Inspection on 31/08/09 for Seabank House

This inspection was carried out on 31st August 2009.

CQC 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Seabank House 24/07/08

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 15/11/2009.

Key inspection report CARE HOME ADULTS 18-65 Seabank House 111 Seabank Road Wallasey Wirral CH45 7PD Lead Inspector Diane Sharrock Key Unannounced Inspection 31 July and 21 August 2009 14:00 Seabank House DS0000018938.V376982.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Seabank House DS0000018938.V376982.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Seabank House DS0000018938.V376982.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Seabank House Address 111 Seabank Road Wallasey Wirral CH45 7PD 0151 512 0887 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.V376982.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1 The registered person may provide the following category 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 24 July 2008 Brief Description of the Service: Seabank House is a large detached house in Wallasey. 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 and dining room. 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. The owner Helen Gifford is also registered as the manager of Seabank House. A copy of the statement of purpose and service user guide, which describes the services offered at Seabank House was displayed at the front entrance. At the time of the visit the fees were £308 to £614 per person a week. The fees do not include, hairdressing, clothing, holidays and other items agreed and pointed out by the owner. Seabank House DS0000018938.V376982.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 visit to the home took place over 2 days, 30 July and 21 August 2009. It was unannounced and was one part of the inspection of the home in which we also looked at various information received about the home since our last inspection there. Before the visit, we asked the manager to complete a detailed questionnaire about the home that we call an annual quality assurance assessment (AQAA). This gave us lots of information about developments at the home and statistical data that we used to plan our visit to the home. We also sent out surveys to people living at Seabank House, to staff and to professionals working with the home to find out their views about it. At the time of writing this report, only four surveys from staff had been returned to us. During our visit, we talked with people who live at the home and with staff. We observed how staff were providing support for the people living at Seabank House and we walked round the building to see its facilities. Some people living at the home agreed for us to look at their bedrooms. We also spent time looking at records and policies and talking with the manager to see how the home was being run. Following concerns and requirements made at our last visit to Seabank House we arranged for a management review within the commission to review the outstanding areas of concern. We then met the manager/owner to discuss the outstanding issues and the commission’s procedures for services that were not complying with the regulations and not improving services to an acceptable standard. We also issued “a serious warning letter” to the manager to ensure they were clear as to what actions needed to be taken to improve services at Seabank House to enable full compliance with the Care Home Regulations 2001. We also requested that the manager submit a detailed action plan to the commission stating exactly what actions she would take to improve services at Seabank House. The manager told us that she had taken various actions to help meet requirements made. She submitted an updated improvement plan to us on 27 October 2008. She told us she had developed questionnaires/surveys to help get regular opinions from people regarding the service to offer people the chance to make comments about Seabank House. Seabank House DS0000018938.V376982.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Following our last visit to Seabank House, the manager/owner has carried out various work to help improve the home and shown what they have done to meet some of the requirements made by the commission. The manager was continuing to make improvements to the home’s environment and has purchased a large wall to wall wardrobe for one bedroom. She plans to refurbish all of the bedrooms with these new wardrobes and purchase one each month. Some of the communal areas, lounge, dining room and various bedrooms have been painted and decorated and a new carpet has been supplied to the main stairwell, which has helped to improve the environment. The manager has developed a pictorial style statement of purpose and complaints procedure which helps people to understand what’s offered at Seabank House. The manager has reviewed the training needs of most of the staff and organised a training plan which covers a lot of training to help staff keep up to date with the skills needed to do the job. Seabank House DS0000018938.V376982.R01.S.doc Version 5.2 Page 7 What they could do better: During this visit to the home, the manager told us that she had not developed the questionnaires/surveys she told us on 27 October 2008 that she had done, as part of the improvements needed at the home. This is of concern as any information supplied to the commission must always be truthful and accurate and we must be told about any changes to this information so we have up to date information about the necessary improvements being made to meet requirements. The manager must show compliance in meeting all requirements made to help improve the service to ensure the welfare of the people who live at Seabank house. The manager continues to work long hours at the home, generally alone, supporting people 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 live there. Also it does not give the manager sufficient time to complete managerial tasks and could lead to the manager not completing her duties satisfactorily. The manager needs to review this practice and ensure she has regular managerial hours and time allocated to safely manage the home. The manager must demonstrate that the staffing levels are regularly reviewed and are sufficient to meet the needs and dependency levels of the people living at Seabank House. The information about how the home works and who it is for, called the statement of purpose, should be updated to include the staffing levels people can expect to see and be provided with at Seabank House to meet their needs. Some people who live at the home receive funding for one–to–one support and staffing rotas should be clear to identify that this is being provided. The care plans must show how those people’s needs are being met with this additional support so that everyone is clear and informed about those individual