Inspection on 02/05/06 for Russets

This inspection was carried out on 2nd 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 25 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Russets 05/07/07

Russets 28/09/05

Russets 21/04/05

Russets 17/02/05

Russets 19/04/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Russets Gatcombe Drive Hilsea Portsmouth Hampshire PO2 0TX Lead Inspector Christine Hemmens Unannounced Inspection 2nd May 2006 09:30 Russets DS0000029304.V289394.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 Russets DS0000029304.V289394.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. Russets DS0000029304.V289394.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Russets Address Gatcombe Drive Hilsea Portsmouth Hampshire PO2 0TX 023 9266 3780 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.portsmouthcc.gov.uk Portsmouth City Council Andrew Edward Cooper Care Home 15 Category(ies) of Learning disability (15) registration, with number of places Russets DS0000029304.V289394.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th September 2005 Brief Description of the Service: Russets is a purpose built home run by Portsmouth County Council, which provides respite care for up to 15 adults with learning disabilities. Accommodation is split up into smaller living units and can support people with physical disabilities. Russets can provide daycare although most service users attend local day services. Russets DS0000029304.V289394.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was undertaken over one day by two inspectors and the service was assisted against all key standards. The newly registered manager, service users and staff assisted the inspectors with the inspection and information on the home’s quality and performance has been obtained from relatives and other professionals. Although Russets provides respite and short term care the inspectors established that a service user continues to be supported long term. The manager could demonstrate that there has been work in progress to support the service user to move on. The service user has been wrongly placed for a considerable amount of time and there is an urgency to find appropriate accommodation, as the service cannot fully meet the needs of the individual. Until such time as an appropriate placement is found and a safe transition has taken place the service must demonstrate that it is meeting the service user’s needs appropriately. It is demonstrated through the body of the report that this is not currently happening, especially in terms of meeting health and welfare needs. Commission for Social Care Inspection has met with the provider to discuss concerns regarding this service including the lack of clarity of the purpose of the service, repeated medication errors, the failure to carry out regulation 26 visits, (monthly quality audit reports). The number of service users supported with high dependency versus inadequate staffing levels and the high number of requirements including repeated requirements. The following issues remain a concern and will be addressed again with senior managers within Portsmouth City Council. 1.Lack of clarity about the purpose of the service. 2.Maladministration of medication. 3.High number of requirements including repeated requirements. What the service does well: The service does well to provide an environment to meet the physical and social needs of the service users, the home is spacious, very clean and is fully equipped with specialist equipment such as hoists, overhead tracking, walk-in showers, assisted baths and adapted beds. The service does well to provide a range of in house activities, with in-door and outdoor equipment and there are plans to develop a music and art room, sensory garden and hold monthly discos. Russets DS0000029304.V289394.R01.S.doc Version 5.1 Page 6 The service does well on the whole to employ staff who demonstrate a good understanding of the needs of the service users, have good values and who are receptive to training and change. Service users are provided information in the form of a newsletter and they and their families are asked to share their views on the service. One service user informed the inspector that “I really like coming to Russets because it is fun”, and another said, “it’s okay”. A relative said she felt it met the needs of her son and he appears happy when he returns home. What has improved since the last inspection? What they could do better: The manager has only worked in the service for approximately three months and through the comprehensive action plan he has developed he has identified the strengths and the needs of the service. The manager is aware that he will need to prioritise the needs of the service to safeguard the service users and meet the previous requirements issued by the Commission for Social Care Inspection. As stated above the service must do better to establish its true purpose and reflect this in the Statement of Purpose and Service User Guide. To place service users at Russets long term without the appropriate assessment, support and clear strategy for assisting the person to move on is highly inappropriate. Russets DS0000029304.V289394.R01.S.doc Version 5.1 Page 7 The service has failed to adopt a person centred approach and is not appropriately meeting communication and behavioural needs of the current service user who has been placed long term. This could potentially affect their health and wellbeing and others who access the service. Care plans must clearly state “how” the service user wishes to be supported. A previous visit to the