, a kitchen, laundry, office and one rear bedroom. There is no passenger or chair lift and no wheel chair access. Private accommodation is provided in 9 single bedrooms 8 of which are upstairs on the first and second floors, 4 have en suite facilities including a shower. There is also a bathroom with WC, shower room without WC and 2 more WCs all located upstairs. Weekly fees range from £1,389 to £1,800, additional 1:1 funding is currently £13.31 per hour. Additional charges are made for the following: newspapers/magazines and sweets, hairdressing, chiropody and transport for social activities. Information on the service is made available via the statement of purpose, service user guide and inspection report. Roundtrees DS0000062842.V353453.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit took place over 1 day in October 2007. Surveys were posted out prior to inspection; one was returned from a relative, four returned from staff and none returned from people who live in the home. In addition to this two placing social workers were talked to over the telephone. The Registered manager, one senior support worker and three people who live in the home were spoken to. The interactions between staff and the people who live in the home were observed to find out how the home was run and if the people who lived there were satisfied with the care and facilities provided. The inspector looked around the home and looked at records. Information received by us over the last twelve months was considered in forming a judgement as part of the inspection process. Prior to the visit the inspector referred to notifications sent to the Commission for Social Care Inspection, the event history for the home over the past year and the completed pre-inspection questionnaire, all of which forms part of this inspection. The site visit was led by Regulation Inspector Mrs T Bettison, the visit lasted 8 hours. What the service does well: Most of the people that live at the home were spoken to and said they liked living at Roundtrees and were well looked after. They like the staff who help them do the things they want. Staff spoken to liked working at the home and it is a friendly place to work. One person that lives in the home commented “I like the staff group, keep up the good work”. People have opportunities to go out and are free to spend time in the privacy of their own rooms. These have been personalised making them individual. People spoken to said they liked the food provided, are well fed and encouraged to eat a healthy diet. Staff do most of the cooking. The service has helped people to maintain a stable home life after many previous placements and the people live a reasonably independent lifestyle. Roundtrees DS0000062842.V353453.R01.S.doc Version 5.2 Page 6 One relative commented “this is definitely the best home ……..has been in and meets all of their needs. The staff are good at dealing with issues as they arise and have been a tremendous support to the family”. Medicines are looked after well and staff assist people to take their medicines safely. People have a single room that is nicely personalised to their own taste, providing them with a private area to their liking where they can spend private time or receive visitors. The home is safe and the environmental health team have assessed the kitchen facilities under the Food Safety Act and rated it as “A” which is excellent. What has improved since the last inspection? What they could do better: The people that live in the home must have a thorough assessment of their health, personal and social care needs by a person qualified to do so and a copy obtained by the home so that the staff know what they need to do to meet people’s needs. All of the people that live in the home must have a plan and risk assessments and they must say what staff need to do to make sure peoples health, personal and social care needs are met and that they are protected from harm. People need to have a plan of activities/interests and records kept to show that they are happening and staff need to help them to maintain their independence as much as possible. One staff member commented “we need to try to encourage the (people) to do more” and a person that lives in the home commented “I would like to be taken to the cinema”. Peoples health needs must be written in a plan and staff must meet the complicated health needs of the people that live in the home and ensure that outcomes are recorded. When people have medicines that are taken “when needed” the instructions for staff need to be clear when and why they can help people to take it. Roundtrees DS0000062842.V353453.R01.S.doc Version 5.2 Page 7 There needs to be enough staff in the home so that the staff can meet the needs of people and carry out all of their duties safely. One staff member commented “we need an extra member of staff so that we can have two teams of two”. Staff must be recruited properly and vetted so that people are protected from harm. The home needs to have training plan and all staff need to have an individual training profile and must be provided with training that is directly related to the needs of the people that live in the home. All staff must be provided with basic and special training, e.g. how to deal with behaviour that may harm themselves or staff, how to protect people from harm, how to work with people who have mental health needs and communication needs and to help them to meet the special needs of the people that live in the home. New