Inspection on 06/03/07 for Sarum House

This inspection was carried out on 6th March 2007.

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 no outstanding requirements from the previous inspection report, but made 26 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sarum House 24/02/09

Sarum House 31/01/08

Sarum House 18/09/07

Sarum House 07/02/06

Sarum House 22/06/05

Sarum House 13/12/04

Sarum House 19/05/04

Sarum House 16/01/03

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 Sarum House Beehive Corner Old Sarum Salisbury Wiltshire SP4 6BL Lead Inspector Alyson Fairweather Key Unannounced Inspection 6th March 2007 10:00 Sarum House DS0000032418.V330197.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Sarum House DS0000032418.V330197.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Sarum House DS0000032418.V330197.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sarum House Address Beehive Corner Old Sarum Salisbury Wiltshire SP4 6BL 01722 335283 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) Wiltshire County Council Leonard William Clarke Care Home 14 Category(ies) of Learning disability (10), Learning disability over registration, with number 65 years of age (2), Physical disability (2) of places Sarum House DS0000032418.V330197.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th February 2006 Brief Description of the Service: Sarum House provides personal care and accommodation for 15 people with a learning disability. The home is operated by Wiltshire County Council, and is on the outskirts of Salisbury. A nearby park and ride scheme offers regular bus journeys into the city, and Sarum House also has its own transport. The home is an older property, although good efforts have been made to maintain and enhance it. There are two floors for resident accommodation, and all residents have single bedrooms. Some of the residents on the top floor who have relatively small bedrooms also have their own sitting rooms. The home has no lift, making the upper floor unsuitable for anyone with a physical disability. Baths, showers and toilets for general use are on both floors. Communal areas include a ground floor games room. Sarum House DS0000032418.V330197.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over one day in March. Several residents and staff members were spoken to, as well as the team leader and the home’s service manager. The registered manager was absent at the time. Various documents and files were examined, including care plans, risk assessments, health and safety procedures, staff files and medication records. Ten residents and four family members responded in writing to our questionnaire. We also received comments from a senior social worker and an independent consultant who is helping residents manage planned changes to the service. These changes will mean that some people will be moving from residential accommodation to more independent, supported living, while some may still remain in registered accommodation. The house is currently made up of two floors. The downstairs part of the home houses some older, more frail residents and some people who have lived there for a long time. The upstairs part of the house is used by the residents who have moved from Wiltshire County Council’s training and assessment unit which has closed down, as well as three of Sarum House’s more able residents. Fees vary from £51.65 to £98.60 per week at Sarum House. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: What has improved since the last inspection? Residents are encouraged to be as independent as possible. Support is given to those people who wish do their own laundry or cooking. Support for those Sarum House DS0000032418.V330197.R01.S.doc Version 5.2 Page 6 more dependent residents was seen to be given in a patient and relaxed manner, with good staff-resident interactions observed. One resident said: “I am happy at Sarum House. We laugh and giggle”. What they could do better: The home’s Statement of Purpose was out of date, and the information which is given to prospective residents and their families must be improved as this will help people to choose if they want to live in Sarum House with a fuller knowledge of its’ facilities and services. When the home registered more rooms with the Commission for Social Care Inspection (CSCI) the registration inspector asked the manager to update the Statement of Purpose. This had still not been done. It was concerning to note that the Statement of Purpose also states that the manager has his Registered Manager’s Award (RMA). It was confirmed during the inspection by the service manager that this is not the case, and that the RMA has not yet been awarded. It is a serious matter to misrepresent the qualification of any member of staff, and this information must be removed immediately. The Statement of Purpose must be amended and must contain accurate, up-to-date information about staff qualifications. The manager must provide evidence of the progress of his Registered Manager’s Award. There have been several new residents who have come to stay at Sarum House. They transferred from one of Wiltshire County Council’s independent living schemes which had closed down. When they moved in, these residents came with the assessments from their old living accommodation, as well as some of the staff with whom they were familiar. The move from independent living to the rather more restrictive environment of a residential home, where some of the residents are frail and more dependent on physical care can be very stressful for some people. However, no formal assessments had been done by the home to ensure that they would be able to meet the needs of the new residents. The manager has been asked to make sure that all potential residents have an assessment done before they move into the home in order to ensure that their needs can be met. Residents’ support plans were in a state of confusion, with some information not being recorded and few reviews carried out. Some residents had no risk assessments on file. The lack of risk