service identified that care plans required updating, completing appropriately and reflect the needs, goals and aspirations of the service users, further work is required in this area and further requirements have been made in respect of this. At the time of the inspection the inspectors observed that not all staff afforded the service users with respect and used approaches that conflicted with the way in which the service user required support. The manager informed of this. Staff attend abuse awareness training, however the service must ensure it has accessible to staff current policies and procedures such as the joint authority policy “Protecting Vulnerable Adults”. Despite a recent encouraging pharmacy inspection the staff continues to make medication errors that could potentially affect the wellbeing of the service users. A statutory notice was issued in respect of this just before the inspection. The quality of food, healthy eating options and choices remain a concern as the service has been required previously to promote the service users health and wellbeing by ensuring a there is nutritious supply of food at flexible times. The service must address the issue of service users potentially receiving the same meal at Russets as they do at the day service they attend. A service user informed the inspector that he already had pizza and chips earlier in the day. This is due to the same company providing food for both city council services. The service continues to fail to demonstrate that it has taken all necessary steps and checks on staff to minimise the potential risk of harm to the service users. The service was issued with an immediate requirement at the time of the visit to address the urgency to ensure all ancillary staff have been appropriately recruited and Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks have been carried out. The service also continues to fail to provide evidence that support staff have been appropriately recruited. The manager is in the process of developing an accessible complaints procedure for the service users, however the manager must ensure all relatives are provided with a complaints procedure. A relative with whom the inspector spoke with did not recall recieving a complaints procedure. Russets provides a comfortable environment for the service users to stay, however at the time of the visit it was observed that the temperature in the home was uncomfortably warm, this was also identified in a monthly visit Russets DS0000029304.V289394.R01.S.doc Version 5.1 Page 8 report. Service users had complained that their rooms were too hot and they are unable to alter the heating without calling upon “Interserve” who own the building. The manager must ensure service users are provided with the tools to adjust the heating to their liking. 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. Russets DS0000029304.V289394.R01.S.doc Version 5.1 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Russets DS0000029304.V289394.R01.S.doc Version 5.1 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected 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 adequate. This judgment has been made using available evidence including a visit to this service. The home does well through the assessment and transition process to establish if it can meet the needs of prospective service users’, however the Statement of Purpose and Service User Guide requires further adaptation to reflect the intended purpose of the home. EVIDENCE: The registered manager has been working in the home for approximately three months and is aware through developing a comprehensive action plan that the service needs to make considerable changes to its Statement of Purpose and Service User Guide to reflect the actual service it does and can provide. The manager has been actively collating evidence to demonstrate that the unit has the potential to meet needs such as emergency/assessment service for unexpected crisis situations and short term planned visits. The unit has historically provided long-term placements for service users admitted as emergency placements, although the stated purpose is to provide short term and respite care. The unit continues to provide long-term support for a service user with complex needs despite this being first first raised through the inspection as Russets DS0000029304.V289394.R01.S.doc Version 5.1 Page 11 inappropriate in April 2004 and has since been subject to two further requirements. The Statement of Purpose and Service User Guide are in their early draft stages. The Service User Guide is being adapted in an accessible format, however the manager recognises the importance of ensuring it has meaning for all service users and is aware that this will mean additional work with staff to ensure they are aware of the importance of making the document “real” by using a person centred approach. Some staff with whom the inspectors met were aware that the Statement of Purpose and Service User Guide were currently in their draft form and these documents guided the purpose of the service. The staff demonstrate good practice in working with service users, their families and care managers in the assessment and transition period. The inspectors saw evidence of how the unit is working with a recently referred service user and the family to establish their needs, this has been done by assessing their strengths and needs. A relative with whom the inspector spoke said a member of staff had visited the family home prior to their relative starting respite, and the unit staff were very welcoming and supportive when they visited the