Inspection on 28/09/05 for Russets

This inspection was carried out on 28th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 but made no statutory requirements on the home.

Other inspections for this house

Russets 05/07/07

Russets 02/05/06

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 (Social Services) Gatcombe Drive Hilsea Portsmouth Hampshire PO2 0TX Lead Inspector Clare Hall Unannounced Inspection 28th September 2005 10:00 Russets (Social Services) DS0000029304.V254449.R01.S.doc Version 5.0 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 (Social Services) DS0000029304.V254449.R01.S.doc Version 5.0 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 (Social Services) DS0000029304.V254449.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Russets (Social Services) 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) Portsmouth City Council Mr Peter A Charman Care Home 15 Category(ies) of Learning disability (15) registration, with number of places Russets (Social Services) DS0000029304.V254449.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st April 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 day care although most service users attend local day services Russets (Social Services) DS0000029304.V254449.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector undertook the inspection over one day. The acting manager was not present on the day of the visit but the inspector was fully supported by the seniors and other staff on duty. The home does not currently have a registered manager as required by the Care Standards Act 2000. At present there continues to be four residents living at Russets on a long term basis, contrary to the Statement of Purpose, which is difficult for a respite service to manage, although the home is trying to meet their needs as well as they can. This arrangement is inappropriate particularly for the long term residents, but also for those on respite stays. It was stated at this and the previous inspection that these four longer stay residents have been relocated and are due to move to alternative suitable accommodation. The provider will be asked to confirm their plans in respect of this. As identified above, Russets continues to be without a permanent manager and has been for over two years which has resulted in additional demands being placed on the deputy manager who has acted up into this role whilst dealing with the general understaffing and increasing demands on the service. It was stated again on this visit that the manager’s position is being re-advertised. No application has been received by CSCI to register anyone in respect of the service despite this issue being raised with the responsible individual for the service some months ago. There continues to be an unacceptable level of agency staff being used to support the service, leading to difficulties in providing a consistent quality of care. Staff said they are increasing frustrated due to the limitations imposed on their care provision due to lack of permanent staffing and rigid practices of catering and cleaning services. Staff also feel frustrated that they cannot offer more appropriate leisure activities due to financial limitations and lack of staff. These matters will be discussed with the provider. What the service does well: Residents described the service as nice, like a home, staff say hello and ask how you are, it’s like having a holiday.You go up to the counter sit down and the cook does everything for you. One service user said, “Staff are nice and they like people like me and everyone else”, “your clothes are nicely washed and ironed”. Staff spoke of residents with caring attitudes, knowledge, and respect and appeared very committed to ensuring the service users were supported. Russets (Social Services) DS0000029304.V254449.R01.S.doc Version 5.0 Page 6 The cleaning and laundry staff demonstrated a high standard of service during the visit. Though short staffed all requests by the inspector were received with full co-operation and full assistance. Staff felt that the majority of service users coming to Russets enjoyed their stay. What has improved since the last inspection? What they could do better: The home has been without a registered manager for over two years and Portsmouth City Council have failed to submit an application in respect of registering a manager. Without a registered manager there is lack of leadership and issues raised regarding the home’s standards are not being addressed. Russets can only provide limited daily independent living skills opportunities to service users. Services, including meals, laundry and domestic services are generally provided by contractors with no planned involvement of service users on a daily basis. This results in a lack of flexibility, consultation and choice. The service needs to promote greater opportunities for independence and fulfilment for service users. The provider in the absence of a registered manager has not fully addressed the areas of concern that remain outstanding from this and previous visits and the home is still not running in conjunction with its stated purpose. The service provides services to people with learning disabilities in conjunction with high physical disabilities, both respite care and long stay. This must be reviewed and deemed to be in line with it’s stated purpose, as at present it appears to be all things to all people. There is a lack of clarity amongst the staff regarding the function of the home. Employment of permanent staff must be undertaken to meet the intended needs of the service and the admission of residents with high combined needs must be limited, their dependency measured and admissions restricted when suitable levels of staffing are not available as it was established that an increase in the dependency of the service users and the shortage of staff has a direct effect on the home in meeting the needs of the residents. The current clients have mixed needs, which are not