assessments means that there is no record of how these risks are to be managed, or what the potential consequences could be for the residents. Each resident must have an up to date support plan and risk assessment on file, and these must be reviewed on a regular basis. Medication administration practice must be improved. Medical guidance must be sought regarding the use of the PRN medication for one specific resident, and the reasons for giving any resident medication labelled PRN must be recorded. All medication which is not used or needed must be returned to the Sarum House DS0000032418.V330197.R01.S.doc Version 5.2 Page 7 chemist. All residents who use medication must have a risk assessment on file, and staff must always sign the Medication Administration Record when administering medication. These procedures will help to make sure that residents are not put at risk. There was no evidence of any recent residents’ meeting, although staff were sure that they had taken place. Of the four families who wrote to us, three were aware of the home’s complaints procedures and one was not. There was no complaints folder ready in the home for inspection, although staff were sure that there had been one previously. Staff reported that there had been no complaints made to them. One residents file had a copy of the home’s old complaints form on it, and staff reported that they had not been recently issued with any new ones. The home has been asked to make sure that a file of any complaint made to the home is kept ready for inspection. The complaints procedure, when updated, must be issued to all residents. Staff training records were absent, making it impossible to verify that staff were receiving appropriate training for their job. Some staff files did not contain references, evidence of medical checks or evidence of checks made by the Criminal Record Bureau (CRB) or the Protection of Vulnerable People (POVA) register. This means that residents could be at risk by having staff with no checks and no training specific to the job they do. The manager must ensure that evidence of staff qualifications is sent to the Commission for Social Care Inspection (CSCI) and that all staff files contain the appropriate recruitment information. Supervision sessions had not been held for some time. One staff member had only had one such session in two years. Supervision is one method by which the manager can discuss with staff their work role and any issues arising at work. These sessions should be completely confidential and recorded in their individual file. The manager has been asked to make sure that all staff have formal, recorded supervision at least six times in a year. Part of the responsibility of the senior managers of Wiltshire County Council’s registered care homes is to visit the home on a monthly basis and to write a report about what they looked at and to whom they spoke. This is to ensure that they are monitoring both the health and safety of the residents as well as the quality of the service offered. There were none of these service manager reports available for inspection. The manager has been asked to make sure that these visits are conducted on a regular monthly basis and that a copy of the report is sent to the Commission for Social Care Inspection (CSCI) until further notice. The home’s Statement of Purpose says that Wiltshire Fire Service visits on a regular basis to inspect records and fire prevention equipment. However, in the pre-inspection questionnaire the manager reported that they do not visit now. It was therefore concerning to find that the fire records were in a state of disarray. There was no named fire officer in the fire book, although the home’s procedures say this is necessary. Staff thought that it might be the manager, but there were no records to evidence this. There was no evidence of any fire Sarum House DS0000032418.V330197.R01.S.doc Version 5.2 Page 8 drills taking place, and no evidence that some of the regular household checks had been done. There was no current premises fire risk assessment available. The manager has been asked to make sure that a fire risk assessment is carried out for the premises, and that fire drills are carried out according to the homes procedures, and evidence kept of these drills. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Sarum House DS0000032418.V330197.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sarum House DS0000032418.V330197.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Prospective residents do not have enough information to make a choice about whether they would like to stay in the home. Their needs, hopes and goals are not assessed and recorded before they move in to the home. EVIDENCE: The Statement of Purpose & Service User Guide has not been updated since April 2006, although there has been a change in the home’s registration. This has meant an increase of rooms so that the service can accommodate fifteen residents. After registration in December the manager was asked to update the Statement of Purpose by the CSCI registration inspector. Of the ten residents who wrote to us, seven said they had enough information about the house before they moved in, but three people said they did not. One said that he only saw his bedroom after he arrived at the home. “I saw my room when I got here”. The Statement of Purpose also states that the manager has his Registered Manager’s Award (RMA). It was confirmed during the inspection by the service manager that this is not the case, and that the RMA has not yet been awarded. Sarum House DS0000032418.V330197.R01.S.doc Version 5.2 Page 11 It is a serious matter to misrepresent the qualification of any member of staff, and this information must be removed immediately. The Statement of Purpose must be amended and must contain accurate, up-to-date information about the service on offer. There have been several new residents who have come to stay at Sarum House. They transferred from one of Wiltshire County Council’s independent living schemes which had closed down. Not all of the people living there were