staff need to do basic training (induction) in how to work with people with a learning disability and/or mental health needs within 6 weeks of starting the job People need help to say what they think about the home and staff must listen and respond to their views. The system that helps to improve the standards in the home must work better to make sure that everyone is involved in making decisions about the running of the home and improvements are made. The owner/representative must undertake regular visits to the home and submit reports the CSCI under regulation 26 to evidence that improvements are being made. The home needs to be kept clean and comfortable at all times and furniture and fittings must be of good quality and meet peoples individual needs. One person that lives in the home commented, “it would be better without the pebbles and the furniture could be better” there are pebbles in the back garden that people have used on occasions to throw at each other. 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. Roundtrees DS0000062842.V353453.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Roundtrees DS0000062842.V353453.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 5 People who use the service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. Peoples needs are not thoroughly assessed prior to admission, meaning that the manager and staff are not aware of their needs and consideration is not given as whether the home is sufficiently resourced and staff have the skills to meet their needs. EVIDENCE: There has been one new admission to the home since the previous inspection and two people have moved on to alternative provision. There are five permanent people living in the home and on the day of the visit two of these were away on holiday. It was clear to see from records and discussion with placing social workers that some of the people that live at the home have a diagnosis of mental health needs, the home is registered to take people whose needs are categorised as learning disabled and the staff team have not received any training in the Roundtrees DS0000062842.V353453.R01.S.doc Version 5.2 Page 10 needs of people with mental health needs. The owner and manager must ensure that they do not admit people whose needs they cannot meet. Three of the care files were examined as part of the site visit. None of the files contained a detailed assessment of peoples needs and there were no copies of care management assessments, in addition to this one of the staff spoken to stated that it was difficult to support people to develop new skills as they did not have any previous history’s and did not know what was safe. The manager and staff are not fully aware of what peoples needs are and therefore unable to meet them fully. In addition to this staff thought that some people are funded for 1:1 time however there was no written evidence of this and difficult to see how this could be facilitated within the current staffing structure. Consideration has not been given as to whether the home is sufficiently resourced to meet all of the peoples needs. (See the staffing section of this report.) It was identified at the pervious inspection that people did not have an agreed contract or statement of terms and conditions that explained what the fees are, what would be provided and what may cost extra. Copies of contracts were available and some people had signed them however they did not contain all of the information required. Roundtrees DS0000062842.V353453.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 People who use the service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s individual needs and choices are not being managed appropriately and people are being restricted from making choices without consultation and agreements being made. These shortfalls have the potential to place people at risk and mean that people’s assessed needs may not be met. EVIDENCE: All people that live in the home have a care file, and the inspector is aware that the home are in the process of introducing new planning paperwork, however the files were very disorganised and did not give a clear picture of peoples assessed needs and risk areas. Three care files were examined as part of the inspection process. Because of the lack of assessment information it was difficult to determine if the plans Roundtrees DS0000062842.V353453.R01.S.doc Version 5.2 Page 12 reflected the full range of needs to ensure that all aspects of health, personal and social care needs are identified and planned for. Although the manager stated that they were in the process of preparing all plans onto a new format it was clear that some areas were contradictory or had not been planned for. A risk assessment for one person stated that they needed help to run a bath safely but this had not been detailed how they needed help either in the form of a care plan or risk assessment, in addition to this the same person is at risk of exploitation/vulnerability out in the community but it did not state anywhere how this will be managed. None of the document had been dated or signed. For a person that recently had period of poor mental health there were no updates to plans or risk assessments as to how this is being managed currently and there had been no input to date from the health services. There was no evidence of local authority reviews or CPA reviews taking place for this person. This does not keep people safe from harm. In another care file examined there was