service. Recorded information in the service user’s personal plan demonstrates that the service monitors outcomes of trial visits, identifying any key issues that need to be addressed before the next visit. A comment made by the service user (“Its good”) and recorded in his notes demonstrates the service user was involved in the process. The manager informed the inspector that prospective service users are invited to visit the unit, stay for tea, building up their stay to overnight and weekends visits. The visits are monitored and the needs of the service user evaluated to establish if further assessments are required before the service user has regular stays at the unit. Russets DS0000029304.V289394.R01.S.doc Version 5.1 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. The service does well to support the service users to make choices, however further work is required to ensure personal plans reflect “how” to support the service user to ensure a consistent and person centered approach is used. EVIDENCE: For the purpose of the inspection process the inspectors viewed four residents’ personal plans, these provide personal details such as NOK, GP, other care professionals and care manager contact details. The assessment documentation viewed and referred to in “Choice of Home” provides comprehensive information on the service users strengths, needs, communication, mobility, likes, dislikes, interests, hobbies and weekly social activities including day services. The information identified risks and the current action the service takes to minimise the risk, especially those linked to disruptive behaviour and what actions the staff need to take to pre-empt these. However the personal plan does not include detail on how staff are Russets DS0000029304.V289394.R01.S.doc Version 5.1 Page 13 required to support the resident using a consistent approach with daily living and self help skills. This was further established when viewing the personal plan of service user who had been resident in the home for a number of years. It was identified at the time of the visit that the service was working in liaison with the resident’s family and care manager to move the service user on a appropriate home. The manager confirmed that the service has not been able to meet the needs and complex behaviours of the service user. The continuous placement of residents for long periods of time has been repeatedly addressed with Portsmouth City Council, as their complex needs, behaviours and incompatibilities pose potential risks to others needing the service and places high demands on the staff. However despite the service user being resident for a long time the plan of care did not reflect their entire support needs or have in place a behaviour management plan to meet the challenges presented by them. Areas of concern regarding the service users current health and behavioural needs had not been recorded or addressed through the care planning process. Therefore the requirement to ensure care plans are reviewed, updated, completed appropriately and reflects the needs, goals and aspirations of individuals will be repeated and further action may be taken. However the manager is newly in post and it was the responsibility of the provider in the absence of a manager to ensure requirements were met. The inspector observed poor practice in support of the service user whilst having their meal, the carer providing one to one support was talking on a phone and when the service user was showing signs of restlessness stood in front of the service user with her arms folded. This was brought to the attention of the manager who said he would address this with the member of staff involved. The manager is required to address the plans as a matter of priority for the resident identified at the time of the visit using a person centred approach and seek the support of specialist services in meeting specific challenges. The service user has limited verbal communication therefore the service must ensure staff are aware of the preferred form of communication, routines, likes and dislikes. Three service users with whom the inspector met and a relative with whom the inspector spoke with on the phone confirmed that they felt the service provided them with opportunities to choose what they wanted to do and provided them with the support they required when they needed it. The inspectors observed informed choices being provided and services users making choices of what they wanted to eat and activities they wished to take part in. Russets DS0000029304.V289394.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. The service does well to provide a range of peer, in house and leisure activities for the service users to engage in and respects the rights their rights. However the service must continue to improve resources to support community based activities and ensure it is providing healthy eating options. EVIDENCE: Since the previous visit to the home the service has done well to provide an extensive range of in house activities, including activities to meet sensory and complex needs, however community based activities and resources to fund these are limited, this was raised as a concern following the previous visit to the home. The manager confirmed that he is hoping to arrange more community based activities and trips to places if interest in the summer months, however the manager will be required to demonstrate that service users are provided with opportunities to engage in social and community activities whilst staying at Russets. Russets DS0000029304.V289394.R01.S.doc Version 5.1 Page 15 