Inspection on 16/10/07 for Scott House

This inspection was carried out on 16th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Scott House 17/10/06

Scott House 08/12/05

Scott House 18/07/05

Scott House 10/01/05

Scott House 16/08/04

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

CARE HOME ADULTS 18-65 Scott House 7 Warham Road South Croydon Surrey CR2 6LE Lead Inspector David Halliwell Key Unannounced Inspection 16th October 2007 09:30 Scott House DS0000025834.V352541.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 Scott House DS0000025834.V352541.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. Scott House DS0000025834.V352541.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Scott House Address 7 Warham Road South Croydon Surrey CR2 6LE 020 8686 9312 F/P 020 8668 3212 ronchiwome@yahoo.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Laurel Residential Homes Limited Nina Harman Care Home 21 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (21) of places Scott House DS0000025834.V352541.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A variation has been granted to allow one specified service user over the age of 65 to be accommodated. Date of last inspection Brief Description of the Service: Scott House is a large traditional brick built property situated to the south of Croydon, but close to the towns many community facilities. The house consists of a large lounge with open plan dining area and a conservatory. There are 15 single bedrooms and 3 double - none has en-suite facilities other than wash hand basins. There are 8 toilets, 3 bathrooms and 2 showers. There is a garden to the rear and off-road parking to the front. The stated aim of the home is to provide care for people with long term mental health problems. The average fee for a placement at Scott House is £590 per week. Scott House DS0000025834.V352541.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection visit over 1 day undertaken by the Inspector responsible for Scott House. The Inspection covered all the key standards and involved a tour of the home, a review of all the homes records and formal interviews with staff and service users. Informal interviews were conducted with other service users as a part of the inspection of the home. Since the last inspection carried out at Scott House, some progress has been achieved by the Manager and the staff team in meeting the requirements and recommendations that were set. This is a positive achievement. 6 new requirements have been made as a result of this inspection and 4 new recommendations have also been made. Feedback on all the requirements and recommendations was given verbally to the Manager and to the Proprietor at the end of this inspection visit. The Inspector found the residents and staff very helpful and they are to be thanked for the assistance that they gave him over the course of this inspection visit. What the service does well: What has improved since the last inspection? Positive steps have been taken to meet a number of the previous requirements and good practice recommendations that were made after the last inspection. These developments are covered in the main body of this report. Scott House DS0000025834.V352541.R01.S.doc Version 5.2 Page 6 What they could do better: The following areas were identified as a result of this inspection that still requires development and improvement: 1) At the last inspection a recommendation was made that the Manager should always request full Care Programme Approach documentation from referring agencies at the time of their requesting a new placement. This recommendation was made to help ensure that staff at Scott House have all the available information about a prospective resident at an early stage of the process and that would enable a fully informed decision to be made about whether and how best a service users needs could be met. Since this has not been achieved it is now made a requirement. 2) Residents’ care plans should be developed further in order to build on the progress already made. The care plans need to include more detail as to how the resident’s health and social care needs might best be met. 3) Care plans and care plan objectives should be reviewed regularly and at least once annually or sooner if needs or circumstances for the resident change. 4) Guidance should now be put in place for each resident for PRN medication. This should be held in the medication files and be readily accessible for staff who administer these medications. The guidance should set out clear information for each resident including the side effects and when and when not to use PRN medication. The resident’s GP could greatly assist the process of drawing up this guidance for staff. 5) It is recommended that Laurel House Homes use more externally provided training and also specifically Protection of Vulnerable Adults (POVA) training that is run by the L.B Croydon for staff. There are some maintenance and building works now required: 6) Bathroom no: 2 on the ground floor now needs a new sealed floor as water from the shower and the toilet have both permeated the current floor covering. This could present a health hazard if not addressed in the near future. 7) Bedroom no: 6 the carpet is badly stained and needs replacement. 8) The small toilet on the 1st floor needs a new floor covering as the existing floor is badly compromised by urine spillages. 9) It is a requirement that documentary evidence required under Standard 34 of the National Minimum Standards be gathered for all the staff members at Scott House DS0000025834.V352541.R01.S.doc Version 5.2 Page 7 Scott House and be held on the staff files for review and inspection. This will help to ensure that recruitment practices meet the required standards. 10) It is recommended that some externally provided training be laid on for staff that would compliment and expand the scope and range of the existing “in house” training packages. Suggested areas for external training would be in some of the most important key areas needed to improve staff skills and knowledge including: 1. Needs assessment, care planning, developing action plans, monitoring and review. 