needs. There should be further information available about people’s communication needs updated in their communication plans so that they can be helped to make further choices in their day-to-day lives. All staff should have the necessary training to help them support individual communication needs including those people who like to use Makaton, a specialised form of communication used by some people with a learning disability. Improvements continue to be needed to the management of the finances of the people who live at Seabank house in order to ensure they are safeguarded from the risk of financial abuse. Finance records and assessments must be clear and developed before any purchases being made on behalf of the people who live at Seabank House. Seabank House DS0000018938.V376982.R01.S.doc Version 5.2 Page 8 Assessments must show how people are being advised and supported to make large purchases and include their advocates/ representatives and must show they are getting value for money and that any purchases made are in their best interest. Financial policies and procedures must be clear and easy to understand and must explain the actual financial processes and safe management of their finances so that people can be accurately informed as to how their finances are managed. This may help them to make decisions and choices about the procedures offered. Continued improvements are needed to the home’s environment in order to ensure that people live in a well-maintained, comfortable and safe environment. New carpets and flooring are needed throughout the home as the manager has been unable to get them replaced over the last 12 months due to delays and processing problems with the carpet suppliers. A maintenance, decorating and refurbishment programme must be developed with a plan of dates for all outstanding work to be carried out so people can be included and kept informed and up to date with the developments planned in their home. The planned maintenance programme must include all worn stained carpets, loose flooring in bathroom and toilet areas, old worn bedroom furniture and develop safe areas within the garden area and safe seating within the garden for people to enjoy. Risk assessments must continue to be developed and be in place for all possible hazards in the home’s environment to ensure the safety of everyone at Seabank House. Risk assessments must include all identified hazards such as the small cramped laundry, the garden area and uneven pavements, toiletries stored in bathrooms, uncovered radiators within the home. Action must be taken to continue with the development of staff training. Dates must be obtained for refresher and outstanding training. This is needed to demonstrate that staff are being continually provided with training that is suitable for the work they perform and they are kept up to date with the right skills to do the job. In order to safeguard the people who live at Seabank House a robust recruitment procedure must be used at all times. All staff records must contain updated pictures to confirm their identification and details and evidence of their training. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Seabank House DS0000018938.V376982.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Seabank House DS0000018938.V376982.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not always have the most up to date information about Seabank House to help them make decisions about whether the home would be the right place for them to live. EVIDENCE: No new people have moved into Seabank House since our last visit there. The information the manager sent us before we visited the home said, “Could have more detailed information about personal goals – working on this.” We were also told by the manager, “We utilise the expertise of fellow professionals and work in co operation together with the service user to achieve the best outcome. We promote high values in respect and dignity for each person who lives at Seabank. We provide a homely environment based on individual choice. Specialist equipment for service users are physically evident after assessments carried out by fellow professionals such as community nurses. Individual records of health input such as GP Seabank House DS0000018938.V376982.R01.S.doc Version 5.2 Page 11 appointments are kept to monitor and ensure health and issues are addressed regularly”. The contracts provided by the home generally include the recommended information but clearer information still needs to be included in it about what goods and services that people living in the home would be expected to pay for themselves. An information brochure about the service is available to tell people about Seabank House and support they can expect if they live there. This helps everyone to decide if Seabank house is the right place for the person to live in and if their needs and choices can be met there. Following our last visit to the home, the manager had made sure that this document was available and accessible. This brochure is called a statement of purpose and the manager had developed this document with the use of pictures to help people to understand the information it contained. The statement of purpose would also benefit from being updated further with accurate information about staffing levels peoples can expect at the home, details of services offered with activities and social support, meals and staff training. At the moment, this document does not identify the fees charged for living there and the address for the commission needs to be updated so people know where to contact us if they need to. Seabank House DS0000018938.V376982.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff help to support people to make decisions about what they want to so they can take part in all aspects of life at Seabank House. EVIDENCE: In the information she sent us before our visit, the manager said, “A new health form allows us to monitor people’s health and professional services used like last time a service user visited their GP or had an eye test”. She also told us, “I believe we have a well rounded plan for each service user which covers their work, leisure and personal choices. Minor details are included that are personal to the person have sometimes the most profound effect in making someone’s life more pleasant, safer and enjoyable. We encourage service users to tell us what they want and we provide choices and advice to help them in the decision making process. We accept service user’s decision Seabank House DS0000018938.V376982.R01.S.doc Version 5.2 Page 13 whether we agree or disagree with them, and will point out any possible risk involved and work together to minimise any risk. A new health form allows us to monitor people’s health and professional services used like last time a service user visited their GP or had an eye test”. Individual support