The home is equipped with an impressive sensory room which the inspectors were informed is used frequently. Service users have access to a large secure garden, the manager discussed plans to make it more accessible for service users in wheelchairs, with funding to develop a sensory garden and play area with play equipment that will meet physical needs. A service user informed the inspector that he liked to play basket ball in the garden with his keyworker and joked with his keyworker how much better he was. There was evidence of service users taking part in gardening and the manager informed the inspectors that he hoped to access more of the garden to grow vegetables as some of the service users had expressed an interest. The service has recently purchased a large range of activity equipment such as art and craft materials, musical instruments with plans to make one of the rooms into a music room, and large play equipment such as table tennis, a trampoline and football table has been purchased. However the inspectors were informed that the service users can bring in their own activities and can choose to listen to music or watch DVD’s if they wish. Currently the home is not fully resourced with staff to support the service users in more community-based activities, the manager has plans for outings in the summer and to improve on the current position with staff. However service users are supported to walk to the local shops if they wish, staffing levels permitted. A relative with whom the inspector spoke said she felt her son was happy at the service however wished there was more opportunity for her son to go out when he stayed. The residents with whom the inspectors met said they enjoyed staying at Russets because the staff are nice and they do interesting things. The manager recognises the potential of the service and has plans to support service users to maintain and develop their independence, such as cooking and cleaning. However this is dependent on individual wishes and views the service users have regarding their stay. i.e. a contination of their home life or a place where they can relax. The manager informed the inspectors that some service users wish to continue with day services and peer activities and are supported to do this. The manager informed the inspectors that he has plans to involve the service users in informal decision making about what they would like to get out of their stay and spoke about how he planned to do this, informal discussion followed by a disco, this shows respect for the service users right to make decisions. The service users staying at Russets at the time of the visit said they knew most of the other service users as they attended the same day services. The Russets DS0000029304.V289394.R01.S.doc Version 5.1 Page 16 inspectors observed friendly banter and camaraderie between the services users and staff and there was evidence of positive relationships being formed. The manager informed the inspectors that the service provides same gender care and recorded notes in a service users plan of care confirmed this. The service has developed and provided the Commission for Social Care Inspection with a copy of their gender care policy. There is evidence of some improvement on service users accessing drinks and snacks throughout the day if they wish and a relative informed the inspector that her son had come home informing her he had cooked his own breakfast. However the quality of food and choice provided in the home is poor, the manager is fully aware of the need to address the level of choice and spoke of how he plans to develop with staff and service users an accessible menu plan and assist service users to gain access to the kitchen. However currently the catering is undertaken by contract caters who also provide the catering for the day service, which the majority of the service users attend. An identical menu is provided at each service on the same day, which potentially means the service users are choosing the same meal. A service user informed the inspector that he and already had pizza and chips that day. This was raised as concerns following the previous visit to the home and will be addressed with the providers again. However staff were observed offering alternatives and supporting service users who required assistance to eat. There was a relaxed and unhurried atmosphere and staff ate with the service users. The manager stated he has intentions to address the same menu concern. Russets DS0000029304.V289394.R01.S.doc Version 5.1 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected 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 poor. This judgment has been made using available evidence including a visit to this service. Further improvements must take place to ensure the service users receive care and support in the way that they prefer and require, and the service must ensure that they are fully meeting service users physical and health care needs at all times. The service continues to fail to undertake safe practices in the administration of medication placing service users at risk of potential harm and ill health. This remains a serious concern and further action will be considered. EVIDENCE: The newly appointed manager demonstrated a very good understanding of person centred planning and discussed his plans to introduce this formally into the service through training staff and involving the service users and relatives in the review of their current plans, which will include the service users preferred way of care and support and how they want to structure their stay. This is work in its