ready to move to independent living and needed to have somewhere to live. When questioned, staff felt that the move from more independent living was perhaps a “backward step”. They also had less personal money now. Staff are working hard with these residents to try to maintain their self-caring skills. When they moved in, these residents came with the assessments from their old living accommodation, as well as some of the staff with whom they were familiar. The move from independent living to the rather more restrictive environment of a residential home, where some of the residents are frail and more dependent on physical care can be fairly daunting. However, no formal assessments had been done by the home to ensure that they would be able to meet the needs of the new residents. The manager has been asked to ensure that all potential residents have an assessment done before they move into the home in order to ensure that their needs can be met. Sarum House DS0000032418.V330197.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents’ support plans do not reflect their changing needs and personal goals. People are encouraged to make choices and decisions about their own lives. Infrequently reviewed risk assessments means that residents are potentially at risk. EVIDENCE: The format of resident’s support plans is in the process of being changed. The content of the ones in current use was variable. Some had clearly not been reviewed and some were missing dates. Of the three support plans examined, two were dated May 2006 and had not been reviewed since then. Some of the support plans had not been dated or signed. Staff reported that support plans were reviewed regularly, although perhaps not recorded as such. It is recommended that a record is made of the date when a support plan is reviewed, even if there is no change to it. Sarum House DS0000032418.V330197.R01.S.doc Version 5.2 Page 13 One support plan headed “Cultural/ Spiritual” said the person had “No cultural needs”. There was a typed section which said that this person attends church with the scouts, but was not a regular churchgoer. This had been scored out with a pen and dated 4th March 2006. There was no date to indicate when the original entry had been typed. It is recommended that this area is explored in further detail in order to find out people’s likes and dislikes. There were more signs of review of the support plans of people who had moved from the training and assessment unit. Some residents were being supported to complete their own support plans. Both the social worker and the independent consultant who wrote to us said that if they gave any specialist advice it was incorporated in the resident plan, although it was difficult to see where this had been done. The staff who work in the upstairs part of the home complete monthly summaries of residents’ progress. This is a legacy of the way staff in the closed unit used to keep records. However, one file examined showed that there were no monthly summaries available after July 2006. The registered person has therefore been asked to make sure that all residents’ support plans are reviewed on a regular basis and contain accurate, up-to-date information. Residents are supported to make decisions about their own lives with guidance from the staff. Some are able to manage their own finances, and some have family involvement. Some residents choose to go to day services, although local cut-backs have affected how often this takes place. Of the ten people who wrote to us, six people said they always made decisions about what they did each day”, and four said they sometimes did. One resident said; “My keyworker helps me choose”. There was some confusion about where residents’ risk assessments were kept. Some were on their personal files and some were in a separate file in the office. Some risk assessments regarding the use of a manual hoist for bathing and another relating to going swimming were current and had recently been reviewed. However, some risk assessments had not been reviewed for a lengthy period, and some had not been signed or dated. One risk assessment on a resident’s file talked about the risks of flying. This was dated September 2005 and related to a time when the resident actually went up in a plane. It was no longer relevant. The same resident has a risk assessment on file about being careful when using hot liquids in flasks. This was also dated 2005. When asked about this, the team leader said that this was now out of date as the person doesn’t actually take a flask anymore. There was a risk assessment on file about the use of a kettle which was no longer being used. Another female resident had a risk assessment on file relating to her potential inappropriate behaviour towards a male member of staff. When questioned further about Sarum House DS0000032418.V330197.R01.S.doc Version 5.2 Page 14 this, the service manager said that this was no longer relevant as the staff member had since left. The registered person has therefore been asked to make sure that all resident’s risk assessments are up to date and relevant to their current needs. It is recommended that these risk assessments are kept alongside the individual’s support plans. It is also recommended that all residents’ risk assessments are written using the same format. Sarum House DS0000032418.V330197.