Inspection on 24/07/08 for Seabank House

This inspection was carried out on 24th July 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Seabank House 31/08/09

Seabank House 22/11/07

Seabank House 21/06/06

Seabank House 17/03/06

Seabank House 13/12/05

Seabank House 10/01/05

Seabank House 21/06/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOME ADULTS 18-65 Seabank House 111 Seabank Road Wallasey Wirral CH45 7PD Lead Inspector Beate Field and Diane Sharrock Unannounced Inspection 24th July 2008 10:10 Seabank House DS0000018938.V362764.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 Seabank House DS0000018938.V362764.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. Seabank House DS0000018938.V362764.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Seabank House Address 111 Seabank Road Wallasey Wirral CH45 7PD 0151 630 2791 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) Ms Helen Gifford Ms Helen Gifford Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Seabank House DS0000018938.V362764.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD The maximum number of service users who can be accommodated is: 9 Date of last inspection 27th February 2008 Brief Description of the Service: Seabank House is a large detached house in the Wallasey area. The home is registered to provide personal care for nine adults with a learning disability. Bedroom accommodation is provided in one shared room and seven single rooms. Bedrooms are located on the ground and first floor. Toilets and bathrooms are located on both floors of the home. There is a lounge, kitchen, dining room and staff sleeping-in room on the ground floor. Parking is available on the road at the front and side of the home. The home is within easy reach of New Brighton and Liscard town centre. There is a wide range of facilities such as shops, churches, community centres, a library and public transport within walking distance. A copy of the statement of purpose and service user guide, which describes the services offered at Seabank House was not available at the home as the owner states she is updating and developing this information. At the time of the visit the fees were £308 to £614 per person a week. The fees do not include medical requisites (other than prescription medication) hairdressing, clothing, holidays and other items of a luxury nature. Seabank House DS0000018938.V362764.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This site visit took place over 7 hours. It is based on an unannounced visit to the home, and various information received about the service since the last inspection eg, an Annual Quality Assurance Assessment (AQAA) completed by the manager and questionnaires completed by a member of staff and health care professionals currently working with the people who use the service. During the site visit to the home time we spent time in the office looking at a sample of records and policies and procedures and talking to the manager. A tour of the home was also undertaken. We spoke with the people who use the service and with staff and made observations of staff delivering care to the people who use the service. What the service does well: The people who use the service told the inspectors they enjoy living at Seabank House and made positive comments about the support they receive from the manager and the staff team. The people who use the service are supported to take part in activities in the community including day services, work placements and leisure facilities. The people who use the service are supported to make positive choices and decisions and take responsibility for their actions in their daily lives. The two staff spoken with were very enthusiastic about their work. They knew the needs of the people who use the service well and presented as caring and responsible. The staff spoken with and one who returned a survey were very positive about the service provided to the people who use the service. Some comments made were the home “provides a good service, there is a great atmosphere and the staff care about the residents. I love coming to work at the home.” Seabank House DS0000018938.V362764.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The manager works long hours at the home, generally alone supporting the people who use the service in the morning, undertaking domestic tasks and doing waking night shifts. Working alone at the home and working excessive hours does not support the wellbeing of the people who use the service as this does not give the manager sufficient time to complete managerial tasks and could lead to the manager not completing her duties satisfactorily due to fatigue. The manager needs to review this practice and make the changes necessary to ensure the welfare of the people who use the service and the effective running of the home. Sometimes there are not enough staff at Seabank House in the mornings which can stop people doing what they would like to do. There must be a sufficient amount of staff available at all times to meet the needs of the people who use the service. Care plans need to clearly indicate the action that staff are to take to support the people who use the service with their physical and mental health needs. There should be further information available on the communication needs of the people who use the service so that they can be assisted to make further choices in their day-to-day lives. Complaints procedures should be developed and be openly accessible to everyone and put into a format that the people who use the service can understand. Improvements continue to be needed to the management of the finances of the people who use the service in order to ensure they are safeguarded from the risk of financial abuse. Seabank House DS0000018938.V362764.R01.S.doc Version 5.2 Page 7 Continued improvements are needed to the home environment in order to ensure that the people who use the service live in a well-maintained, comfortable