early stages. Russets DS0000029304.V289394.R01.S.doc Version 5.1 Page 18 However the manager must make improvements to the way the service supports a service user who has been resident in the home for a number of years. The current plans do not support a person centred approach to meeting their complex needs, behaviours and the way in which they communicate. A failure to meet these needs could potentially have a detrimental effect on their emotional and physical wellbeing. This must be done as a matter of priority. The service is advised to involve the specialist health care team in assessing the current physical and emotional needs of the individual. Service users remain registered with their own GP and dentist whilst staying at Russets unless placed for an unspecific length of time, they will then be registered with a local GP. The service has good links with specialist health care teams who are involved in the transition of new service users, provide specific training such as epilepsy training, managing challenges or the use of specific specialist equipment. A community nurse with whom the inspector spoke said the service was generally very good at seeking support and receptive to training and has witnessed an improvement in this area over the last couple of years. The home keeps good records of appointments and their outcomes, however the manager must ensure service users who are currently receiving long-term support have their health care needs appropriately met. The manager must ensure all avenues are explored into the reasons behind specific behaviours, and if these are associated to an underlying health care need and care plans must reflect actions required by staff to appropriately support the service user. Prescribed topical medications must be supported by a care plan, detailing the reason for application, where to be applied, how to be applied, how often, before or after bathing and staff must record daily the outcome of the treatment. The inspectors found evidence to suggest that staff were using their own discretion and applying creams that had not been prescribed by the GP. The staff assist service users to administer their medication, however historically there have been serious concerns on the systems and procedures used and a history of errors. Although the service has recently been inspected by the Commission for Social Care Inspection pharmacy inspector and Portsmouth City Councils Pharmacist and some improvement have been identified the administration of medication remains a serious concern as the service continues to make mistakes placing the service users at potential risk of harm. The Commission for Social Care Inspection received notification before the inspection that a service user went home with too many tablets, the manager undertook an investigation and established that an error had occurred On the day of the inspection a further notification was presented to the inspectors where by a service user was not given the correct amount of medication. The inspectors were advised that an investigation would take place and the Russets DS0000029304.V289394.R01.S.doc Version 5.1 Page 19 member of staff responsible will not administer medication until further training has been provided. The inspector were informed that all staff are to undertake a refresher in the administration of medication and the manager has produced a competency test paper which staff have to complete and be tested against before administering medication. This is seen as good practice however following the inspection and prior to the report being generated a further notification was received where a service user had not received the correct does of medication. The inspectors are aware that this could have had a considerable effect on the service users health. A statutory notice was issued in respect of the medication errors. Russets DS0000029304.V289394.R01.S.doc Version 5.1 Page 20 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 and 23 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. The service is taking steps to assist service users to express their views and ensure they are listened to, however the home must ensure it has taken all necessary steps to ensure service users are safeguarded from potential harm. EVIDENCE: The manager informed the inspectors that he is currently developing an accessible complaints procedure to support the service users to express their concerns. The complaints procedure is currently in draft form. The manager demonstrated a good understanding of the different ways service users may express their concerns or dissatisfaction and the importance of good communication skills, however the inspectors observed a service user communicating dissatisfaction through agitated behaviour and this initially being dealt with inappropriately. This was brought to the attention of the manager at the time. This demonstrates the need for adopting a person centred approach and the need for training such as person centred planning, communication and managing challenging behaviour. A relative with whom the inspector spoke did not recall receiving information on how to complain. The manager must ensure all relatives are issued with the services complaints procedure and a person centred approach is adopted to assist service users to express their views. There has not been any recorded incidents or allegations of abuse, however the service must ensure it follows correct procedures when administering Russets DS0000029304.V289394.R01.S.doc Version 5.1 Page 21 medication as neglecting to give the right dose at the right time could