2. The safe handling of medications. 3. POVA 4. Fire safety 5. Food hygene 6. Health and safety. 11) A training file needs to be developed that contains all the staff members’ training completed over the last 5 years and all their future training needs that have been identified in the supervision process. 12) Training needs for all the staff team should be aggregated into a training matrix that may be used by the management team to plan all future training courses in the year ahead. This will serve a dual purpose in that it will easily inform the Manager what training the staff team have received and where the gaps in training exist. 13) A requirement remains in place for staff supervision. It is that supervision notes are maintained regularly and kept on staff files, also that areas of discussion in supervision must include the areas already discussed but that are to do with the: • Translation of the homes philosophy and aims into working with individuals, • Monitoring of work with individual service users and the analysis of care plan outcomes, • Support and professional guidance, and the • Identification of training and development needs, • Annual appraisals. 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. Scott House DS0000025834.V352541.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Scott House DS0000025834.V352541.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 - Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users needs are being assessed by the staff at Scott House however these needs would be better informed if the referring agencies supplied more comprehensive and detailed information at the point of referral. EVIDENCE: Standard 2 – At this inspection 4 of the 20 residents’ files were inspected. 3 of the 4 residents’ files indicated that they had had a basic assessment of their needs. Not all the files had up to date Care Programme Approach (CPA) documentation. This is the information provided by the referring clinical teams that should be provided at the point of referral to Scott House and that should be reviewed annually. CPA documentation includes a full needs and risk assessment of the person and sets out care plan objectives that the care provider should be aiming to meet. It is therefore an essential piece of information to obtain at the point of referral Also as part of the needs assessment process to be carried out by the home, there should also be a risk assessment that identifies any areas of risk to or for the resident. This should be reviewed as the risks change or otherwise annually. Inspection of the 4 residents’ files selected indicated that 2 residents had not had a risk assessment carried out and 1 other resident who had had a Scott House DS0000025834.V352541.R01.S.doc Version 5.2 Page 10 risk assessment carried out had had it completed in February 2006 but it had not been subsequently reviewed. Inspection of several other of the residents files did indicate that rather standardised and limited risk assessments had been carried out identifying only one or two areas of the same risk for each of the residents. Given that needs assessments and risk assessments have not always been fully carried out or updated annually it may mean that not all the residents’ needs are being met or risks identified. At the last inspection a recommendation was made that the Manager should always request full CPA documentation from referring agencies at the time of their requesting a new placement. This recommendation was made to help ensure that staff at Scott House have all the available information about a prospective resident at an early stage of the process and would enable a fully informed decision to be made about whether and how best a service users needs could be met. This is now a requirement. Scott House DS0000025834.V352541.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 & 9 - Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users cannot be fully assured that all their assessed and changing needs are reflected in their individual care plans. Service users are enabled to make decisions about their lives with assistance as needed and they are supported to take risks in order to maximise their independence wherever possible. EVIDENCE: Standard 6 - The Inspector reviewed 4 residents’ files and found evidence that individual care plans had been drawn up for each of these residents. The care plans seen at this inspection set out 3 or 4 care plan objectives for each of the resident. For instance on one file the care plan objectives were as follows: 1. To promote and maintain good health, 2. To promote a healthy eating pattern and to maintain a stable weight, 3. To join in activities and outings at Scott House. Scott House DS0000025834.V352541.R01.S.doc Version 5.2 Page 12 The stated purpose of Scott House is to provide long term care for the residents who have complex and long-term mental health problems. With this in mind the resident’s care plans and the associated care plan objectives are structured to take this into account. This said it is recommended that the care plans be developed further to include more detail as to how the resident’s health and social care needs might be met. On inspection of the 4 residents’ files it became clear that not all the care plans or care plan objectives had been regularly reviewed. Review of these objectives is expected at least annually or sooner if circumstances change for the resident concerned. For one resident who had moved to Scott House from Jordan Lodge no new care planning had been carried out and only those care plan objectives that had been set at Jordan Lodge were on the file. This indicates that no revision or updating had occurred for this resident since he moved into Scott House in June 2007. On another resident’s