compatible in this environment. Further concerns identified at this and on a previous visit were that the staff are not being consistently provided with adequate supervision. Other areas of serious concern identified at this and on a prior visit were that the homes current process for the safe administration of medication is inadequate and had to be improved. Current practice demonstrated that Russets (Social Services) DS0000029304.V254449.R01.S.doc Version 5.0 Page 7 requirements made following a Pharmacy inspection have been ignored and requests for a review of policy has not been undertaken. The provision for activities and meeting the residents emotional and social needs requires further development. All required records in relation to staff recruitment are still not kept in the home and this must be addressed. The service does not undertake adequate steps to seek the opinions of those using the service. There is no quality performance review undertaken and the opinions of service users are not sought adequately. It is of significant concern that the service fails to promote the principles of “Valuing People” , government guidance aimed at developing meaningful services and lifestyles for people who have a learning disability. 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 (Social Services) DS0000029304.V254449.R01.S.doc Version 5.0 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 Russets (Social Services) DS0000029304.V254449.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 5 The homes statement of purpose is not reflective of the actual service being provided to the people for whom the service is intended and consequently and the needs of the service users are being compromised. The process for admission, the stated purpose of the home and the specific needs of individuals must be reviewed. EVIDENCE: The home is still accommodating 4 long-term service users at Russets, which is not in accordance with the statement of purpose as a respite care facility. This matter has been raised previously. Staff reported that residents using the respite facility have a range of needs from those with high physical needs and those who are quite active with a mild learning disability. Accommodating residents on a long-term basis and those requiring respite further complicates this. Staff felt the situation demanding when trying to accommodate the range of identified needs of residents. The current combination of needs is not compatible and the home must continue to address this as the individual needs of current long/short- term stay service users are not being met. Files still lacked contracts for service users and this was stated at the last inspection as having been under review. Russets (Social Services) DS0000029304.V254449.R01.S.doc Version 5.0 Page 10 The reviewed statement of purpose and service user guide, which was also discussed with staff during the visit, stated the home to be driven by the needs, abilities of the service users and that they are committed to achieving their stated aims and objectives. It states that Russets provides short-term care and it aims to respond to Person Centred Planning approach and to deliver services based on “ordinary life” principles and the promotion of independent living. This was not evident in practice nor felt by staff to be reflective of the service. This will be further discussed throughout the standards. Russets (Social Services) DS0000029304.V254449.R01.S.doc Version 5.0 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 8 The care planning process is poor, including the individual plans themselves and the system for reviewing these. The inspector felt the lack of strong management contributes to this. The impact on the long term residents of having people staying in their home short term and therefore constantly coming and going has to be acknowledged. Service users are neither consulted with nor participate in all aspects of life in the home. EVIDENCE: Staff explained that meeting the needs of the long and short term residents, including those with high needs requiring 1:1 support and those with mild learning disability on short term respite and those residents on long term stay was very difficult. The needs of the long stay clients for the promotion of independent living skills and monitoring of health were not being met. It was not evident through the care plan documents and discussions with the staff that the service users are enabled to take control of their own lives. The Russets (Social Services) DS0000029304.V254449.R01.S.doc Version 5.0 Page 12 care plan documents were in the process of review by the last manager over two years ago and viewing these documents the residents still had the old and new documents in their files. Neither of which had been completed in adequate details where other information has been overly repetitive. The care plan did not fully reflect the needs, aspirations and goals of the individual and were in some instances not updated reviewed or completed. The details for the key worker related to staff who had left and daily choices preferences had not been documented. The standard of care documentation in general was very poor and staff did agree stating that due to a lack of permanent staff this was not being addressed. There was no regular daily recording of what service users were doing or what individual needs had been met. Staff informed the inspector that they do not implement any type of feedback process or currently offer service users with the opportunity to participate in the day to day running of the home and to contribute to the development and review of policies, procedures and services. The documents and information provided i.e. statement of purpose and service user guide need to more accessible to the service users and provided in a suitable format. This also needs to be addressed with regards to information about its policies, procedures, and activities and services. Russets (Social