potentially lead to physical harm. The manager could not provide evidence that service users are safeguarded from potential risk of harm, as he could not demonstrate at the time of the visit that all staff including ancillary staff have been checked for Protection of Vulnerable Adult (POVA) and Criminal Record Bureau (CRB) disclosures. There was evidence of staff receiving training in abuse awareness and this was confirmed by a member of staff with whom the inspector spoke with, however the service did not have an up to date policy on protecting vulnerable adults and therefore must ensure the service obtains the joint authority policy on “Protecting Vulnerable Adults” without delay. Russets DS0000029304.V289394.R01.S.doc Version 5.1 Page 22 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, 27,28, 29 and 30 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The service does well to provide an environment that is clean, spacious and adapted to meet the needs of the service users accessing it. EVIDENCE: Russets is a purpose built two-storey respite service, which can accommodate up to fifteen services users at one time. The service is very well designed to meet physical needs and has ample space and communal rooms, which service users can choose to use as they wish. These include a sensory room, games room, music and arts and crafts room and a conference room where service users can meet with care managers, family members and other professionals whilst staying at Russets. The home is equipped with good quality furniture and furnishings however would benefit in some areas of the home from some homely comforts such as pictures. The home is generally very clean and tidy, however some cupboards were untidy and there was evidence in an accident book that a member of staff had wrenched their back trying to retrieve a piece of equipment. Therefore the Russets DS0000029304.V289394.R01.S.doc Version 5.1 Page 23 manager must ensure cupboards are kept tidy for safe access and to prevent potential accidents. The manager spoke of how he plans to provide service users with information about the service and who’s on duty. He plans to have a large “welcome” notice board placed in the entrance, which will provide information on the service and photographs of the staff, and there are plans to have a visual staff rota displayed to notify the service users who is on duty. Following the previous visit to Russets the service was required to promote service users’ independence, support service users to access the kitchen and use the facilities to prepare snacks and drinks when they choose, some improvement has been made in this area, however the manager must consider how this can be further improved upon to promote a person centred approach to the individual needs and wishes whilst resident. This will be reviewed during the next visit to the home. The manager has produced an action plan that details how he wishes to utilise the service better to include providing an emergency/rehabilitation service in the self contained flat and a “drop in support centre” for service users and their families. The manager is aware that this would have to be presented to the Commission for Social Care Inspection for consultation as the plans currently sit outside of the services registration criteria and Statement of Purpose. The service has ample bathroom and toilet facilities with specialist equipment to assist with mobility such as overhead tracking, handrails and baths. Service users requiring specific aids and equipment such as bath moulds and chairs are encouraged to bring them into the service during their stay. The inspectors observed the service to be hygienically clean, Russets has regular cleaning staff contracted by “Interserve”, and the company leases the building to PCC, maintains it and provides the catering facilities. At the time of the visit carpets in the main lounge were being cleaned and the kitchen was observed to be very clean and tidy. Staff confirmed they are aware of infection control procedures and are provided with gloves and aprons when required. Safe practices are in place for the disposal of contaminated wastes and soiled linen. The environment appeared to be very warm and stuffy, when asked about the heating control it was reported to the inspectors that the radiators do not have thermostatic controls and the service has to request the owners of the property “Interserve” to adjust the heating. Service users are unable to adjust the heating in their rooms and it has been reported at reported visits made under regulation 26 notices that service users have complained about being too hot in their rooms. This must be addressed. Russets DS0000029304.V289394.R01.S.doc Version 5.1 Page 24 Russets DS0000029304.V289394.R01.S.doc Version 5.1 Page 25 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): 32,34,35 and 36 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. The service generally does well to provide service users with competent and qualified staff where staff are supervised and trained to meet their needs, however further improvements are required in this area to ensure service users health and wellbeing is maintained Service users are not protected by the homes recruitment policies and procedures. EVIDENCE: The manager has identified in his action plan the need to use his current staff effectively, reduce wastage and use of agency, and provide greater flexibility at weekends. The manager is currently undertaking a review of staffing versus the dependency levels of service users. The service currently still relies on agency staff however the