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social and leisure activities are varied and tailored to individual need, although some people reported that if staffing levels were improved they would like to do more. People have as much or as little contact with family and friends as they wish, and are encouraged and supported by staff. Residents’ rights are respected and responsibilities recognised in their daily lives. They are offered a healthy diet, and those who self-cater are encouraged to use healthy options. EVIDENCE: Residents are encouraged to develop and maintain their independence as much as possible and they can come and go as they wish. Some people have supported work and one resident works in the local Mencap shop. One resident goes to Evergreens for crafts and likes tabletop games, dominoes and potting plants. Another goes to Elizabeth House and likes football, sports, computers and swimming. This person also likes to visit the people upstairs in the training Sarum House DS0000032418.V330197.R01.S.doc Version 5.2 Page 16 and assessment unit. Some residents use the local park and ride bus independently. Another resident has her own bicycle which she uses as transport. Sarum House has its own transport available, and some residents have enjoyed trips outside the home. These have included going to the theatre, cinema, going out for meals, visiting local wildlife parks and zoos and going to the New Forest. Other activities provided by the home include a games room, videos and computer games. However, staff and residents reported that there were often not enough staff to be able to support residents in activities. One resident was being funded for one-to-one care but there were still times when he was unable to be accompanied when he wanted to go out. One person wrote to us that he could go out at the weekends “sometimes” if there were enough staff. He said he would like to go to the football with his keyworker more often. The home’s own quality audit reported that the local Community Team for People with Learning Disabilities (CTPLD) said that feedback from residents during the review process was generally positive, except around the issue of day activities and the loss of some time spent at Sarum Centre. It is recommended that consideration should be given to spending more time supporting residents with individual activities. Friendships both inside and outside the home are encouraged, and staff support links between residents and their family and friends, although the frequency of contact varies depending on the individual circumstances. Residents are free to visit friends outside the house at any time, and can entertain and choose to see who they like either in the privacy of their own bedrooms or in the communal areas available. All four relatives who wrote to us said they could visit your relative in private. Staff encourage and support residents to develop the skills which will be needed by residents who wish to move into less supported accommodation, and the people who live upstairs are somewhat more independent. They do their own cooking, and cleaning and maintain their own rooms. Support is given to those people who are less able to do domestic chores such as shopping, cooking and laundry. The food provided in the home was of a good quality, with a good supply of fruit and vegetables available. A wide variety of eating routines are catered for, and staff were obviously aware of people’s likes and dislikes. Healthy eating options are encouraged, and records are kept. The upstairs and downstairs parts of the home have separate arrangements for cooking. Downstairs the food is prepared by staff for residents and a full menu is kept of what is on offer each day. Residents contribute to menu planning by telling staff what they would like to eat. The upstairs part of the house is where the people who moved from the training and assessment unit live. They make their own Sarum House DS0000032418.V330197.R01.S.doc Version 5.2 Page 17 arrangements regarding food preparation, and each make a financial contribution to a food budget. The residents take it in turn to cook for each other. The menus showed that the main meal is usually in the evening, except at weekends. Sarum House DS0000032418.V330197.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The personal care needs of residents are written in care plans so that they can receive support in the way they need and prefer. Their physical and emotional health needs are not always recorded, making it difficult to assess if they are met. The home’s poor practice in medication recording means that residents are potentially at risk. EVIDENCE: All residents have support plans for any personal care required. The information contained in them is gathered from the community care assessment, the home’s own assessment and staff knowledge of the residents. People have guidelines in place which say how they like to be helped to get washed and dressed. Two people need support with bathing, and one uses a hoist. A risk assessment is in place for this. There is a good gender mix of both male and female keyworkers. All residents are registered with a GP whilst living in the home, and all other medical professionals are seen as and when required. This varies according to Sarum House DS0000032418.V330197.R01.S.doc Version 5.2 Page 19 the needs of individuals. The home has good links with local learning disability teams, and can call for support if any crisis periods arise. All residents attend reviews on a regular basis, accompanied by staff, and support plans can be amended at this time. One file checked had received guidelines from a clinical psychologist on how to manage obsessional behaviour. However, one resident who has mild epilepsy had no documentation on epilepsy management in his file. This means that staff may be unaware of the best way to look after them in the event of a seizure. The home must ensure that this is completed. The home has a policy in place for all medication, and all staff have medication training when they first start work. Medication is kept in a locked trolley in a locked room on the ground floor. Whilst checking the medication administration record (MAR) it was noted that there was a gap where the signature of the person administering medication had failed to sign. The home must ensure that staff always sign the record when administering medication. One resident was currently experiencing a period of mental ill-health and was refusing medication. This medication was put in a pot and kept in the medication trolley ready to return to the chemist. This was labelled as “Tuesday”. It is recommended that any dropped or refused medication has the full date recorded. Another resident had been prescribed paracetamol on an “as required” basis (PRN). This medication