plans were in place for all of the people living at Seabank House. We looked at two of these during our visit. They were easy to read and gave individualised information relating to the choices each person had made. The manager and staff had developed these support plans following our last visit to Seabank House and had updated the plans with regular reviews of the support provided. The support plans provided 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 live at Seabank house. Support plans contain information about the support the person needs with their personal, social and health care needs and some gave information about how to provide this. This helps to make sure that staff have the up to date information to provide the support each person needs, in the way they prefer. Staff have developed support plans to identify each person’s preferred methods of communication. One plan indicated the person uses Makaton, a form of sign language developed for people with a learning disability to use. The plan would benefit from being developed further to show the signs and pictures the person regularly uses to help staff clearly identify what they are saying. All staff should have training and guidance on the use of this specialised communication tool so that they are all ware of how to support people who like to use Makaton. We met some of the people living at the home who all indicated they were happy living there. We observed good relationships and rapport between the staff and people living at Seabank House. They were happy and relaxed in the company of the staff. Seabank House DS0000018938.V376982.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): This is what people staying in this care home experience: 12, 13, 14, 15, 16 and 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Seabank House are supported to take part in appropriate activities so they have opportunities for their social and personal development. EVIDENCE: The information the manager sent us before our visit to the home said, “We have provided more indoor activities that the service users have asked for, we continue to listen to what they want and to respond were possible service users make their own minds up to take part or just watch”. People living at Seabank House are supported by staff to take part in group activities and one to one activities. Not long before our visit, everyone living at the home had been to “Flamingo Land” for their annual holiday. Everybody Seabank House DS0000018938.V376982.R01.S.doc Version 5.2 Page 15 said they really enjoyed their holiday and one person showed us their holiday pictures. Everyone can go on an annual holiday if they choose to and if they have the funds to pay for the trip. The manager has developed support plans following our last visit and has updated records regarding what activities people enjoy. This information helps with planning the one to one and group activities to make sure suitable opportunities for taking part in activities are made available for everyone living at the home. During our visit we observed people returning from day services and talking positively about their time there. We discussed the views leading out of the home from both the front and back of the building. The garden views had a lot of weeds and overgrown hedges and uneven surfaces. We discussed improvements needed to enhance the seating areas for people so they could enjoy using the garden. The manager told us that staff carry the dining room tables and chairs outside when people want to sit out during good weather. We noticed on the second day of our visit to the home that the manager had organised some garden maintenance of the front of the home and plans to improve the garden areas and facilities although there were no dates for completing this work. We looked at the staffing levels when everyone was back at the home and on the days they did not go out to day services. Most evenings there were just 2 staff on duty and at the weekend there were just 3 staff on duty. There was no assessment or evidence to show how the staffing levels are calculated to make sure that the needs of all the people living at Seabank House can be met, especially if everyone wanted to go out or do individual activities. Staff were observed to have a good rapport with the people who live at Seabank House and we saw staff help people with various choices and activities such as what they wanted to eat and in cooking cakes in the kitchen of the home on the first day of our visit there. Support staff are responsible for all catering duties and encourage people to eat a balanced diet. People said they liked the meals at the home. The care plans we saw showed that special dietary needs are catered for. The menus showed that the meals provided are varied and balanced. Occasionally people who live at Seabank House go to local pubs and choose to eat out. Seabank House DS0000018938.V376982.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to look after their health so they can stay safe and comfortable in how they live their life. EVIDENCE: The manager told us in the information she sent before our visit to the home, “We support each service user with their healthcare and physical and emotional needs, we ensure all appointments with relevant professionals are kept and any identified needs are actioned and met. We support each person with their medication and explain the reasons why it has been prescribed. We monitor people’s well being and ensure regular checks are carried out such as eye tests. Each service user has an identified key worker who is responsible for checking and monitoring support given to each individual is how they want it to be given and they are satisfied”. Seabank House DS0000018938.V376982.R01.S.doc Version 5.2 Page 17 Individual care plans were in place for all of the people living at Seabank House. We looked at two of these during our visit. They were easy to read and had been developed further following our last visit to the home. They provided staff with information that related to the choices decided and indicated by each person living at Seabank house. The support plans provide the staff team with individualised information about the most appropriate way to support people with their personal care needs and requests. Staff had introduced health action plans to show how people are supported to get health care appointments including specialised support from the dieticians and practice nurses. It was clear from meeting people living at the home that they had the help they need from staff to maintain their personal cleanliness and appearance. The staff manage the medication for seven of the people who live at Seabank House. We found that medications were appropriately stored and managed safely, 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. We identified that some people needed specialised assistance with their medication and it should only be given by staff that have up to date training on how to administer the medication safely. Some staff had received this specialised training but others hadn’t and for some, the most recent training update had been in 2007. Regular refresher training should be organised as a matter of good practice as this helps staff to be fully up to date with the emergency medication administration techniques they might need to use to help keep people safe. The manager reported that all staff who give out medicines to people living at the home have received up to date training on how to do this safely. Staff on duty confirmed to us that they had completed this training course and were up to date in medication administration. Seabank House DS0000018938.V376982.