manager confirmed that the agency staff are familiar with the service and the majority of the service users. The service does well to provide staff with a wide range of training to give them the skills and competencies to appropriately support the service users. This was confirmed by a member of staff who said that he had attended Russets DS0000029304.V289394.R01.S.doc Version 5.1 Page 26 countless training sessions including mandatory training such as moving and handling, first aid and fire and training specific to the needs of the service users such as epilepsy, P.E.G feeding, communication and managing challenging behaviour. A specialist health care worker with whom the inspector spoke confirmed that the service was good at seeking advice and support that the service is receptive to training. The inspectors viewed evidence that staff were now receiving supervision every six to eight weeks. A member of staff with whom the inspector met with confirmed that they were now receiving support and supervision. The manager has identified in his action plan the need for staff to be supervised at least monthly and have an annual appraisal. There is evidence of some staff having achieved and undertaking NVQ 2 and 3 and evidence of some staff undertaking Learning Disability Award Framework (LDAF), however the manager could not confirm what stage staff were at with this, and agreed he would follow this up. The recruitment procedures remain poor, the manager cannot evidence that all staff have had the appropriate checks undertaken on them. Staff could confirm that they had completed an application form, provided references and identification, however only a few files could be located in service to demonstrate this. The deputy manager informed the inspectors that the service had been in the process of obtaining information from their human resources department when informed they didn’t need to hold staff files. The inspectors informed the manager that this would be investigated. However an immediate requirement was issued at the time of the visit, as the manager could not confirm if ancillary staff working for “Interserve” had all appropriate checks undertaken on them. The manager of “Interserve” confirmed that checks are applied for but could not evidence this. It is the responsibility of the manager to determines the level of check that needs to be undertaken for ancillary staff depending on the extent of which individuals have unsupervised access to the residents. Russets DS0000029304.V289394.R01.S.doc Version 5.1 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. Steady improvements in the running of the service and involvements of the service user and their families are being made, however further work in seeking the views of service users is required. The service as far as feasibly possible provides a safe environment for service users to stay, however the management must ensure staff are vigilant in storing hazardous substances (COSHH). EVIDENCE: The registered manager confirmed he had only been in post for three months and his main priority was to evaluate the service and develop an action plan to the address the status and its purpose and to address the concerns and requirements raised by the Commission for Social Care Inspection. The action plan demonstrates that the manager is aware of his responsibilities and the need to continuously assess, monitor, implement and evaluate the quality and Russets DS0000029304.V289394.R01.S.doc Version 5.1 Page 28 its purpose. The manager is fully aware of the task ahead to improve the service and has gone some way to addressing these in the short period of time he has been in post. As identified in the report, activites for service users has greatly improved and the manager has many other plans to improve upon these. The manager is fully aware of the concerns raised in the quality of care plans and again demonstrated through discussion and the action plan that these need addressing. He is aware of the complexities of managing such a service where dependency levels versus compatibly and staffing levels are paramount. Staff confirmed that they attend regular staff meetings, which are minuted. The manager has introduced quality systems in the home such as a daily shift plan which identifies specific required daily jobs and who is nominated to do them. Activites are recorded and evaluated. The manager spoke of organising service users’ meetings using an independent person to assist with the meeting. The manager spoke of how he visualises the meetings going with a plan to follow this with a disco. Service users are asked to complete a questionnaire at the end of their stay but these are rarely completed, the manager also intends to introduce an alternative way of seeking the service users views. A relative informed the inspector that the service was going to hold relativesmeetings and viewed this as a very good idea as it will help to net work with other families and share good and bad points about the service. The manager has nominated an enthusiastic and IT talented member of staff to produce a regular newsletter for service users and relatives, providing general information and up and coming events. The home is very well maintained and is generally safe for the service users stays. All staff are trained in fire awareness, health and safety and infection control and all safety and serviceable equipment such as the fire apparatus, boiler, hoists and lift are checked as per the required regulations and documentation is in place to support this. However the manager must ensure staff safely lock away all substances