no LA assessment but there was a LA care plan that stated that the persons mental health be monitored and CPA reviews to take place. There was a risk and relapse plan dated 2005 and another 2006 but no evidence of recent review. In daily notes there was a record of this person stating that they wanted to end their life but no plan, risk assessment, review or health interventions to cover this. A LA (FACS) review had taken place in January 2007 but none since. In the third care file examined there were contradictions in the plans, in one area it stated that the person looks after their own money but elsewhere it stated that they are not able to manage their money. There was no evidence of any reviews having taken place and this person is under the care of the Mental health team and there had been no CPA review. This particular person has informed both the home manager and his social worker that he wants to move away from the home but there was little evidence that this had been addressed and what the feedback was to the person. In addition to this the person informed the inspector that they would like a bigger room in the home, this could easily be facilitated as the home have a large empty vacant room at present. This request must be actioned by the home immediately. A number of people in the home have restrictions/limitations placed upon them e.g. managed alcohol consumption, numbers of cigarettes limited, people not allowed to go out without a staff member with them, but there was no evidence of how these decisions had been reached and who had agreed to them. Roundtrees DS0000062842.V353453.R01.S.doc Version 5.2 Page 13 One person has some additional funding to enable them to go out on 1:1 with staff but there was no evidence of this happening in practice. In all three care files examined there was a basic health plan however there has been no input from the health authority/community team learning disability in the development of health screening or health action plans and there was no evidence of outcomes of monitoring of health needs. This is detailed further in the health section of this report. In this home most of the people display behaviours that can be difficult to manage and there have been 52 incidents reported to the CSCI and the LA since the previous inspection. These have included altercations between people that live in the home and assaults on staff. Staff stated that there are times when they have to use Restrictive physical interventions to protect themselves; the person and others that live in the home from the risk of harm. Where specific techniques or methods of communication are needed in order to minimise the risks there were basic behaviour management plans in place but these did not detail what specific techniques of RPI can be used for each individual. The homes policy and procedure for the use of RPI states that staff must have received training and this must be updated annually. All of the staff files were examined and the staff team had all received training in October 2005 and this had not been updated. The training provided must include the use of RPI if the staff in the home are using this practice. Discussion with staff suggested that peoples basic care needs were being met even though there was a lack of clear plans and guidance. This approach is dependent on staff memory and good verbal communication systems. People are at risk of not having their care needs met or being placed at the risk of harm if these informal systems break down. In addition to this although staff appeared willing and very caring, they are not provided in adequate numbers and have not received adequate training to meet the needs of the people that live in the home. Roundtrees DS0000062842.V353453.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): 12,13,14,15,16 and 17 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. A range of activities provided within the home and community mean that some people have the opportunity to participate in activities that meet their needs however due to poor planning this is not evidenced and improvements are needed. EVIDENCE: There are five people living at the home on a permanent basis and on the day of the visit two were away from the home. One has gone to America for two weeks holiday with their family and the other is in Scarborough for a couple of days to attend a parents birthday party. Roundtrees DS0000062842.V353453.R01.S.doc Version 5.2 Page 15 The other three people were at the home for part of the day and one went out to a basic skills class at the Dyslexia centre and the other went out to a local café bar for a drink. During the site visit three care files were examined only one contained a weekly activity plan and there were no records of outcomes to support whether these had actually taken place or not. Observations indicated that staff members interact very well with the people that live in the home. There was a warm, friendly and relaxed atmosphere in the house during the course of the inspection. Discussion with staff and relatives indicated that family and friends are able to visit the home and see people in private if required. They can use any of the communal facilities and there is no restriction on visiting times. The people that live in the home have their own TV, music systems and personal items in their bedrooms. Menus reflected that staff promoted a healthy eating menu and tried to balance this with people’s likes/dislikes and special treats on occasions. The staff members generally prepare the meals with people helping if they were able to, wanted to and if it was safe. People told us that they liked the food and the evening meal on the day of the visit was a beef stew. The kitchen was clean, tidy and well stocked and the environmental heath team have assessed the home under the Food safety Act and given it rating of “A” which is excellent. Roundtrees DS0000062842.V353453.