was dated October 2005. The PRN sheet accompanying it was dated 2003, and said that it should be given “for pain” There was no evidence that this had been reviewed or why the resident would be suffering pain. The medication had been given to the resident on a recent occasion, but no reason given as to why. The home must ensure that a medication review is held for the use of PRN paracetamol for residents who have not recently needed it. The home must also ensure that the reason for giving people PRN medication is recorded. There were various other errors discovered whilst checking the home’s medication systems. There was old medication which had been due to be returned to the chemist because the resident now receives it in a blister pack and there was no risk assessment on file to indicate the support which was given to people who want to look after their own medication. The home has been asked to ensure that all medication which is not needed is returned to the chemist and that all people who need help with their medication, and those who look after their own, have a risk assessment completed. It is also recommended that all medication due to be returned to the chemist is stored together instead of on different shelves, and that a regular stock check is made of all the medication in the home, and that a record is kept of this check. Sarum House DS0000032418.V330197.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There was little evidence that residents feel their views are listened to and acted on. Lack of evidence of training, and the particular instance relating to one resident means that people are at risk from potential abuse. EVIDENCE: All ten residents who replied to our questionnaire said that they knew who to talk to if they weren’t happy and all said they knew how to make a complaint. Some said that they would speak to the manager or their keyworker. However, the questionnaires, when they were returned, were all signed by staff and the manager, making it impossible to gauge if this is an accurate response by residents. It is recommended that an independent advocate is sought when asking for residents’ views of the quality of the home. There was no evidence of any recent residents’ meeting, although staff were sure that they had taken place. Of the four families who wrote to us, three were aware of the home’s complaints procedures and one was not. It was concerning to note that there was no complaints folder ready in the home for inspection, although staff were sure that there had been one previously. Staff reported that there had been no complaints made to them. One residents file had a copy of the home’s old complaints form on it, and staff reported that they had not been recently issued with any new ones. The home Sarum House DS0000032418.V330197.R01.S.doc Version 5.2 Page 21 has been asked to make sure that a file of any complaint made to the home is kept ready for inspection. The complaints procedure, when updated, must be issued to all residents. The home has a copy of the organisational policy and procedure on responding to allegations of abuse, and staff said that they would be comfortable reporting any incidences of poor practice if they saw them. However, there was no evidence of any staff training in Protection of Vulnerable Adults, and the home has been asked to ensure that this is done. One resident has recently been absconding in the middle of the night. He has stolen the key from one of the doors in order to let himself out and in. This means that other residents are potentially at risk as other people could be brought back to the house. Since the key has been removed from his reach, he has now resorted to leaving the premises by going out of fire door. This means that the other residents have been placed at risk. Any visitor could be brought back and the fact that the door has been left open means that any intruder could enter the building. Staff on duty at night have a “sleep-in” shift, and therefore no waking night staff are on duty. Although this person has a “dual diagnosis” of learning disability and mental disorder, staff said they have had little training in mental health issues. Staff also said that they believe that his mental health needs are now greater than his learning disability. Given the vulnerable nature of the current residents, the home must review the mental health needs of this resident, with consideration given to the registration category of the home. Sarum House DS0000032418.V330197.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean and hygienic throughout, and residents live in a homely, comfortable and safe environment. EVIDENCE: There have been many recent changes in the building. There are now eight single bedrooms downstairs (although one is currently vacant) and seven more upstairs. Four of these were registered last year, and because of the small size of the bedrooms, each of the four residents was given another adjacent room which could act as their sitting room. This is still currently called by staff the “Training and Assessment Unit”. The furnishings throughout the house are of good quality and give the house a homely feel. Residents’ bedrooms were comfortable and each contained individual personal items, such as stereos and TVs. Sarum House DS0000032418.V330197.R01.S.doc Version 5.2 Page 23 Future plans for Sarum House mean that some people will be moving from residential accommodation to more independent, supported living. When the home closes, some of the residents may still require to be living in registered accommodation. The home was clean and tidy. There was a kitchen and a separate laundry area, which reduced the risk of cross-infection. New infection control guidelines were in place. Of the ten residents who wrote to us, all said that the home was always fresh and clean. Sarum House DS0000032418.V330197.