environment. Risk assessments must be in place for all possible hazards in the home environment to ensure the safety of the people who use the service. Updated maintenance checks must be in place for all facilities including fire alarms and emergency lighting. A record of all training provided to staff, including induction training needs to be maintained. This is needed to demonstrate that staff are being provided with training that is suitable for the work they perform. In order to safeguard the people who use the service a robust recruitment procedure must at all times be in operation. Records must contain evidence that staff have been appropriately vetted before they begin work at the home. A system needs to be put in place for evaluating the quality of the services provided in order to ensure that good standards in all aspects of care provision are maintained at all times. Evidence of consultation with the people who use the service and their relatives, around important issues affecting the home, such as plans for improving the home environment should be made available. 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. Seabank House DS0000018938.V362764.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 Seabank House DS0000018938.V362764.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): 1, 2 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The contracts need to give clearer information around what the people who use the service will be expected to pay for themselves. Evidence that purchases made on behalf of the people who use the service are in their best interests needs to be documented. EVIDENCE: A copy of the home’s statement of purpose and service user guides were not available at this visit as the manager has taken them from the premises to update them. The manager agreed to forward a copy of both documents on completion. There have been no new admissions to the home since the last inspection. Records show the home carries out pre admission assessments prior to prospective residents being admitted. This information is then used to form the basis of a care plan to support the individual. Seabank House DS0000018938.V362764.R01.S.doc Version 5.2 Page 10 The contracts generally provide the recommended information that would support the best interests of the people using the service. However, clearer information needs to be included in the contract about what goods the people who use the service will be expected to pay for themselves. Since the last visit to the home some of the people who use the service have purchased reclining chairs for use in the lounge. These people would be unable to make an informed decision about such a purchase. The manager said that the relatives of some people had been consulted and had given their agreement, however, this information had not been documented. One person does not have any contact with relatives and an appropriate advocate was not consulted. In order to show that the people who use the service are having their finances appropriately safeguarded there needs to be evidence that where an individual is unable to make important decision about their finances for themselves an appropriate advocate is consulted. The contracts also need to provide information around any furnishings a person using the service would be expected to pay for. Seabank House DS0000018938.V362764.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are not provided with the information they need to fully support the people who use the service. EVIDENCE: Individual care plans are in place for all of the people living at Seabank House. We looked at four of these during our visit. They were easy to read and gave very personal information that related to the choices decided and indicated by each person using the service. The care plans provide individualised information about what makes the person happy, sad, frightened and angry. The plans build a picture of the important things to the people who use the service including those things that are non negotiable in their daily lives. Seabank House DS0000018938.V362764.R01.S.doc Version 5.2 Page 12 Care plans contain information about the support the person needs with their personal and health care and gave some information about how to provide this. There is however limited information about how the service identifies and meets people’s physical and mental health needs. This needs to be addressed to ensure that staff have the information they need to fully support the people using the service. Some care plans gave brief details about some risks identified for people such as possible seizures and use of a wheelchair, however updated actions for risks assessments associated with moving and handling and use of bed rails had not been carried out. We also noted that one care plan refers to a person needing two staff to assist them in the morning, however there was only one member of staff available on the day of the visit and indicated on the rota for the rest of the week. This reduced the choices for the person as to how to spend their time at the home until a second member of staff was available at 2pm. Three of the four care plans seen had been reviewed recently. The review is generally indicated by altering the care plan and writing the date of the review. In time this may make it difficult for staff to work out which information is the most up to date. A separate record of the review of the care plan should be documented. Relatives and professionals are not invited to the reviews of care plans. This should be addressed to ensure that the points of view of all the people relevant to the person using the service inform the care plan. There continues to be limited information available on the preferred methods of communication of the people who use the service. Further information on the way the people who use the service make their wishes and needs known should be documented as this will ensure