file although a review had taken place no revision or updating had been carried out to the care plan. In addition a care plan objective had been set to do with increasing the resident’s opportunities for increased social inclusion however there was no evidence of any proactivitiy or action planning to assist the resident in achieving this stated goal. This means that success in achieving the care plan objectives that have been identified is limited. It is therefore required that care plans are not only developed as required in the above paragraph but also that they are reviewed regularly and at least once annually or sooner if needs or circumstances for the resident change. It would be good to see much more key worker pro activity in the development of both the care plans and action planning and review that supports the care plan objectives. Of the files reviewed it was clear to the Inspector that whilst some key areas of need are being addressed in the plans other areas of need, which would assist in ensuring the unit’s objective of providing a comprehensive long term care for the residents was not being evidenced in the care plans. The development of care planning was discussed in full with the registered Manager and one of the Proprietors who have agreed to develop this detail in the care plans for each of the residents. All of the information required in schedule 3 of the Regulations was seen by the Inspector to be documented on the files. Regular residents meetings are held within the home and this provides an opportunity for residents to make their views known about relevant topical issues. Standard 7 – Residents informed the Inspector that they are enabled to make decisions about their lives with assistance as needed. Staff were seen by the Inspector to ask residents about many different aspects of life within the home Scott House DS0000025834.V352541.R01.S.doc Version 5.2 Page 13 including what activities they would choose to do, any outings perhaps to the shops or as to menu choices as an example. Over the course of this inspection this was also evidenced to the Inspector through the exchanges seen between staff and the residents where staff were clearly respecting where appropriate residents to make their own decisions. The Manager told the Inspector that the residents are involved in the review of their care plans and where appropriate families or close relatives sometimes accompany the residents acting as advocates. The Manager told the Inspector that if the resident would like to have an independent advocate staff will arrange this for them. Standard 9 – As described under Standard 2 limited risk assessments were seen on each of the files reviewed as a part of the initial assessment and care planning undertaken by Scott House. These assessments were seen to support the residents to take acceptable risks in order to maximise their independence wherever possible. Scott House DS0000025834.V352541.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 & 17. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users are enabled to take part in culturally and activities appropriate to their needs and wishes. They are also encouraged to take an active part in the community. Service users maintain appropriate personal relationships as they wish and staff do respect their rights and responsibilities recognised in their daily lives. Service users are offered a healthy diet that they seem to enjoy. EVIDENCE: Standard 12 – The stated purpose of Scott House is to provide long-term care and support for the residents who have complex and long-term mental health problems. With this in mind the range of activities that residents say that they Scott House DS0000025834.V352541.R01.S.doc Version 5.2 Page 15 wish to be involved in is somewhat limited. However there was evidence that support staff do appropriately encourage residents to get involved in daily activities and the use of the home’s daily task board has assisted in encouraging residents to expand their range of interests. The Manager told the Inspector that staff actively work with residents and their families and friends to assist in the maintenance of these relationships and if the residents wish to do so. Visitors to the home are encouraged and use the visitor’s book to sign in. Residents are enabled to take part in age and culturally appropriate activities by the support staff but only occasionally choose or feel able to do so. Standard 13 – Previous interviews with residents demonstrated that their wishes for an active community social life are limited and although staff do try to encourage residents to be involved as much as possible in local activities there is not a huge take up of these opportunities. Some residents told the Inspector that they like to go to the shops. One resident goes to church every Sunday and several residents use a local café where they meet other local people. Residents can and often do make full use of local public transport facilities in order to get out and about and to see friends and family. Residents interviewed felt that transport facilities were good. The Manager informed the Inspector that all residents are registered to vote in elections and are supported by staff to do so if they wish. However staff interviewed by the Inspector also reflected the difficulty in encouraging and motivating some residents to take an active part in this and other activities. The Inspector saw information made available within the home about local activities for residents to take up if they wish. Standard 15 – Some of the service users interviewed by the Inspector said that they do keep in regular contact with their families and friends. One resident said that he sees his parents every weekend and that he enjoys the regularity of this contact. Staff encourage the residents to keep and maintain contacts with family and friends so that service users do benefit from having these appropriate relationships. The Inspector spoke to the