Services) DS0000029304.V254449.R01.S.doc Version 5.0 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12 and 17 Practices within the home do not enable service users to have opportunities to maintain and develop independent living skills. The provision of food is inappropriate, inflexible and does not meet the needs of the service users. The activities arranged by the home are not formally organized and recorded, resulting in an ad hoc provision that does not meet the needs of the residents. EVIDENCE: It was discussed that most of the service users having respite care at the Russets attend day sevices. Those who were not attending any daytime activities were confirmed to be remaining at the home by choice. One service user clearly stated she regarded Russets as a holiday and it had been agreed she doesn’t attend day services when staying there. Russets (Social Services) DS0000029304.V254449.R01.S.doc Version 5.0 Page 14 Through discussion with staff and observing the activity of service users it was identified that service users are not given the opportunities to learn and use practical life skills. Staff felt a better relationship with day services could lead to better support of service users when identifying and achieving personal goals and identify valued and fulfilling activities. Assessment records held did not identify that regular activities are undertaken. The assessment of an individual’s social needs was not identified in records kept to demonstrate these needs had been addressed or met. Discussions indicated that, as the residents are staying for respite it is difficult to forward plan activities and that in recent weeks up to six agency staff have been employed at weekends, which makes it impossible for the senior to leave the premises and organize activities. One staff member stated that she had volunteered to become an activity co-coordinator for the home and that this was being considered. Other staff stated that the homes activities need to be more team led, supported and planned. Staff felt that the catering provision within the home is rigid and does not allow for flexibility, and from observation the inspector would strongly endorse this. The system for the provision of food and drinks is not led by the needs of the service users. Service users are unable to have choices to meal times and cannot participate in daily living skills by undertaking budgeting, shopping for foods and food preparation as the home has its meals provided through a catering service which provides reheated cold provisions at set times. It was observed that special individual items of food had been provided for service users by staff as a snack when identified. The menu indicates that service users are offered a choice of food but choices must be stated the evening before. Staff state that if a resident is admitted after the choice is made then there would not be an available choice. All food is cold packed and all meat products reconstituted. The home is now being provided with some fresh vegetables, but this is a recent development. Staff state the service offered by the catering service contracted to provide meals is rigid and unsuitable. Staff also described the food as “not nice” and needing improvement. The same company provides the food at day services, and a caterer informed the inspector that the long stay service users have been eating cold packs every day of their stay as they also get the same meals provided. At home and at day service. Snacks are limited as staff do not have access to the main kitchen and the satellite kitchen has limited provisions. Staff cannot spontaneously cook a meal with a service user or do a cooking activity without it incurring costs, as there are no provisions for this. So the service users are not actively supported to help plan, prepare and serve meals. Staff stated that service users cannot Russets (Social Services) DS0000029304.V254449.R01.S.doc Version 5.0 Page 15 choose when to eat, as the evening meal is served at five o’clock by the contractors. The service users guide for the home states, “there are three kitchen areas where people are able to make snacks or drinks or where meals can be prepared and cooked either through choice or as part of a programme”. This was neither evident nor supported by staff and service users. One service user showed the inspector a plastic bottle she fills up to take to bed. “It’s so hot at night.” she explained. Through further discussions with staff it was discovered that the upstairs kitchen is kept locked and during the night the service user needs to ring for the night staff if they need a drink as glasses and drinks cannot be accessed upstairs and are not provided for in rooms. The two satellite kitchens providing tea and coffee making facilities and limited food stuffs are not always open .The upstairs kitchen is kept locked. Service users stated they do not make their own drinks. One service user said “staff bring in a big tray of tea”. “The staff make the tea and offer them to everyone”. Care plans did not identify personal individual goals relating to daily living tasks that service users are promoted to undertake. The situation regarding the provision of food and drinks is not acceptable in relation either to the short stay or long stay residents and must be addressed as a matter of urgency. This will be further discussed with the provider. A service user informed the inspector that she can do puzzles watch TV and can go out into the garden for the fresh air. Conversations with staff and service users identified that the relationships are supported and contact with friend and family encourage. During the visit staff were observed entering service users’ bedrooms with the individual’s permission. One service user wished to show the inspector her room, which was locked, and the key held by her. It was confirmed by staff and residents that staff do not open service users’ mail without their agreement but will assist them should they request it in reading letters sent to them. Service users in the Russets do not have responsibility for housekeeping tasks (e.g. cooking, cleaning rooms and common areas, laundry, maintaining gardens) even though it is specified in the Service Users’ Guide that independent living skills will be promoted. Russets (Social Services) DS0000029304.V254449.