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 and 20 People who use the service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. Peoples health and personal care needs are at times met on an informal basis, the quality of the care plans, risk assessments and recording methods are very basic. These shortfalls have the potential to place people at risk and means that there is the potential for their health needs to be not met. EVIDENCE: Although there was evidence in all three files of appointments with the GP and for some people dentist and chiropody this was not the same for all of the people. There was little evidence that people were seeing consultant psychiatrists and little community nursing involvement. Roundtrees DS0000062842.V353453.R01.S.doc Version 5.2 Page 17 In all three care files examined there was a basic health plan however there has been no input from the health authority/community team learning disability in the development of health screening or health action plans and there was no evidence of outcomes of monitoring of health needs. There were lots of blank forms in the files for recording outcomes however these had not been filled in. In one of the care files the person wears glasses but there was no evidence that he had ever seen the optician, he had also had a period of poor mental health and following a discussion with the inspector at the time a referral had been made for CPN input, but this was back in august of this year and to date no one had visited and this had not been followed up by the manager. In another file the person had had a speech and language assessment and some recommendations had been made for the staff to follow, none of this had been transferred into a care plan or heath action plan. For a person that recently had a period of poor health there were no updates to plans or risk assessments as to how this is being managed currently and there had been no input to date from the health services. There was no evidence of local authority reviews or CPA reviews taking place for this person. This does not keep people safe from harm. In another care file examined there was no LA assessment but there was a LA care plan that stated that the persons mental health be monitored and CPA reviews to take place. There was a risk and relapse plan dated 2005 and another 2006 but no evidence of recent review. In daily notes there was a record of this person stating that they wanted to end their life but no plan, risk assessment, review or health interventions to cover this. A number of people in the home have restrictions/limitations placed upon them e.g. managed alcohol consumption, numbers of cigarettes limited, people not allowed to go out without a staff member with them, but there was no evidence of how these decisions had been reached and who had agreed to them. Medication systems were examined; the home has policies and procedures to cover all aspects of medicines management and to ensure that staff had the necessary guidance. Storage of all medications was found to be satisfactory; medications were stored appropriately and stock control was effective. The home did not have any controlled medication at the time of the visit although systems were in place should they need it. Roundtrees DS0000062842.V353453.R01.S.doc Version 5.2 Page 18 Transcribing records and medication administration records were checked and found to be satisfactory. There were protocols in place for the administration of medication on a PRN basis, these were not detailed enough and did not specify which medication, how much and if more can be administered when and how much and in what circumstances. All of the staff who give people medication have now all received training and have been assessed as competent by the home manager. Roundtrees DS0000062842.V353453.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 and 23 People who use the service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints system. However because of the poor care planning, poor attention to health needs and poor quality risk assessment, people who live in the home are not protected from the risk of harm. EVIDENCE: The home has a formal complaints procedure. There had been no complaints to the home or the Commission for Social Care Inspection since the previous inspection. From the care files examined it was evident that a number of people in the home have restrictions/limitations placed upon them e.g. managed alcohol consumption, numbers of cigarettes limited, people not allowed to go out without a staff member with them, but there was no evidence of how these decisions had been reached and who had agreed to them. In this home most of the people display behaviours that can be difficult to manage and there have been a number of incidents reported to the CSCI and the LA. Staff stated that there are times when they have to use Restrictive physical interventions to protect themselves; the person and others that live in the home from the risk of harm. Roundtrees DS0000062842.V353453.R01.S.doc Version 5.2 Page 20 Where specific