mother of one resident who was very pleased with the support the staff at Scott House offers her son. She said she regularly visits her son at Scott House and is always made to feel welcome. Standard 16 - Policies seen by the Inspector to be established within the home ensure that service users rights to privacy, respect and dignity are respected. Residents said that they felt staff respected these rights. Residents said that they have a key to their own bedrooms, their mail is unopened, their preferred form of address is used by staff and staff do knock Scott House DS0000025834.V352541.R01.S.doc Version 5.2 Page 16 on their doors before entering. The Inspector observed staff to be interacting with residents in a friendly and respectful manner. Interviews both with staff and residents confirmed that residents participate in household chores as a part of the community living experience. Following recent legislative changes the area for smokers in the house has now been given up and smokers are able to use a sheltered area in the back garden. The Manager told the Inspector that a new wooden shelter will soon be put up so that those residents who wish to smoke can do in a relatively sheltered place. There are appropriate policies regarding drug and alcohol taking on the premises. The room that was previously used for the smokers has now been developed into a new activities room. This development is greatly welcomed and by some of the residents as it has opened up opportunities for more daily activities such as chess and other board games, bowling, karaoke and art. At the time of this inspection one resident had just completed painting a lovely new watercolour; this was not possible before the activities room was developed. Standard 17 - With regards to meals and meal times there is a planned and varied menu which residents told the Inspector they enjoy. The Inspector saw suitably planned menus for 3 weeks ahead. Specific needs are catered for and alternative choices are provided. Residents are able to state their preferences when the menus are planned and there are discussions about this at the residents meetings, which are held regularly. The Manager informed the Inspector that some residents are involved in the purchasing of the food and with the preparation of some meals. Food monitoring sheets are in use for residents in order to monitor and ensure that they do have a varied and nutritious intake of food each week. At the last inspection a requirement was made because the recording on these sheets was seen to lack sufficient detail. This was discussed in full with the Manager and has now been met. Staff now record what each resident has actually consumed and this is linked in with the resident’s healthcare needs. Where in some cases residents do have a healthcare need which requires a reduction in fatty and high in cholesterol foods the food monitoring sheet should prove helpful and will assist in positive action being taken in order to assist in reaching the care plan objective. Working together with the residents GP and dieticians should also be considered where appropriate. Scott House DS0000025834.V352541.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 & 20. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users can be assured that they will receive personal support in the way they prefer and require. They may also be assured that their physical and healthcare needs will be met although recording in care plans needs to be further developed. Service users can be assured that they will be protected by the homes policies and procedures for dealing with medication and medicines. EVIDENCE: Standard 18 – The Manager explained to the Inspector that residents are expected to be up and about each morning by about 9.30am so that they are able to participate in their care packages and this includes their need to take their medications at 9.30 each morning. The residents interviewed at this inspection said that they do choose when to go to bed, when to have a bath, what they wish to wear and what activities they do during the day. Scott House DS0000025834.V352541.R01.S.doc Version 5.2 Page 18 Residents do not have a choice of their allocated key worker however the Manager said that they have a chance to discuss any issues they may have or which arise subsequent to the allocation of their key workers. Residents did not raise any concerns with the Inspector about their key workers. Residents at Scott House continue to receive regular input from their Community Psychiatric Nurses and other mental health professionals. Standard 19 – With regards to the health care of the residents the Manager informed the Inspector that all residents are supported to keep well through accessing appropriate healthcare and associated mental health care support. All residents are signed up with one of the local GP surgeries and some are registered with a local dentist. The Manager said that whether or not a resident uses the dentist is left up to the resident’s own decision but staff will encourage residents to use this service if required. Residents who spoke with the Inspector said that they go to see their GPs as and when necessary but they said they prefer not to go to the dentist. Resident’s health checks are usually undertaken by the GP at their surgeries. An optician regularly visits the home and provides eyesight checks for all residents and there is access for residents to the chiropody services. Community nurses also visit residents at the home and administer medication as required. Standard 20 - The home’s policies and procedures manual contains a policy for medication that includes the procedures that staff need to take in order to ensure the safe administration of medication to residents. A member of staff who was interviewed indicated to the Inspector that they were aware of the policy and know what the procedures are when administering medication to the residents. The Manager told the Inspector that only senior