the staff team are able to communicate effectively with the people living at the home. A review of the communication aids available should be undertaken. We spoke with most of the people living at the home who all indicated they were happy living there and “like the staff.” Observations of the people using the service with the staff showed that they were happy and relaxed in the company of the staff. A relative who returned a survey was also happy with the care provided. They said “My relative has been at the home for a number of years and they have always been looked after very well by the manager and the staff who are very caring people. I have never had any problems since they have been at the home.” Seabank House DS0000018938.V362764.R01.S.doc Version 5.2 Page 13 Surveys were returned by 3 health care professionals who work with the people who use the service. They said that the staff usually or sometimes seek advice and act upon it and that the health care needs of the people who use the service are either always or sometimes met. They said “the service does extremely well at supporting clients emotional/social and psychological needs.” “The standard of care by the staff team is excellent.” They considered that improvements need to be made to the communication systems at the home, as information is not always being passed on to the manager. They also said that improvement could be made to the care of the people who use the service by having closer working relationships with social workers and health care professionals. Seabank House DS0000018938.V362764.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 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. The people who use the service take part in appropriate activities that provide opportunities for their educational, social and personal development. EVIDENCE: The home works hard to support the people who use the service to make positive decisions and choices in their lives including being involved in voluntary work, college courses, leisure activities, holiday destinations and relationships. One person who uses the service told the inspectors about how much they enjoy their voluntary work at a local park. Seabank House DS0000018938.V362764.R01.S.doc Version 5.2 Page 15 The home has few set routines. However there is an expectation that the people who use the service will assist with some household chores such as tidying their rooms and helping with meal preparation. The people who use the service are encouraged to view Monday to Friday as time to carryout work related tasks and the weekend as leisure time. The people who use the service take part in both group activities and one to one activities with the staff. The manager works hard to promote a sense of community and provides opportunities for the people who use the service to enjoy time together. For example an annual holiday, visits to local pubs and restaurants. The care plans provide the staff team with brief information about what activities the people who use the service enjoy. The people who use the service are regularly involved in community life and community activities. Friendships and family contact are promoted. The people who use the service told the inspectors they liked living at the home and enjoy the activities that they do. They talked about a recent birthday celebration, which they had enjoyed, plans for another birthday celebration at the weekend, a holiday to Spain and looking forward to a holiday in Blackpool. Everyone can go on an annual holiday if they choose to and if they have the funds to pay for the trip. During the visit the people who use the service were observed returning from day services and talking positively about their time there. We observed the people who use the service and the staff team interacting in a relaxed and warm manner. Staff were observed to have a good rapport with the people who use the service and were observed to assist them in various choices especially in when they wanted to eat and in were they wanted to go in the home. The rights, likes, dislikes and choices of the people who use the service were seen to be respected during our visit. The support workers are responsible for all catering duties and encourage the people who use the service to eat a balanced diet. Examination of care plans and risk assessments indicate special dietary needs are catered for. The menus showed that the meals provided are varied and balanced. The people who use the service told the inspector they liked the meals at the home. Seabank House DS0000018938.V362764.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Records of personal care do not show that the people using the service are having their needs met in accordance with their care plans. Some further improvements are needed to the management of medication. EVIDENCE: The care plans provide the staff team with personal information about the most appropriate way to support the people who use the service with their personal care needs and requests. Records show that people are supported to access and get to health care appointments. Daily records showed that staff do not always record what type of personal care has been given so it is not always clear that the personal care needs of the people who use the service are met. Some health care records around the monitoring of weight and fluids were not up to date. Seabank House DS0000018938.V362764.R01.S.doc Version 5.2 Page 17 It was clear from meeting the people living at the home, that they had the help they need from staff to maintain their personal cleanliness and appearance. Following our last visit in November 2007 a pharmacy inspector has visited the home twice to review medication practices. During our visit we noticed some improvements to previous practices especially regarding the storing and recording of medications. The staff manage the medication for 7 people who use the service. Medication was stored and mostly recorded