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. It was impossible to verify that residents are supported by competent and qualified staff. There was no evidence of appropriate training. Not all relevant information was available to verify that residents are protected by Wiltshire County Council’s recruitment policies and practice. Residents do not benefit from well supported and supervised staff. EVIDENCE: Most of the staff working in Sarum House have had a number of years experience of working with people with learning disabilities, although some have recently been employed. They have knowledge of the specific conditions of residents and seek advice from the appropriate professionals when they need more support. The recognised qualification for care staff is the NVQ, and they can study for NVQ Level 2 or 3. It was not possible to discover how many staff had achieved an NVQ or how many were currently studying for one, because there was no training file in place. The home has been asked to ensure that evidence of staff training is Sarum House DS0000032418.V330197.R01.S.doc Version 5.2 Page 25 made available for inspection. The manager must submit to Commission for Social Care Inspection (CSCI) an up-to-date record of the number of staff with NVQ and the number of staff still studying for NVQ. Of the ten residents who responded to our questionnaire, nine people said that staff “always” treated them well, and one said “sometimes”. One person said “They are my friends”. Because of the fact that the manager and staff helped complete the questionnaire with residents, it is difficult to know if this is how people really feel. As noted previously, a recommendation has been made that an independent advocate should be sought when asking for residents’ views. Relatives who responded to our questionnaire were happy with the care which staff provided. One person who wrote to us said: “The clients are treated with kindness and respect. My son is very happy here”. Another relative said: “Thank you so much for all your support and help. You really are stars and we appreciate everything you do”. Both the independent consultant and the social worker who wrote to us said that staff demonstrate a clear understanding of the care needs of residents. When asked whether, in their opinion, are there always sufficient members of staff on duty, all four relatives said yes. However, some residents commented that there were not always enough staff on duty to support them with activities. It was concerning to note that one resident, who currently has funding for one-to-one staffing, was told by staff that there wasn’t a free member of staff to take him out when he requested it. This is even more concerning when it is clear that staff had recorded that he was “unsettled”. When asked “Do the carers listen and act on what you say”, seven people said “always” and three said “sometimes”. One person said: “Sometimes they are busy”. Staff reported that there were times when the home had been short staffed, and relief staff were often used. Some of this related to the fact that, until recently, they had been told that job vacancies could not be filled. The home has had to rely on contracted staff’s goodwill as well as relief staff. Staff also related that, at times, their morale had been low. It is recommended that staffing levels should be reviewed in light of current residents’ level of need. Sarum House is supported in its recruitment by Wiltshire County Council’s human resources department. Employment checks include Criminal Records Bureau (CRB) and checks against the Protection of Vulnerable Adults (POVA) register, two written references and a medical declaration. All potential staff complete an application form, and this should be kept on the individual staff member’s file. On examination of two staff files, it was noted that one had no references and no medical declaration and the other had no references, no evidence of CRB or POVA checks and no medical declaration. Sarum House DS0000032418.V330197.R01.S.doc Version 5.2 Page 26 Guidance issued by CSCI says that the minimum expectation with regard to evidence of CRB checks is that on receipt of the Disclosure, the umbrella organisation or corporate body should issue a letter to providers stating the name of the person; date of Disclosure; Level of disclosure; Including POVA Check (if requested); Disclosure reference number; Date POVAFirst check was received (if this was sought); and POVAFirst Reference number. Inspectors will accept the letter as evidence of the providers meeting the requirement for staff to be CRB checked. Letters (rather than Disclosures) should be kept on file in the home. This will assist CSCI inspectors when they sample Disclosures to confirm that employers have followed robust recruitment practices. The manager has therefore been asked to ensure that all staff files contain two references, a medical declaration and evidence of a CRB and POVA check. It was disappointing to find that it was impossible to see any staff training files, as no-one knew where they were. There was therefore no evidence that any training had been done, although it was reported by staff that they had done some training in looking after a stoma, and that a certificate was due to be sent to them soon. One staff file examined had no evidence of any induction training for the staff member. The home has been asked to ensure that all new staff must have evidence of induction training, and that evidence of all staff training is available for inspection. One resident has a recently been discharged from a psychiatric hospital, and shows some signs of psychosis. Staff at Sarum House have, in the past, had some training in dual diagnosis, but it would be beneficial both to them and to the resident, to have training in mental health which is more appropriate to the particular resident, and the manager has been asked to ensure that this is done. Staff also reported that it would be helpful to them to have some training in dementia, and it is recommended that this training is offered. There were no supervision files available for inspection. The team leader reported that some work was in progress, but the records were not available. When questioned about her own supervision sessions, the senior carer was unable to produce any files, and had to admit that she had had only one supervision session in two years. This lack of monitoring of senior care staff by the manager is unacceptable, and must be immediately addressed. The manager has been asked to make sure that all care staff have formal, recorded supervision at least six times in every year. Sarum House DS0000032418.V330197.