staff administer medication to the residents and that these staff receive regular training to do with the safe handling of medicines. The Manager informed the Inspector that no resident at the time of this inspection self-administers medication. Inspection of the medication records MAR sheets found no unexplained gaps. Each of the residents’ files inspected had a medication profile that identifies the prescribed medications for each resident. This is a welcome development as it should assist in ensuring the safe administration of medications to the residents. The Inspector looked at the medication records for each resident who uses PRN medication and it is recommended that guidance now be put in place for each resident. This should be held in the medication files and be readily accessible for staff who administer these medications. The guidance should set out clear information for each resident including Scott House DS0000025834.V352541.R01.S.doc Version 5.2 Page 19 the side effects and when and when not to use PRN medication. The resident’s GP could greatly assist the process of drawing up this guidance for staff. The Inspector undertook a stock take of medications held in the home, together with the Manager. Records kept were inspected and stock levels of medications were seen to be satisfactory. The Manager told the Inspector that Boots the Chemists provide all the residents requirements for medication and that they do carry out their own check on procedures carried out in the home to do with medication. Their last visit was on the 23rd April 2007 and the Manager told the Inspector that no problems or issues had arisen as a result of that inspection by Boots. The Manager and the Proprietor were advised that following recent changes in the legislation, an appropriate medication cabinet will be required for controlled drugs. Scott House DS0000025834.V352541.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): Standards 22 & 23 - Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users can be assured that their views will be listened to and acted upon appropriately. They can also be assured that they will be protected from abuse, neglect and self-harm. EVIDENCE: Standard 22 – Residents confirmed to the Inspector that they feel their views are listened to and acted upon. They also all said that if they had a complaint they know the procedure to be followed and would do so if they needed to. Staff interviewed confirmed to the Inspector that the residents were all aware of the complaints process and that the whole staff group took any issues raised by residents seriously. The complaints record was reviewed by the Inspector, no complaints had been made since the last inspection visit. Standard 23 - The home has an adult protection policy (POVA) and the Manager informed the Inspector since the last inspection all but 5 of the staff group had received POVA training. The Manager told the Inspector that these 5 members of staff would be receiving the same “in house” training on 30th October 2007. Evidence of staff training was seen in the files held in the main office. Scott House DS0000025834.V352541.R01.S.doc Version 5.2 Page 21 It is recommended that Laurel House Homes also use externally provided POVA training run by the L.B Croydon for staff. The benefits of the in house training are understood in that training can be individually tailored to the exact requirements of each of the 3 homes. However were staff to receive the external training alternately every 2 years then they would also benefit from any new developments arising on the national side of this training. Staff might also benefit from being part of a wider discussion with other practicing social and healthcare professionals with whom they can discuss adult protection issues more generally. Training in this area should mean that staff are better aware of what abuse is and the safeguards in place for the protection of the residents should they need them. The Inspector saw the allegation of abuse record; no allegations had been made since the last inspection. The acting Manager confirmed this to the Inspector. The policies and procedures manual for the home includes a whistle blowing policy and a policy on dealing with violence and aggression. Understanding the policies and procedures is a part of the staff induction process and staff are asked to sign to say that they have read and understood the policies and procedures. A review of staffing records held on staff files by the Inspector confirmed that all staff had signed such an agreement. The Manager informed the Inspector that training in this area is offered to staff. The home does look after residents’ money and the Inspector reviewed the financial records for these transactions that all were in order. All transactions are dated and signed for by both staff and residents to confirm satisfaction by all parties. The Inspector found no anomalies. At the last inspection it was recommended that an inventory for residents valuable belongings be drawn up and maintained and kept up to date by key workers for all residents’ belongings that are kept in their bedrooms. Evidence that this was carried out in February 2007 was seen by the Inspector and should add to the measures already in place to ensure the protection of the resident’s property. Scott House DS0000025834.V352541.