correctly, with clear records of medication received and given or not given. This helps to reduce the risk of mistakes occurring and provides a clear audit trail to check people receive their medication correctly. The use of occasional administration of medications was discussed with the owner as one record was unclear as to how many times it had been given in one day and it did not have a care plan. The use of this medication needs to be included in a care plan so that staff and the people who use the service have clear and accurate advice as to when this type of medication should be given and how to safely record it. Since the last visit to the home the manager and a senior carer have received training around assessing the competence of staff to administer medication. The manager reported that several staff have begun a distance learning course around the safe handling of medication and some staff have completed this training. The work-books seen at the time of the visit were blank, however, staff confirmed that they had completed the course. The manager is to forward evidence of staff training in the safe handling of medication to the CSCI. Seabank House DS0000018938.V362764.R01.S.doc Version 5.2 Page 18 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 adequate. This judgement has been made using available evidence including a visit to this service. Improvements continue to be needed to the management of the finances of the people who use the service in order to ensure they are safeguarded from the risk of financial abuse. EVIDENCE: A copy of a complaint procedure was not available at this visit to the home. The manager said that she does not have a procedure around the management of complaints. The manager reported that no complaints had been made to the home since the last inspection of the service. Since our last visit to the service we have received two complaints made to the CSCI about the running of the home. Some issues raised were substantiated. We discussed the recent anonymous complaints with the owner and how this indicates (in light of her having little evidence around the management of complaints) a need for her to review and develop an accessible procedure for the people who use the service, their relatives/advocates and staff for the management of complaints. Seabank House DS0000018938.V362764.R01.S.doc Version 5.2 Page 19 The people who use the service who were spoken with during the visit were happy with the service and said they would speak with the manager if they had any concerns or worries. A survey returned by a relative was very positive about the home and raised no issues or concerns. This relative said that they would know how to complain if they needed to. The manager reported that all staff have now been trained in the protection of vulnerable people. The staff training records did not support this. The manager must ensure that the records of staff training accurately reflect the training provided to staff. Staff have access to appropriate adult protection procedures. The staff spoken with were able to demonstrate a clear understanding of how to protect vulnerable adults from abuse. The owner manages most people’s money and social services are responsible for the finances of one person who uses the service. The owner has a safe place for the storage and management of financial records. Although a better system has been introduced for the management of people’s finances, the records had not been kept up to date and were disorganised and did not give accurate balances. As already indicated, there was no evidence that some of the people who use the service gave permission for the purchase of furniture from their finances. There was also no evidence that they had consented to their money being used to fund a holiday. As the people who use the service may not be able to give this permission, evidence that an advocate has been consulted needs to be available. The contracts also need to provide information around additional services/goods a person using the service would be expected to pay for. Seabank House DS0000018938.V362764.R01.S.doc Version 5.2 Page 20 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, 25 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Further improvements are needed to the environment and risk assessments need to be clearly recorded in order to provide the people who use the service with a safe and comfortable home. EVIDENCE: The owner showed us around the home and one person offered to show us their bedroom during our visit. The people who use the service said they liked their bedrooms and had everything they needed including personal belongings they had purchased and chosen. Seabank House DS0000018938.V362764.R01.S.doc Version 5.2 Page 21 The owner was the only person on duty and most areas were clean but some needing tidying and hovering to help give a better standard of cleanliness at all times of the day. The lounge had wallpaper peeling off the wall and the carpet was stained and faded making this area look neglected in parts. The owner was able to explain verbally the plans for redecoration of this area and other parts of the home including the bedrooms, replacement of carpets and bedroom furniture and decoration of the toilets and bathrooms. However, there were no specific dates of when this would occur as currently there is just one person responsible for the decoration and they only work one day a week at the home. Some of the bedrooms seen had been personalised to reflect the hobbies and styles of the people who use the service, however some were in need of redecoration and repair. One bedroom had been recently decorated with matching wallpaper chosen by the resident, matching linen, carpet and a new bed which helped provide an attractive and more modern and well maintained room. Some improvements to the home environment had been noticed from our previous visit and the owner has been sending in monthly