harmful to health (COSHH) including toiletries. The manager must also ensure harmful substances are locked away when the laundry is not being supervised. The services accident-reporting system is repetitive where a minimum of three separate accidents incident forms are completed. The manager agreed that the procedure was excessive and intended to bring this to the attention of his manager. Russets DS0000029304.V289394.R01.S.doc Version 5.1 Page 29 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 1 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 3 25 X 26 2 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 1 35 X 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 3 16 2 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 1 X 3 X 2 X X 2 X Russets DS0000029304.V289394.R01.S.doc Version 5.1 Page 30 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 YA1 Regulation 4(3)(a)(b) 16(1) Requirement The service continues to accommodate service users on a long-term basis and not in accordance with the statement of purpose. This requirement was first raised in April 2004. You are required to inform the Commission for Social Care Inspection by the given date of the action you are taking in respect of this. The registered manager must provide service users and the Commission for Social Care Inspection with the final version of the Statement of Purpose and Service User Guide by the stipulated timescale. The registered manager must ensure personal plans reflect “how” the service users wishes and needs to be supported using a person centred approach. Timescale for action 30/06/06 2 YA1 4(2) 5(2) 30/06/06 3 YA6 12(1)(2) (3)(4) 15(1) 31/07/06 Russets DS0000029304.V289394.R01.S.doc Version 5.1 Page 31 4. YA6 12(1)(a) 12(3) 15(1)(2) 5 YA6YA16YA35 12(2) 12(4) 15(1) 18(1)(a) 18(2) The registered manager 31/05/06 must prioritise reviewing and developing the personal plans, behavioural strategies, and the communication and health care needs of the service user identified in the body of the report using a person centred approach. 31/05/06 The registered manager must ensure all staff are fully aware of the values of respect, the correct approach to minimising challenges and understanding service users behaviours through the way in which they communication. The registered manager must demonstrate that service users have access to community-based activites whilst staying at the service. The registered must ensure the service users have access to a range of quality foods and choices, alternative to those that they receive at the day service. Please confirm in writing the Commission for Social Care Inspection the action you have taken. 31/08/06 6. YA13 16(2)(m) 7. YA16YA17 16(2)(i) 31/07/06 8. YA18YA19 12(1)(a)(b) 12(2) 12(3) 13(1)(b) The registered manager must ensure the service is fully meeting the physical and health care needs of all the service users in their 30/06/06 Russets DS0000029304.V289394.R01.S.doc Version 5.1 Page 32 care especially those placed for an unspecific length of time. All care must be provided in the way in which the service user prefers. 9. YA34 19(1) (a)(b)(c) All staff records required under Schedule 2 including ancillary staff must be available in the service by the given date. This requirement has been raised for a third occasion 19/04/04 and 28/09/06. The failure to comply with the requirement will result in enforcement action being taken. 10. YA23YA34 19(1) The registered manager must take immediate action to address the situation of ancillary staff working in the service with out POVA and CRB checks. An immediate requirement was issued at the time of the inspection. 11. YA22 22 The registered manager must ensure all relatives/representatives are issued with a copy of the services’ complaints procedure. The registered manager must obtain a copy of the joint authority policy “Protecting Vulnerable Adults”. The registered manager 30/06/06 02/05/06 05/06/06 12. YA23YA40 13(6) 30/06/06 13. Russets YA24YA26 23(2)(p) 30/06/06 Page 33 DS0000029304.V289394.R01.S.doc Version 5.1 must ensure service users are able to control or are assisted to control the temperature of their rooms. The registered manager must provide an action plan on how and when this will be addressed to the Commission for Social Care Inspection by the given date. 14 YA39 24(1) (a)(b)(c) 24(2)(3) The registered manager must develop a robust system for quality auditing the views of service users, relatives/representatives and professionals and forward to the outcome of the quality review report to the Commission for Social Care Inspection. The requirement to seek the views of the service users has been repeated therefore a further failure to comply will result in further action being taken. 15 YA1YA5YA22YA39 24(1)(a)(b) The registered manager 24(3) must ensure all service information and information for seeking the views of the service users is provided in an accessible format to meet their individual sensory and cognitive abilities. 31/08/06 31/07/06 Russets DS0000029304.V289394.R01.S.doc Version 5.1 Page 34 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA24 Good Practice Recommendations The registered manager is advised to keep all cupboards tidy and equipment easily accessible to minimise the risk of staff injuring themselves. Russets DS0000029304.V289394.R01.S.doc Version 5.1 Page 35 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Russets DS0000029304.V289394.R01.S.doc Version 5.1 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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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