techniques or methods of communication are needed in order to minimise the risks there were basic behaviour management plans in place but these did not detail what specific techniques of RPI can be used for each individual. The homes policy and procedure for the use of RPI states that staff must have received training and this must be updated annually. All of the staff files were examined and the staff team had all received training in October 2005 and this had not been updated. The training provided must include the use of RPI if the staff in the home are using this practice. From discussion with staff and staff training records it was evident that most of the staff including the manager and senor staff have received training or briefing on the Protection Of Vulnerable Adults Policies and Procedures and their responsibilities within this however because of the poor management of difficult behaviours and poor quality of plans and records people who live in the home are not protected from the risk of harm. Roundtrees DS0000062842.V353453.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 and 30 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. People live in a home which has its regular maintenance checks completed however it does not provide people with a clean, homely and comfortable place in which to live. EVIDENCE: The home is on Beverley Road, a main bus route into the city centre. There are a range of local shops and amenities close by. There is an enclosed rear garden and parking is limited to nearby street parking. On the ground floor is a large through lounge and dining room, a kitchen, laundry, office and one rear bedroom. There is no passenger or chair lift and no wheel chair access. Roundtrees DS0000062842.V353453.R01.S.doc Version 5.2 Page 22 Private accommodation is provided in 9 single bedrooms 8 of which are upstairs on the first and second floors, 4 have en suite facilities including a shower. There is also a bathroom with WC, shower room without WC and 2 more WCs all located upstairs. It was evident form discussion with the manager, staff and form observation that the home is in need of major refurbishment and more regular cleaning. The staff and the people that live there are responsible for the general cleaning of the home however with the current staffing arrangements and reluctance of the some of the people who live in the home this is proving very difficult. Given the staff hours in the home this is unacceptable and the registered person must review the care staff hours provided and give consideration to employing a cleaner. As a result on the day of the visit the home was very dirty in places. Some of the bedrooms were very dirty; and had a malodour; the windows both inside and out were so dirty it was difficult to see out of them. The home is situated on a very busy road and the windows could do to be professionally cleaned inside and out on a more regular basis. The whole house is in need of redecoration and a number of items of furniture need replacing, chest of drawers in some bedrooms, one of the beds was particularly bad and the sofas in the living room were very very dirty and worn. The manager told us that she had put in a bid for the home to refurbished and upgraded, this must be actioned with some urgency. Roundtrees DS0000062842.V353453.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32, 33, 34, 35 and 36 People who use the service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. The current staffing arrangements are not sufficient to meet the needs of the people who live in the home, staff are not adequately recruited, supervised trained placing people at risk. EVIDENCE: The inspector was informed that the home currently has 10 staff in total, comprising of • • • • 1x Registered manager 1x deputy manager (this is currently a vacant post) 3 x senior health care workers 6 x health care workers Roundtrees DS0000062842.V353453.R01.S.doc Version 5.2 Page 24 The rota evidenced that there are usually 3 health care workers allocated per day shift with one of these being a senior support worker or the deputy manager post. The manager works supernumerary from 8.00-4.00. The home currently has 5 people living at the home all of which have either a learning disability and/or mental health difficulties. However the home is registered for 9 people. Staff have the responsibility of cleaning bedrooms, bathrooms and all communal areas, supporting people to attend appointments, activities, and in addition to this attend to their care needs. Examination of staff files evidenced that new staff had not had any induction that meets LDAF standards and that recruitment was not robust, two staff did not have a CRB clearance and did not have two references. In addition to this none of the information required by schedule 2 was on file. I.e. copies of passport, driving licences, etc. Mandatory training consisted of in house packs that staff read and complete a questionnaire that the manager marks and there had been no service specific training provided. A training plan was not available however the home does have 50 of staff qualified to NVQ level 2. None of the staff had had an appraisal and most staff had only had one supervision since the previous inspection. The registered person is required to review the staffing structure to ensure that all of the persons needs are met and to ensure that staff are appropriately trained for their role. The registered person is also required to ensure that staff are up to date with all mandatory training and service specific training is provided in mental health awareness and managing behaviour that may pose a risk to themselves or others. Roundtrees DS0000062842.V353453.