letters to explain what works have been carried out since November 2007. One bedroom had a loose carpet and in one bathroom the flooring was waiting to be replaced, some rooms had uncovered radiators and use of bedrails on beds. There were no risks assessments in place or development plans to state what actions were being taken to reduce any associated risks or improve the safety for the people using the service. There was no maintenance, decoration or development plan to let people know when their room or bedroom would be redecorated. There was no evidence of a planned approach to the ongoing investment to the upkeep of the environment and no evidence of what funds are available to bring the home into a good standard of décor throughout. The kitchen is a domestic kitchen, which is accessible to most of the people who use the service and provides a large open space which was clean, tidy and organised. There is a designated laundry room, which has one washing machine and some washing was drying in this room. It was quite full and cramped with washing and storage of linen. Staff had to use a table lamp as they couldn’t reach the Seabank House DS0000018938.V362764.R01.S.doc Version 5.2 Page 22 ceiling light. This was not appropriate as no risk assessment was available until the light was safely replaced. On the outside of the home the gardens are unkempt with weeds and look neglected giving a poor outlook and poor view from bedrooms. Regular checks are carried out of the fire alarm and emergency lighting and regular drills are undertaken. Care needs to be taken to record the duration of the tests of fire alarm and emergency lighting. There was evidence of an up to date check of the portable appliances, gas safety and electrical wiring. A copy of the service checks of the fire alarm and emergency lighting were not available. Updated checks must be in place to show safe management of these areas to help provide a safe environment to live in. A requirement to make this information available was made at the last visit to the home. Seabank House DS0000018938.V362764.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The recruitment practices and the staffing levels at the home do not fully safeguard and support the people who use the service. EVIDENCE: The rotas were seen for a four-week period. These show that in the morning during the week there is generally one member of staff available, generally the manager, until 2pm. Most of the people who use the service are at day services during this time. When the majority of residents are at the home, in the late afternoon and at the weekends, there are between 2 and 3 members of staff available. The rotas show that the manager works nights and day shifts at the home. The rota for the week of the visit showed the manager was working 87 hours. The rotas for the other 3 weeks showed the manager was working over 70 hours. The majority of these hours are made up of waking night duties. Seabank House DS0000018938.V362764.R01.S.doc Version 5.2 Page 24 The manager carries out care tasks and domestic tasks when she works alone at the service during the day. Working alone at the home and working excessive hours does not support the wellbeing of the people who use the service as this does not give the manager sufficient time to complete managerial tasks and could lead to the manager not completing her duties satisfactorily due to fatigue. As already indicated, one care plan refers to a person needing two staff to assist them in the morning, however there was only one member of staff available on the day of the visit until 2pm. There was also only one member of staff indicated on the rota until 2pm for the rest of the week. This reduced the choices for the person as to how to spend their time at the home until a second member of staff was available at 2pm. There must be a sufficient amount of staff available at all times to meet the needs of the people who use the service. The manager reported that staff receive a brief induction. This covers the home’s policies and procedures, day-to-day routines; care plans and health and safety issues. A record of this induction was not available on four of the staff training records seen. Staff need to have access to a more thorough induction, which meets the standards of Skills for Care. A more detailed evidence based recording system should be put in place to identify that the Skills for Care workforce training targets have been met and any learning needs identified for staff. The AQAA completed by the manager shows that 4 out of ten staff have completed an NVQ 2 in working with adults with a learning disability. A further four staff are undertaking this training. A senior member of staff is working towards an NVQ 3. The people who use the service would benefit from at least 50 of staff having completed a relevant qualification in caring for adults with a learning disability. Since the last visit to the service the majority of staff have attended training around health and safety, first aid and equality and diversity. Staff are currently working on a distance learning course around the safe handling of medication. Care needs to be taken to ensure that all certificates of training are available on staff training records, to help show evidence that all staff are supported in being up-to-date in training necessary for their work and development while at the home. At previous inspections the manager has been advised of the need to provide further specialist training in the area of learning disabilities. To ensure the staff team are aware of best practice within this field. Since the last inspection Seabank House DS0000018938.V362764.R01.S.doc Version 5.2 Page 25 staff have attended some further training linked to the disabilities and specific conditions of some of the people who use the service. Members of the staff team spoken with told the inspectors that they enjoy working at the home and are well supported by the