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): Standards 24 & 30 - Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users do live in safe and comfortable surroundings and said that they are happy living in this environment. Service users may be assured that the home is clean and hygienic. EVIDENCE: Standard 24 – A tour of the premises together with the Manager covered all areas of the home including, with their permission several of the residents bedrooms. They told the Inspector that they are happy with their rooms. The general impression of the environment and décor of the home was found to be clean, hygienic and free from any unpleasant odours. Since the last inspection good progress has been made in meeting a number of maintenance issues that were identified at that time. Scott House DS0000025834.V352541.R01.S.doc Version 5.2 Page 23 The floor in the first floor bathroom has now been replaced. This should help prevent water to ingress and subsequent potential hygiene problems. Similarly the floor in the laundry area has also been replaced and is now watertight. A new floor has been provided for the staircase at the rear of the building. Bathroom no: 8 has been refurbished following a fire that occurred in the waste paper basket and a cigarette that was put in it by a resident. All waste paper baskets in the bathrooms and toilets have now been replaced with metal bins. This should help prevent a fire from occurring again and help better protect the residents. A new carpet has been provided for bedroom no: 18 and the resident living in that room told the Inspector that they were pleased that this had been done as it makes the room more homely. The maintenance and repairman told the Inspector that the flooring outside the kitchen and the adjacent bedrooms has been replaced and a new floor covering is going to be laid this week by outside contractors. As already mentioned earlier in this report the room that had been the smoking room has now been re-arranged as an activities room and coffee and tea facilities have been re-sited nearer to the kitchen. Both these developments have been welcomed by the residents and represent an improvement in the quality of the services being provided for the residents. Bathroom no: 2 on the ground floor now needs a new and sealed floor as water from the shower and the toilet have both permeated the current floor covering. This could present a health hazard if not addressed in the near future. Bedroom no: 6 the carpet is badly stained and needs replacement. The small toilet on the 1st floor needs a new floor covering as the existing floor is badly compromised by urine spillages. Standard 30 – The home was seen to be clean and hygienic. Policies and procedures were seen to be in place and the laundry area is sufficiently far from the food preparation area to avoid any potential for cross infection. Appropriate hand washing facilities are provided for staff and residents who use the facilities. All staff have undertaken training in Infection Control, Health & Safety and Food Hygiene which assists in the maintenance of high standards in this home. Scott House DS0000025834.V352541.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): Standards 32, 34, 35 & 36. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users can be assured that they will be supported by competent and qualified staff. They may not be fully assured that they will be supported and protected by the home’s recruitment and supervision policy and procedures. Staff training and staff supervision practices still need improvements to be implemented. EVIDENCE: Standard 32 - The Manager informed the Inspector that as a part of the induction process all staff are issued with job descriptions and are asked to read and discuss the homes policies and procedures. Evidence of this was seen by the Inspector on staff files and from discussions with staff interviewed. Staff have copies of the General Social Care Standards / Code of Conduct. Volunteers are not used within the home. The Manager told the Inspector that there is a training programme underway to ensure that all staff are NVQ qualified by the required date. She said that 7 staff have now completed their NVQ level 2 training, 2 staff have achieved NVQ level 3 and the remaining 2 staff have gained their NVQ level 4. Scott House DS0000025834.V352541.R01.S.doc Version 5.2 Page 25 Staff interviewed confirmed with the Inspector that they had completed their NVQ training and evidence of NVQ training certificates were seen in the office records. Standard 34 - The Manager told the Inspector that the home does have a recruitment policy and procedure and that all staffing posts are filled by application and interview. Evidence of these processes being used was seen by the Inspector on the staffing files. The acting Manager said that she, one of the Proprietors and sometimes another homes Manager constitute the interview panel. Review of 4 of the staffing files evidenced that suitable application forms are completed as a part of the process. However evidence seen on the files did not show that 2 references are always obtained including one from the last employer. 2 staff files had no references in them. All staff files reviewed by the Inspector did evidence that proper CRB checks have been carried out for staff employed within this home. Photographs were not held on 2 of the 4 staff files inspected; this is needed as it would help ensure correct identification. Other official documentary evidence confirming identification either in the form of a passport, birth or marriage certificate are also required to be held on staffing files. Equally training certificates and other evidence of qualifications gained by the staff member should also be held on the staffing files. It is therefore now a requirement that documentary evidence required under Standard 34 of the National Minimum Standards be gathered for all the staff members at Scott House and held on the staff files for review and inspection. This will help to ensure that recruitment practices meet the required standards. Staff interviewed confirmed that all have a contract of employment and that they understand their terms and conditions as well as their roles and responsibilities within the home. Standard 35 - The Manager informed the Inspector that there is an overall training and development plan and budget for the 3 units that make up the Laurel Group of Homes. Disaggregating the information specifically for Scott House was not possible. The Manager at Scott House is responsible for the training and development of the Laurel Group of