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. The overall management and conduct of the home is unsatisfactory and does not demonstrate that it is acting in the best interests of the people that live there and ensuring that they are kept safe from harm. EVIDENCE: The manager of the service has been in post since 27/6/06 and has obtained NVQ level 4 and registered manager award. Although the manager stated that she has not had lot of management experience she has had approximately 30 years working with people with a learning disability and/or vulnerable groups. She also has the NVQ level 3 in supervisory management and the first aid certificate. Staff spoken to said she was supportive and approachable. Roundtrees DS0000062842.V353453.R01.S.doc Version 5.2 Page 26 The management of the home appears to be disorganised and this is not helped by the very small office. Care files were stored on high shelves and during the visit kept falling off the shelf creating a health and safety hazard. Consideration must be given to providing a more appropriate office space with lockable facilities for care files and other documentation. There is a lack of care plans and guidelines, poor attention to providing both mandatory and service specific training. Recruitment is poor and does not safeguard people in the home. Risk has not been managed effectively and therefore people are not being protected from harm. Incidences of behaviour management are not being managed appropriately and recorded and monitored. The current staffing structure and number of hours provided within the home mean that although the staff are willing they do not have the time within the shift to undertake all of the duties required to ensure that peoples complex personal, health and safety needs are met, the home is kept clean and that a range of activities are provided that meet their diverse needs. All of the supplies and equipment had been serviced/maintained appropriately meaning that the home is safe for the people that live there. The CSCI has not received copies of any regulation 26 visits undertaken on a monthly basis and this needs to be addressed. The manager could not tell the inspector if the service had a formalised QA system although she did say that questionnaires had been sent out to relatives and the people that live in the home. These were seen during the visit. Roundtrees DS0000062842.V353453.R01.S.doc Version 5.2 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 x 2 1 3 1 4 x 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 1 25 x 26 1 27 x 28 x 29 x 30 1 STAFFING Standard No Score 31 x 32 1 33 1 34 1 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 1 x 1 x LIFESTYLES Standard No Score 11 x 12 2 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 2 x 1 x 1 x x 2 x Roundtrees DS0000062842.V353453.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA2 Regulation 14 Requirement Timescale for action 30/11/07 2 YA3 12 3 YA3 12 (2) 4 YA5 5 The registered person must ensure that they obtain a copy of the care management assessment integrated with the care programme approach for people with mental health problems, so that staff are aware of peoples needs and can meet them. The registered person must 24/10/07 demonstrate that they can meet the needs of the people that are referred to the home and must ensure that people are within the registration category of the home to comply with the care standards act. The registered person must 24/10/07 ensure that people are enabled to make choices about where they live or the room they occupy. Independent advocacy services must be sought if the person wants or needs this. The registered person must 30/11/07 ensure that each person has an individual written contract or statement of terms and conditions in accordance with NMS 5. so that they know what DS0000062842.V353453.R01.S.doc Version 5.2 Roundtrees Page 29 5 YA6 15 and 17 6 YA6 15 and 17 7 YA7 13 (6 and 7) 8 YA7 15 (1 and 2)17 9 YA9 13 and 17 they can expect form the home. (Previous target dates of 31/03/06 16/10/06 not met). The registered person must ensure that plans are developed and agreed with people and must detail the action to be taken by staff to meet their assessed personal, health and welfare needs. The registered person must ensure that people are reviewed at least 6 monthly and plans are updated to reflect changing needs so that all of their needs are met as they change. The registered person must ensure that where people display behaviours that are difficult to manage or the use of restrictive physical interventions are used to prevent self harm or abuse or harm to others that this is agreed by a multi agency meeting and documented appropriately. Behaviour management guidelines must detail specific techniques to be used with each individual to protect people from the risk of harm. The registered person must ensure that staff follow the principles of the mental capacity act and that decisions are taken in respect of peoples best interests and appropriate records maintained, to ensure that people are able to exercise choice and control over their lives. The registered person must ensure that risk assessments are developed to cover all areas that pose risk to the people that live in the home or to the DS0000062842.V353453.R01.S.doc 