manager. The staff spoken with were very enthusiastic about their work. They knew the needs of the people who use the service well and presented as caring and responsible. Staff were very positive about the service provided to the people who use the service. Some comments made were the home, “provides a good service, there is a great atmosphere and the staff care about the residents. I love coming to work at the home.” “Staff get on well with each other and the residents. The residents are well cared for.” During the visit the inspectors observed the staff team supporting the people who use the service in a caring supportive manner. The people who use the service told the inspectors they like the staff and liked going out with them. No new staff have been recruited since the last visit to the home. The recruitment records for five staff who are currently working at the home were requested. These records did not provide evidence that the people who use the service are safeguarded by the manager’s recruitment process. There were no records available around the recruitment of one member of staff. There was no evidence available of a criminal records bureau check having been carried out on another member of staff. Only one of the five staff had been employed following receipt of two written references. There was no evidence to indicate that four of the staff were physically and mentally fit to work at the home. A photograph of each member of staff was also unavailable. The records seen contained contracts and job descriptions. Seabank House DS0000018938.V362764.R01.S.doc Version 5.2 Page 26 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 adequate. This judgement has been made using available evidence including a visit to this service. The management of the home and the systems in place for quality assurance do not fully support the wellbeing of the people who use the service. EVIDENCE: The manager is a qualified nurse. The manager began an NVQ Level 4 in management in March 2007 and is currently working towards this qualification. The training records for the manager showed that she has undertaken some training to update her knowledge and skills. Not all the certificates relating to the training undertaken were available at this visit. As already indicated, a record must be maintained of all training undertaken by staff in order to Seabank House DS0000018938.V362764.R01.S.doc Version 5.2 Page 27 demonstrate that staff are being provided with training that is suitable for the work they perform. As already indicated the manager works long hours at the home, generally alone supporting the people who use the service in the morning, undertaking domestic tasks and doing waking night shifts. Working alone at the home and working excessive hours does not support the wellbeing of the people who use the service as this does not give the manager sufficient time to complete managerial tasks and could lead to the manager not completing her duties satisfactorily due to fatigue. The shortfalls in the record keeping around staff recruitment, staff training, care planning, risk assessments and finances indicate that the management of the home is not as affective as it needs to be to promote the welfare of the people using the service. Requirements around ensuring the records of staff recruitment and the finances of the people who use the service are adequately maintained have been identified at previous visits to this service. The staff spoken with were very aware of the needs of the people who use the service. The manager and staff gain the views of the people who use the service on an informal basis through group and individual discussion. Discussion with the people who use the service and examination of a selection of care plan and daily diary entries indicate their opinions are sought and valued in all areas of the homes life. The owner said they do not have formal meetings due to having close and daily communication with everyone at the home, however there was limited information on how anyone was kept informed and included in the developments of the home. Other ways of maintaining standards and improving the quality of the service provided need to be looked at such as surveys for relatives and health and social care professionals, regular auditing of records to ensure they are up to date and contain the required information. The accident records were examined and indicated appropriate information had been recorded and appropriate actions had been taken. As already indicated, some risk assessment records relating to the safety of the environment were not available at this visit and action needs to be taken to address this. It was difficult for the owner to find recorded maintenance checks and certificates in the current filing system however some checks were produced Seabank House DS0000018938.V362764.R01.S.doc Version 5.2 Page 28 and showed regular checks by contractors to keep facilities maintained and safe. The manager reported that all staff are provided with training around health and safety matters with training updates being arranged when needed. The records of training did not support this as it could not be identified when some staff had received training around food hygiene, the use of the hoist, using specialist feeding equipment, infection control and first aid. As already indicated the records of staff training need to clearly demonstrate the training staff have received. Seabank House DS0000018938.V362764.