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 The staff procedure for the administration of medicines is unsafe. Guidance given by the CSCI pharmacy inspector has been ignored. Policies requested following previous visits have not been put in place. EVIDENCE: One-service users discussed her forthcoming move from the home. This service user was able to attend a meeting and discuss her preferences for placement and chose not to go home Following the last inspection it was arranged for a pharmacy inspection to be undertaken due to concerns identified in the home practice for administering and recording medication. A pharmacy inspection has been undertaken and requirement made to improve safety of practice. On the day of the inspection it was observed that the practice for filling dosset boxes, which the service was requested to stop undertaking, was continuing, and that policies required to be put in place with regards to risk assessment for the safe practice for self-administration of medicine is still not available. The homes new statement of purpose states that the home will carry out careful procedures for the administration of medicines. This was not evident. Russets (Social Services) DS0000029304.V254449.R01.S.doc Version 5.0 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Staff are aware of abuse procedures. Service users views regarding their respite stay are not sought. The home has a complaints procedure but it needs to be in a more service user-friendly format. EVIDENCE: The Russets does not have appropriate systems for hearing and responding to issues raised by service users. Key workers do not undertake Service user meetings or individual consultations and staff state they have their reviews by the care workers, which address any concerns every three months. As the home provides respite care the service ought to monitor whether the service user feels their needs have been met during this period. Good practice would be to undertake discharge /exit interviews. The complaints procedure needs to be more accessible and provided in a more suitable format for this client group. Service users spoken to stated they would tell the lady in the office if they had a problem or wanted to complain. Staff stated that abuse training has been provided and described how they identify signs of abuse and encourage people to voice concerns so they can be addressed appropriately through abuse procedures. Russets (Social Services) DS0000029304.V254449.R01.S.doc Version 5.0 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, and 30 The home is clean, light and airy and well maintained. The physical environment is suited to respite care and support of service users with physical disabilities. It is not, however suited to people who are staying in the longer term. EVIDENCE: The inspector toured the premises. Facilities are appropriate for residents who are accommodated for short periods, for whom the building was intended. However for residents who are longer term they are not homely. The facilities include a lounge area to the upper floor and two on the ground floor. There is an activity room on the ground floor where service users can play games and there is a computer but this is not on line. There is a pay phone on the ground floor. All rooms are single with en-suite facilities. They were clean light and airy. There are overhead hoists in the ground floor bedrooms, bathrooms and shower room. The building does have good wheelchair access and has a shaft lift. There is a call system in all the rooms. Russets (Social Services) DS0000029304.V254449.R01.S.doc Version 5.0 Page 19 There is a large storage area on the ground floor for wheelchairs and portable hoists. The general maintenance of the building is of a good standard and all areas well decorated and maintained. The upstairs lounge area lacks electrical equipment and the curtains are not in place as these have been removed or damaged by a service user. A strategy must be developed to ensure the area remains appropriately furnished and that curtains are replaced as soon as they are removed. One service user accompanied the inspector to the upper floor on request and gave permission to view her room, which was nicely personalised with cards pictures and personal electrical items. All clothes were stored clean and ironed appropriately and the service users stated she was very happy with her room and bathroom facilities apart from her bathroom light was a bit bright. The laundry facilities are well sited and have appropriate hand washing facilities. The laundry floors are impermeable with finishes that are readily cleanable. Maintenance staff demonstrated regular water check certificates for chlorination and testing for bacteriology and the monitoring records for the temperature all of which were within safe limits. The domestic supervisor stated that it was being investigated where staff could undertake appropriate training in relation to their role including infection control training as this was identified as lacking at the last visit. The staff did inform the inspector that the under floor heating makes the home very hot. The individual thermostats are not accessible to residents and care staff and have to be manually adjusted by the home’s maintenance staff if requested. The staff did state that a water dispenser or cooler would be beneficial for both staff and service users. The home does have one but it is restricted for use by the catering and domestic contact staff only. Russets (Social Services) DS0000029304.V254449.R01.S.doc Version 5.0 Page 20 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 