Homes staff. Scott House DS0000025834.V352541.R01.S.doc Version 5.2 Page 26 The Manager informed the Inspector that a structured induction programme is offered to new staff and documentary evidence of this was seen by the Inspector on staff files and supported during the interview of staff. Recent “in house” training for staff has included: • Care planning • Boundary setting • Supervision • Health and safety • Fire safety • POVA • 1st Aid • Infection control • Medication • Food hygene • Room checks • Social inclusion • Water temperatures • Breakaway techniques It is recommended however that some externally provided training be laid on for staff that would compliment and expand the scope and range of the existing “in house” training packages. Suggested areas are in some of the most important key areas for staff skills and knowledge including: 1. Needs assessment, care planning, developing action plans, monitoring and review. 2. The safe handling of medications. 3. POVA 4. Fire safety 5. Food hygene 6. and health and safety. It is required that a training file be developed that contains all the staff members’ training completed over the last 5 years and all their future training needs that have been identified in the supervision process. Also that training needs for all the staff team should be aggregated into a training matrix that may be used by the management team to plan all future training courses in the year ahead. This will serve a dual purpose in that it will easily inform the Manager what training the staff team have received and where the gaps in training exist. Standard 36 - From discussions with the Manager and from interviews with 2 staff it is clear that at present staff receive ongoing supervision and support in Scott House DS0000025834.V352541.R01.S.doc Version 5.2 Page 27 the work they undertake and a supervision record is maintained that is signed by both parties. However the record made of key areas of discussion or of all the decisions and agreements made still falls short of what is required. This was made subject to a requirement at the last inspection and it is disappointing that little progress has been made to date in this important area of work. The Manager agreed with the Inspector that there is still work to be done in continuing to improve the quality of staff supervision in the home. It is essential for instance that there is discussion in supervision with staff about how to implement in practice the home’s philosophy and aims when working with individual residents. Equally it is essential for the successful delivery of care to residents as well as providing job satisfaction for staff, that supervisors help them to monitor their work with individual service users and analyse the success or not of care plan outcomes in meeting their residents’ needs. For this reason a requirement remains in place for supervision. It is that supervision notes are maintained regularly and kept on staff files, also that areas of discussion in supervision must include the areas already discussed but that are to do with the: • Translation of the homes philosophy and aims into working with individuals, • Monitoring of work with individual service users and the analysis of care plan outcomes, • Support and professional guidance, and the • Identification of training and development needs, • Annual appraisals. Scott House DS0000025834.V352541.R01.S.doc Version 5.2 Page 28 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): Standards 37, 39 & 41. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users benefit from a well run home and when completed the quality assurance process will ensure that service users can be confident that their views and those of other relevant people underpin the development and review of the home. The health and safety of service users and staff are protected by the policies and working practices in the home. EVIDENCE: Standard 37 – At this inspection the Manager told the Inspector that she has the Registered Manager’s Award [at Level 4]. Scott House DS0000025834.V352541.R01.S.doc Version 5.2 Page 29 The Inspector has seen the Managers job description that covers all the requirements set out under the Standard 37.3. Standard 39 - The Inspector spoke to the Manager about the development of the quality assurance system referred to in the last inspection report. The Manager told the Inspector that the following information is collected as a part of the home’s internal quality assurance process. The Inspector asked whether an analysis of the feedback information has been carried out and the Manager told the Inspector that this is yet to be done. However the intention is to use the information to develop an annual development plan for the home. Information sources the Manager told the Inspector include the following: • Internal audit and system checks including installation checks such as the boiler, electric systems, fire risk assessment and other building risk assessments, • Regulation 26 reports sent to the CSCI, • Feedback gained from residents and referring professionals, • General letters and feedback. Unfortunately no information was available to be seen by the Inspector for these areas. A quality assurance audit for measuring the effectiveness of staff training was available and was seen by the Inspector. This provides a useful management tool that would be helpfully supplemented by a summary and action plan that covers the implementation of any identified needs and changes. Standard 42 – The Inspector was shown information to do with relevant Health and Safety legislation. Policies and procedures were also seen for Health and Safety, risk assessment, moving and handling and fire. The Manager informed the Inspector that all staff receive training in moving and handling, fire safety, first aid, food hygiene, and infection control. This was supported by staff interviewed who confirmed that they had received training in these areas. Up to date certificates confirming approved