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 2 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 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 2 2 X 2 X 2 X X 2 X Seabank House DS0000018938.V362764.R01.S.doc Version 5.2 Page 30 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 (1) Requirement The registered person must ensure that care plans clearly indicate the support the people who use the service need with their physical and mental health. So as to provide staff with the information they need to fully support the people using the service. Timescale for action 24/08/08 2. YA23 13 (6) 24/08/08 The registered person must ensure the financial records of the people who use the service are appropriately and accurately maintained in order to safeguard them from financial abuse (this requirement remains outstanding from a previous inspection.) The registered person must ensure that clear and accurate, financial agreements and financial assessments are available to evidence that any actions they take with regards to the finances of the people who use the service are in their best interests. 24/08/08 3. YA23 13 (6) Seabank House DS0000018938.V362764.R01.S.doc Version 5.2 Page 31 4. YA24 23 (2) (b) YA25 The registered person must continue to improve the home environment for the people who use the service in order to ensure that the people who use the service live in a wellmaintained environment. The registered person is to continue to provide the Commission with a monthly update as to the work to be carried out and work completed. 24/08/08 5. YA24 YA42 23 (4) (c) (iv) 24/08/08 The registered person must provide evidence that the fire alarm and emergency lighting have been recently serviced in order to demonstrate that this fire equipment is being appropriately maintained (this requirement remains outstanding from a previous inspection.) 24/08/08 The registered person must ensure staff records are well maintained in order to demonstrate that staff have been appropriately recruited to work at the home (this requirement remains outstanding from a previous inspection.) The registered person must ensure that there are sufficient numbers of staff available at all times to meet the needs of the people using the service. The registered person must ensure that a record is maintained of all training provided to staff, including induction training. This is needed to demonstrate that staff DS0000018938.V362764.R01.S.doc 6. YA34 19 (1) (b) 7. YA35 18 (1) (a) 24/08/08 8. YA35 17 (2) 24/08/08 YA37 Seabank House Version 5.2 Page 32 YA42 9. YA39 24 (1) are being provided with training that is suitable for the work they perform. The registered person must ensure that there is a system in place for evaluating the quality of the services provided in order to ensure that good standards in all aspects of care provision are maintained at all times. The registered person must ensure that risk assessments are in place and up to date for all hazards. This includes uncovered radiators, loose fitted carpets, bed rails, moving and handling and lighting in the laundry. 24/10/08 10. YA9YA30 YA42 13 (4) (c) 13 (5) 24/08/08 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 YA1 YA5 Good Practice Recommendations A copy of the revised statement of purpose and service user guide are to be forwarded to the CSCI. Where a person using the service is unable to make decisions about their finances for themselves there needs to be evidence that an appropriate advocate has been consulted. The contracts also need to provide information around any goods and additional services a person using the service would be expected to pay for. The review of the care plan should be documented separately to the care plan to avoid confusion. 3. YA6 Seabank House DS0000018938.V362764.R01.S.doc Version 5.2 Page 33 4. YA6 Relatives and professionals should be invited to the reviews of care plans, in accordance with the wishes of the people using the service so that the points of view of all the people relevant to the person using the service inform the care plan. Further information on the preferred methods of communication of the people who use the service should be documented as this will ensure the staff team are able to communicate effectively with the people living at the home. A review of the communication aids available should be undertaken with a view to providing more pictorial aids. A record of the personal care provided to the people who use the service should be made consistently to provide evidence that staff are meeting peoples needs as detailed in their individual care plans. Medicines and related records should continue to be reviewed and care plans put in place for medications that are used on an occasional basis. Regular quality audits should be carried to make sure all practices in the administration of medicines are safe. The manager is to forward evidence of staff training in the safe handling of medication to the CSCI. A complaints procedure that can be understood by the people who use the service and is readily accessible for them, their relatives/advocates needs to be available. A clear complaint procedure for staff also needs to be available. A development plan should be produced and shared with the people who use the service, staff and relatives to show what plans are taking place regarding the decoration and maintenance of the home. 50 of care staff at the home (including agency staff) are to hold an NVQ Level 2 in Care or equivalent. In order to maintain good standards and a good quality of care for the people who use the service the manager should not work excessive hours at the home and should have specific time allocated for managerial tasks. DS0000018938.V362764.R01.S.doc Version 5.2 Page 34 5. YA7 6. 7. YA7 YA19 8. YA20 9. 10. 11. YA20 YA20 YA22 12. YA24 13. 14. YA32 YA33 YA37 Seabank House 15. 16. 17. YA35 YA37 YA39 Staff should have access to a more thorough induction, which meets the standards of Skills for Care. The manager is to obtain an NVQ Level 4 (or equivalent) in management. Regular staff, resident and relative meetings should be carried out. Seabank House DS0000018938.V362764.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Waterloo, Liverpool L22 OLG 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 Seabank House DS0000018938.V362764.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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