and 35 The numbers of permanent staff on duty do not meet the needs of the service and the home does not store on the premises the necessary records required. The home does not keep accessible appropriate records to demonstrate that staff are provided with the training necessary to enable them to fulfil their role. EVIDENCE: The home has had an acting manager for over two years and the service does not employ sufficient permanent staff for the service it provides, relying heavily on agency staff. Staff confirmed that training provision is improving and new staff stated they are undertaking the TOPPS Induction and foundation training in support of the Learning Disabilities Award Framework following a visit by the council to introduce it to staff. Unfortunately the member of staff involved in supervising this was not available nor the documents/records available to support this. Training records did not identify the above. The records and discussions with staff identified that supervision for staff has not been undertaken regularly. Records would indicate that the home does not meet the required numbers of staff trained in care (NVQ). Russets (Social Services) DS0000029304.V254449.R01.S.doc Version 5.0 Page 21 Staff discussion and training records identified that training in manual handling, administration of rectal diazepam, health and safety, first aid and food hygiene had been undertaken as well as training in coping with challenging behaviour, case recording, epilepsy and fire safety. It was identified that records were now being kept to identify the training of staff and these records needed to be regularly reviewed to identify training refreshers. Records indicated that some staff had not undergone the mandatory training requirements and regular updates. The duty rota and discussions with staff identified that recently up to six staff employed on one day were agency staff. Senior staff were not getting the support of other senior permanent staff but were being supported by health care workers and agency staff. Staff did state that up to seven health care workers have recently been recruited but have not yet started their employment and that when using agency staff they were generally the same good quality staff that are supplied, therefore the residents are familiar with them. Staff said that at times the staffing level is sufficient, however at other times the dependency of the service users and the incompatibility is such that individual needs cannot be met. The needs of long and short term residents differ also. One agency staff member was observed undertaking an impromptu cooking session of making pavlovas with two residents after going out to purchase food items. Staff notices and recorded minutes seen indicate that regular staff meetings take place (minimum six per year) and are recorded and actioned. Staff recruitment files are still not kept on the premises and therefore cannot be audited. It cannot therefore be evidenced that the appropriate recruitment procedures are undertaken. Russets (Social Services) DS0000029304.V254449.R01.S.doc Version 5.0 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, and 39 Issues of concern raised through inspection reports are not being addressed. The home does not have a registered manager and Portsmouth City Council have not submitted an application in respect of this. There is a significant lack of permanent staff, which further affects the care provision and frustrates the staff employed. There is no process for monitoring service user satisfaction. EVIDENCE: The home has been without a registered manager for over two years and the Portsmouth City Council has failed to submit an application in respect of registering a manager. Without a permanent and strong manager there is lack of leadership and issues raised regarding the homes standards are not being addressed. The home lacks a manager who can communicates a clear sense of direction so that staff and service users have a common understanding to the Russets (Social Services) DS0000029304.V254449.R01.S.doc Version 5.0 Page 23 aims and purpose of the home. The staff were very complimentary about the current deputy manager and stated that they felt supported and that issues raised internally were addressed. They also stated that they felt their views and opinions were considered. The current services have been described by the staff to conflict with those stated by the provider and written in their stated intended purpose. Staff describe the home as being the equivalent to hotel services where service users are not expected to undertake household domestic or daily living tasks and they do not address issues relating to skills due to the short stay of the service user where as other staff and the statement suggests that in dependent living skills will be and are promoted as this is an aim of the intended service. Due to the lack of permanent staff care plan assessments and documents and their reviews have been neglected. Service user opinion is not sought and satisfaction surveys not undertaken. Information provided has not been thoughtfully developed to be appropriate to this service user group and due to the mix of the needs of service users through being respite and long stay neither group are having their needs met appropriately in this setting. . The staff stated that they had stopped any quality monitoring systems and that they had not sought the views of service users. There are no systems in place to measure success in achieving the aims, objectives and statement of purpose of the home. One service user stated she has her money kept by staff in the office and it is returned to her when she leaves. Random checks were undertaken on monies held for service users and were found to be correct. Russets (Social Services) DS0000029304.V254449.R01.S.doc Version 5.0 Page 24 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 1 X 2 X 1 Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X 2 X