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents do not benefit from a well run home. They cannot be confident that their views underpin the monitoring and review of care practice. The lack of evidenced health and safety checks carried out means that residents do not live in a safe environment. EVIDENCE: The manager, Mr Len Clarke was registered in February 2006. At his interview he stated that he had started his NVQ level 4, but was having difficulty accessing an assessor. The Commission for Social Care Inspection was assured by a senior representative of Wiltshire County Council that this matter would be expedited in order to allow him to complete his qualification. Sarum House DS0000032418.V330197.R01.S.doc Version 5.2 Page 28 As stated in the paragraph relating to the home’s Statement of Purpose (Standard 1) Mr Clarke has recorded that he has his Registered Manager’s Award (RMA). It was confirmed during the inspection by the service manager that this is not the case, and that the RMA has not yet been awarded. It is a serious matter to misrepresent the qualification of any member of staff, and this information must be removed immediately. There was no training file on site to verify the manager’s progress, and he has therefore been asked to provide evidence of the progress of his Registered Manager’s Award. In discussion with staff it was clear that the lack of clear management guidance had led to a feeling that “no-one knows where anything is anymore”. The manager had taken responsibility for several areas, including risk assessment and fire procedures. Unfortunately this had led to confusion for care staff and to some procedures not being followed. It is therefore recommended that the home’s manager should delegate more responsibility to senior staff and retain responsibility for monitoring progress through supervision sessions and spot checks. The views of residents have been sought as part of the consultation regarding the closure of the home and the need for new accommodation. An independent consultant has been employed by Wiltshire County Council who is helping resident manage the change from residential care to independent living. Staff spoken to were clear that they wished the service to be run in the interests of the residents. However, staff said that there has been no resident questionnaire done for some time, and there was no evidence of any resident meetings, although staff said that these had happened. Of the ten residents’ feedback forms returned to CSCI, eight had been completed by the manager or another staff member, and only two had been completed by themselves. It is admirable that staff wish to have the voice of the resident heard. However, it could be said that there is slight conflict of interest at times over the responses to some of the questions. For example, one question asks “Do the staff treat you well”? Nine people said always and one said sometimes. One comment reported was “They are my friends”. One feedback form was completed on behalf of the resident by the “manager – and friend”. It would perhaps be preferable to have a more independent advocate for residents who are unable to complete these themselves. The manager may wish to reflect on the fact that he is an employed member of staff of Wiltshire County Council and that any “friendship” with a resident may be inappropriate. In discussion with two members of staff, they both said that sometimes residents feel uncomfortable talking to a stranger and can relate better to staff, thus they feel that residents are being honest when they give the Sarum House DS0000032418.V330197.R01.S.doc Version 5.2 Page 29 answers to questions. However, the service must try to involve independent advocacy to help get feedback from the residents about the quality of the service provided. This should be part of the home’s internal quality assurance to assess where it might improve according to the opinions of its residents. Part of the responsibility of the senior managers of registered care homes is to visit the home on a monthly basis and to write a report about what they looked at and to whom they spoke. This is to ensure that they are monitoring both the health and safety of the residents as well as the quality of the service offered. There were none of these service manager reports available for inspection. The manager has been asked to make sure that these visits are conducted on a regular monthly basis and that a copy of the report is sent to the Commission for Social Care Inspection (CSCI). It should be noted that Sarum House has had a recent internal quality audit. This showed that there were several deficits in the running of the home. There was a wall planner in the office which showed dates of some of the statutory tests which must be done in care homes. However, this planner was for the year 2007 and it was not clear if these tests had been done in 2006 or not, as some of the dates where work was recorded were in the future. There were no training records to show that staff have been trained in areas relating to health and safety, such as fire safety, manual handling and prevention of spread of infection. The home’s Statement of Purpose says that Wiltshire Fire Service visits on a regular basis to inspect records and fire prevention equipment. However, in the pre-inspection questionnaire the manager reported that they do not visit now. It was therefore concerning to find that the fire records were in a state of disarray. There was no named fire officer in the fire book, although the home’s procedures say this is necessary. Staff thought that it might be the manager, but there were no records to evidence this. There was no evidence of any fire drills taking place, and no evidence that some of the regular household checks had been done. There was no current premises fire risk assessment available. The manager has been asked to make sure that a fire risk assessment is carried out for the premises, and that fire drills are carried out according to the homes procedures, and evidence kept of these drills. Sarum House DS0000032418.V330197.