31/01/08 31/01/08 30/11/07 30/11/07 31/01/08 Roundtrees Version 5.2 Page 30 10 YA12 11 YA14 12 YA18 13 YA19 14 YA20 15 YA24 16 YA24 public and that they are maintained and reviewed to ensure people are protected form the risk of harm. 16 (m and The registered person must n) ensure that people are supported to develop their full potential and participate in a range of activities and /or continued education and this is detailed within their plan. 16 (m and The registered person must n) ensure that people are able to take a 7 day holiday or a series of one day outings as part of their contract price so that they are enabled to take a break from the home and the people they live with. 13 (1) The registered person must ensure that people receive additional specialist health support and advice as needed so that their complex health needs are met. 13 (1) The registered person must ensure that people’s health needs are met by the identification, planning and meeting of health needs and preparation of health action plans. 13 (2) The registered person must ensure that medications that are given on a PRN basis have a written protocol that details when and how much should be given so that staff are clear about when and why it can be administered. 23 The registered person must ensure that the home is kept accessible, safe and well maintained to meet peoples needs in a comfortable and homely way. 23 The registered person must ensure that furnishings and DS0000062842.V353453.R01.S.doc 31/01/08 31/01/08 30/11/07 31/01/08 30/11/07 30/11/07 30/11/07 Roundtrees Version 5.2 Page 31 17 YA26 23 18 YA30 23 19 YA32 18 20 YA33 18 21 YA33 13 (1) 22 YA34 19 fittings are of good quality and fulfil their purpose so that people live in a nice home. The registered person must ensure that people are provided with a bed, table and chest of drawers that are of good quality and that bedding, curtains and floor coverings are of good quality and the design is suitable for the person so that people live in a nice environment. The registered person must ensure that the home is kept clean, hygienic and free from offensive odours throughout. The registered person must ensure that all staff receive training in how to meet the needs of people with mental health needs and those that present behaviour that is difficult to manage so that staff are clear about their roles and responsibilities and that they can keep themselves and other people free from harm. The registered person must review the staff hours and provide sufficient numbers of staff to meet the assessed needs of people at all times. The registered person must ensure that where indicated specialist services are secured from relevant professionals to support the assessed needs of people that live in the home. The registered person must ensure that two written references as well as all other employment checks must be obtained before new staff starts to work in the home to ensure people are protected from the risk of harm. (Previous timescale not met DS0000062842.V353453.R01.S.doc 30/11/07 30/11/07 30/11/07 31/01/08 30/11/07 24/10/07 Roundtrees Version 5.2 Page 32 16/10/06) 23 YA34 19 The registered person must ensure that new staff are confirmed in post only following completion of a satisfactory police and CRB check to ensure that people are protected form harm. The registered person must ensure that all staff receive formal induction training within 6 weeks of commencement in post so that they know what is expected of them and what peoples needs are and are able to meet them. (Previous target date of 31/03/06 not met). The registered person must ensure that the home has training and development plan that ensures staff have the necessary training to meet peoples needs. The registered person must ensure that each member of staff has a training and development profile and at least five days paid training per year to ensure staff have the necessary training to meet peoples needs. The registered person must ensure that staff receive regular, recorded supervision meetings at least 6 times per year so that they are supported to do their jobs properly. The registered person must ensure that staff have an annual appraisal to ensure staff have the necessary training to meet peoples needs. The registered person must ensure that the home is managed effectively, that polices and procedures are implemented and that the DS0000062842.V353453.R01.S.doc 24/10/07 24 YA35 18 30/11/07 25 YA35 18 31/01/08 26 YA35 18 31/01/08 27 YA36 18 31/03/08 28 YA36 18 31/03/08 29 YA37 8 31/03/08 Roundtrees Version 5.2 Page 33 30 YA39 24 and 26 31 YA42 8 home complies with the care standards act and regulations. The registered person must 31/03/08 ensure that the home has an effective quality monitoring system that seeks the views of the people that live in the home and stakeholders and an internal audit takes place at least annually. Visits must take place monthly as per regulation 26 and a copy of the report be sent to the CSCI. The registered person must 30/11/07 ensure the health and safety of staff and the people that live in the home by ensuring that all mandatory training is up to date and that staff have received training in how to a manage difficult behaviour. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Roundtrees DS0000062842.V353453.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 Roundtrees DS0000062842.V353453.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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