X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 X X X X 2 LIFESTYLES Standard No Score 11 1 12 2 13 X 14 2 15 X 16 2 17 Standard No 31 32 33 34 35 36 Score X 2 X 1 2 2 CONDUCT AND MANAGEMENT OF THE HOME 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Russets (Social Services) Score X X 1 X Standard No 37 38 39 40 41 42 43 Score 2 2 2 2 2 X X DS0000029304.V254449.R01.S.doc Version 5.0 Page 25 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard 20 Regulation 13(2) Requirement The Responsible Individual must ensure that all staff undertaking the administration of medication are trained and competent to do so and give medications according to the Royal Pharmaceutical Guidelines. The current procedure for the recording, receipt, and administration of medications is unsafe and requires urgent review and continuing audit. Appropriate guidance must be given to staff regarding covert administration of medications and guidance for crushing of medication. This requirement has been raised on a previous visit and has not been met. Failure to address the above may result in enforcement action being taken The Responsible Individual must ensure that the service users social needs are met through the provision of adequate activities and leisure. A plan of action for the provision of regular activities DS0000029304.V254449.R01.S.doc Timescale for action 31/10/05 2 14 12,16 31/12/05 Russets (Social Services) Version 5.0 Page 26 appropriately staffed with an appropriate budget must be forwarded to the CSCI by the given date. This requirement has been raised on a previous visit and has not been met. Failure to address the above may result in enforcement action being taken. The home continues to 28/09/05 accomodate service users on a long term basis. Service users must only be admitted with the statement of purpose, that is, for short term care. This will be further discussed with the providers. This requirement was raised in April 2004. 30/11/05 All staff records required under Schedule 2 must be available in the Home by the given date. This requirement has been raised again and it was stated in the report of the 19.04.04 that failure to comply with this requirement will result in the registration authority taking enforcement action. This will be further discussed with the provider. All staff employed must be 31/12/05 provided with the appropriate training to undertake the work they are employed for. This must include LDAF-accredited training,vocational qualifications in care,and competency in administration of medication.This requirement also applies to domestic staff and their being an appropriate level of training provided in infection control and competency in using equipments and receipt of adequate DS0000029304.V254449.R01.S.doc Version 5.0 Page 27 3 1 16 4 41 19 5 30 19 Russets (Social Services) 6 36 18(2) induction. Records must be kept to demonstrate compliance. This standard has been partially met and will be monitored at the next inspection. All staff must be appropriately supervised. This requirement has been raised on a previous visit and has not been met. Failure to address the above may result in enforcement action being taken. All staff, permanent and agency, including domestic and ancillary staff must have a formal, recorded supervision session by the given date, and at least every eight weeks thereafter. 30/11/05 7 3 18(1) 8 9 1 6 5 15,17 31/12/05 A review of the dependency of the clients must be ongoing and appropriate numbers of permanent staff employed to meet service users needs.The occupancy /vacancy level of the home must be adjusted accordingly when there are incompatabilities of service user groups,individuals with challenging behaviour and residents with high physical needs.The home can not admit unlimited numbers of clients with combined learning disability with high physical needs. You are required to inform CSCI by the given date of the action you have taken in respect of this matter. The service provided must reflect 30/11/05 the statement of purpose for the home. Care documents must be 30/11/05 reviewed,updated, completed appropriately and reflect the needs, aspirations and goals of DS0000029304.V254449.R01.S.doc Version 5.0 Page 28 Russets (Social Services) 10 40 18 11 39,8 24 12 38,8,16 16 13 17 16(i) the individual. All must be reviewed by the given date. Documents and other information for service users must be provided in a suitable format by the given date. The opinions, preferences and feedback of services users must be sought and considered and service user must be given the opportunity to participate in the day to day running of the home. Please confirm in writing by the given date the action you have taken by the given date. Practices within the home must allow / enable service users to have opportunities to maintain/ develop independent living skills. The registered person must promote service users’ health and wellbeing by ensuring the supply of nutritious, meals at flexible times. Service users must be actively supported to help plan, prepare and serve meals. Drinks must be available at night. This will be further discussed with the provider. An application must be received for Portsmouth City Council in respect of registering a manager for the Home. Terms and conditions of stay must be provided to service users. 30/11/05 30/11/05 30/11/05 31/12/05 14 1 8.1 31/12/05 15 5 5(1) b 30/11/05 Russets (Social Services) DS0000029304.V254449.R01.S.doc Version 5.0 Page 29 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 17 Good Practice Recommendations Service users and staff to have access to cold water at all times, and consideration should be given to the provision of a water cooler. Russets (Social Services) DS0000029304.V254449.R01.S.doc Version 5.0 Page 30 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 (Social Services) DS0000029304.V254449.R01.S.doc Version 5.0 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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