and satisfactory conditions were seen by the Inspector for: Boiler & Gas – 3.9.07 Fire alarms – 10.8.07 Fire extinguishers – 11.5.07 Portable electric appliances – 1.2.07 Electrical installation – 2.2.05 satisfactory for 5 years Water checked - 2.10.06 Emergency lighting – 17.1.07 Certificate of insurance – dated 6.2.07 and valid to 6.2.08. Scott House DS0000025834.V352541.R01.S.doc Version 5.2 Page 30 The last LFEPA visit was carried out on 10.9.07 no requirements were made as a result of this visit. All food was seen to be stored appropriately and properly labelled with dates of opening and expiry. Records were seen by the Inspector that confirmed regular tests had been carried out for the: Fire alarm - weekly Fire extinguishers - weekly Emergency lighting – 6 monthly last on 30.5.07 Fridge and freezer temperatures records were checked and records indicate that they came within the acceptable ranges. Accident records were checked – records were noted to do with residents smoking in their bedrooms and in the bathrooms. Hot water temperatures were also checked and records indicated that they also came within the acceptable range. At the time of this inspection no fire doors were seen to be wedged open and the building appeared to be secure. The Manager showed the Inspector a recently completed (8.10.07) fire risk assessment for the building and a general risk assessment for the building and for the communal areas that was carried out in June 2007. Both are welcomed as they should assist in the prevention of accidents and will inform the maintenance programme for the building. Scott House DS0000025834.V352541.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 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 3 23 3 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 3 33 X 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Scott House DS0000025834.V352541.R01.S.doc Version 5.2 Page 32 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. Standard YA2 Regulation 14 Requirement Timescale for action 01/12/07 2. YA6 14 3. YA24 23 That the Manager should always request full CPA documentation from referring agencies at the time of their requesting a new placement. This would help ensure that staff at Scott House have all the available information about a prospective resident at an early stage of the process and would enable a fully informed decision to be made about whether and how best a service users needs could be met. Care plans should be reviewed 01/12/07 regularly and at least once annually or sooner if needs or circumstances for the resident change. 1) Bathroom no: 2 on the 01/12/07 ground floor now needs a new sealed floor as water from the shower and the toilet have both permeated the current floor covering. This could present a health hazard if not addressed in the near future. 2) Bedroom no: 6 the carpet is badly stained and needs replacement. Scott House DS0000025834.V352541.R01.S.doc Version 5.2 Page 33 3) The small toilet on the 1st floor needs a new floor covering as the existing floor is badly compromised by urine spillages. 4. YA34 17 It is a requirement that 01/12/07 documentary evidence required under Standard 34 of the National Minimum Standards be gathered for all the staff members at Scott House and held on the staff files for review and inspection. This will help to ensure that recruitment practices meet the required standards. 1) That a training file be 01/12/07 developed that contains all the staff members’ training completed over the last 5 years and all their future training needs that have been identified in the supervision process. 2) That training needs for all the staff team should be aggregated into a training matrix that may be used by the management team to plan all future training courses in the year ahead. This will serve a dual purpose in that it will easily inform the Manager what training the staff team have received and where the gaps in training exist. Staff supervision - supervision 01/12/07 notes must be maintained regularly and kept on staff files, also that areas of discussion in supervision must include the areas already discussed but that are to do with the: • Translation of the homes philosophy and aims into working with individuals, • Monitoring of work with individual service users and the analysis of care DS0000025834.V352541.R01.S.doc Version 5.2 Page 34 5. YA35 18 6. YA36 18 Scott House • • • plan outcomes, Support and professional guidance, and the Identification of training and development needs, Annual appraisals. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA6 YA20 Good Practice Recommendations That the residents’ care plans be developed further to include more detail as to how the resident’s health and social care needs might be met. PRN guidance should now be put in place for each resident. This should be held in the medication files and be readily accessible for staff who administer these medications. The guidance should set out clear information for each resident including the side effects and when and when not to use PRN medication. The resident’s GP could greatly assist the process of drawing up this guidance for staff. It is recommended that Laurel House Homes also use externally provided POVA training run by the L.B Croydon for their staff. It is recommended that some externally provided training be laid on for staff that would compliment and expand the scope and range of the existing “in house” training packages. Suggested areas are in some of the most important key areas for staff skills and knowledge including: • Needs assessment, care planning, developing action plans, monitoring and review. • The safe handling of medications. • POVA • Fire safety • Food hygene • Health and safety. 3. 4. YA23 YA34 Scott House DS0000025834.V352541.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 Scott House DS0000025834.V352541.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. 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