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 1 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 1 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 1 33 X 34 2 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 1 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 X 1 X 2 X X 1 X Sarum House DS0000032418.V330197.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No 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 YA1 2 YA1 3 YA2 4 YA6 5 6 7 YA9 YA19 YA20 15 (2) (b) 13 (4) (c) 13 (4) (c) 13 (2) 14 (1) (2) 6 (a) 6 (a) Standard Regulation Requirement The Statement of Purpose must be amended and must contain accurate, up-to-date information about the service. The misleading reference to the qualification of the manager must be removed. All potential residents must have an assessment done by the home before they move in to show that the home can meet their needs. All residents’ support plans must be reviewed on a regular basis and must contain accurate, upto-date information All residents’ risk assessments must be up to date and relevant to their current needs. An epilepsy management plan must be put in place for the identified resident. Staff must always sign the Medication Administration Record when giving residents their medication. A medication review must be held for the use of PRN medication for residents who have not recently needed it. DS0000032418.V330197.R01.S.doc Timescale for action 09/05/07 09/04/07 09/05/07 09/05/07 09/05/07 19/03/07 10/03/07 8 YA20 13 (2) 09/04/07 Sarum House Version 5.2 Page 32 9 10 11 YA20 YA20 YA20 13 (2) 13 (4) (c) 13 (2) 12 YA22 17 Schedule 4 (11) 22 (5) 13 (6) 12 (1) (a) 13 14 15 YA22 YA23 YA23 16 YA32 18 (1) (a) 17 YA34 17 Schedule 2 18 (1) (c) (i) 18 (1) (c) (i) 18 (1) (c) (i) 18 YA35 19 YA35 All medication which is not used or needed must be returned to the chemist. All residents who use medication must have a risk assessment on file. The reasons for giving any resident medication labelled PRN must be recorded. A complaints log must be kept of any complaint made to the home and must be kept ready for inspection. All residents must be issued with an up-to-date copy of the home’s complaints procedure. All staff must receive training in the Protection of Vulnerable Adults. The mental health needs of the identified resident must be reviewed, with consideration given to the registration category of the home. The manager must submit an up-to-date record of the number of staff with NVQ and the number of staff still studying for NVQ. All staff files must contain two references, a medical declaration and evidence of a CRB and POVA check. Evidence of all staff training must be made availabe for inspection. All new staff must have evidence of induction training on file. All staff must have access to mental health training appropriate to the needs of the specific resident. All care staff must have formal, recorded supervision at least six times in every year. DS0000032418.V330197.R01.S.doc 19/03/07 19/03/07 19/03/07 09/04/07 09/05/07 09/05/07 19/03/07 09/05/07 09/05/07 09/05/07 09/04/07 20 YA35 09/05/07 21 YA36 18 (2) 09/05/07 Sarum House Version 5.2 Page 33 22 23 YA37 YA39 9 (2) (b) (i) 24 (3) 24 YA39 26 25 YA42 13 (4) (c) The manager must provide evidence of the progress of his Registered Manager’s Award. The service must involve independent advocacy to help get feedback from the residents about the quality of the service provided. This should be part of the home’s internal quality assurance to assess where it might improve according to the opinions of its residents. Copies of the report of the monthly monitoring visits to the home must be sent to the CSCI until further notice. A fire risk assessment must be carried out for the premises. 09/05/07 09/05/07 09/05/07 09/04/07 26 YA42 13 (4) (c) 09/04/07 Fire drills must be carried out according to the homes procedures, and evidence kept of these drills. Sarum House DS0000032418.V330197.R01.S.doc Version 5.2 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 2 3 4 5 6 7 8 9 10 11 12 Refer to Standard YA6 YA6 YA9 YA9 YA13 YA20 YA20 YA20 YA32 YA35 YA37 YA37 Good Practice Recommendations A record should be made of the date when a support plan is reviewed, even if there is no change to it. The area in support plans which looks at people’s religious and cultural needs should be explored in further detail in order to find out people’s likes and dislikes. Residents’ risk assessments should be kept alongside their support plans. All residents’ risk assessments should be written using the same format. Consideration should be given to spending more time supporting residents with individual activities. The date should be recorded for any dropped or refused medication which is to be returned to the chemist. All medication to be returned to the chemist should be stored together. A regular stock check should be made of all the medication in the home, and a record should be kept of this check. Staffing levels should be reviewed in light of current residents’ level of need. Staff should be offered the opportunity to have training in dementia. The home’s manager should delegate more responsibility to senior staff and retain responsibility for monitoring progress through supervision sessions and spot checks. The manager may wish to reflect on the fact that he is an employed member of staff of Wiltshire County Council and that any “friendship” with a resident may be inappropriate. Sarum House DS0000032418.V330197.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Sarum House DS0000032418.V330197.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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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