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements continue to be needed to the management of the finances in order to ensure that people are safeguarded from the risk of financial abuse. EVIDENCE: The information we received before our visit to Seabank House told us, “We have compiled a pictorial complaints form for service users. We have regular contact with relatives and others who support the service users. Staff attend Wirral Adult Protection courses. Regular conversations with service users listening to their views”. We were also told of plans to “Introduce advocacy, simplify pictorial form, introduce questionnaire for service user’s satisfaction levels”. At this visit a copy of the complaints procedure for the home was available. The manager told us that one complaint had been made to the home since our last inspection there. We looked at these records which showed a good detailed investigation and that the manager had taken appropriate action to resolve the complaints. Since our last visit to Seabank House we had received one complaint, which was the same as the one received by the home, and which had also been Seabank House DS0000018938.V376982.R01.S.doc Version 5.2 Page 19 referred and dealt with by Wirral social services under the local safeguarding procedures. Following our last visit, the manager told us that they had started to organise and provide regular house meetings for staff and people living at Seabank house. On the first day of our visit, there was no evidence of these meetings. Following that visit, the manager organised a house meeting in August and we saw the minutes of this on the second day of our visit. This process has helped to develop a way for people living at the home and staff to raise their comments or concerns. They have also become involved in picking the colour schemes of the new carpets. The people who live at Seabank House said they were happy and said they would speak with the staff if they wanted to ask anything. Some staff had not received training or updates about safeguarding procedures and abuse awareness. Some certificates showed that some people last had this necessary training in 2007. The manager must ensure that staff are provided with this necessary training regularly so they have up to date knowledge on what to do to make sure that people living in the home are safe from abuse. Staff on duty at the time of our visit discussed the local safeguarding procedures and what they would do if they ever had concerns. They were able to demonstrate an understanding of how to protect vulnerable adults from abuse. The manager of the home manages the money of all but one person living at Seabank House; social services are responsible for the finances of the other person. The manager has a safe place for the storage and management of financial records. We looked at a small sample of money stored on behalf of two people living at Seabank House. The manager has developed a clear and improved system for the management of people’s finances. The records had been kept up to date and were organised and accurate. The balances we checked were correct. The manager had also developed assessments to show she had identified which of the people living at the home was capable of making their own decisions and who needed support or advice from their next of kin regarding how they spend their money. Some people had confirmed they were happy for items to be purchased on their behalf and some relatives had identified they would like to be consulted regarding any planned purchases of large items. Some people had been identified as being able to make their own personal decisions about what they wanted to do with their money. However, as identified at our last visit, there was still no evidence that some of the people who live at Seabank House had given permission for the purchase of large Seabank House DS0000018938.V376982.R01.S.doc Version 5.2 Page 20 items such as furniture, holidays and spending money and equipment such as, “leg braces.” Since our last visit to Seabank House, staff had organised a holiday for the people who live there. Some people would not be able to make an informed decision about spending money in this way, so evidence that an advocate or relative had been consulted each time a large purchase is made needs to be available. We noted this point at our last visit and advised that if the manager continued to manage the money of people living at Seabank House they must have clear, accurate and transparent records to show that their money was being managed properly and spent in their best interests. 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/ relative is consulted and a clear assessment is carried out. There was no evidence that people had consented to their money being used to fund the recent annual holiday. The manager stated she had not deducted the money as yet as she had not worked out the costing. This meant that nobody had the necessary information about how much they would be charged for their annual holiday or what costs they had incurred. This situation remained the same during the second day of our visit. This meant there were no records or assessments to show the planning, reasons and costings for such expenditure. The manager had submitted an improvement plan to us on 27 October 2008 as required after our last inspection of the home. In this, referring to large purchases and people’s capacity to make decisions about them, she told us, “I will ensure written consent is at Seabank House before such purchases are made”. As she had failed to carry this our, this requirement remains outstanding and must be complied with as a matter of urgency to show that the finances of the people living at Seabank House are safe and being managed in their best interests. The contract that each person has with the home still needs to include information about any additional services/goods a person living at Seabank House would be expected to pay for, over and above their weekly fees. Seabank House DS0000018938.V376982.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 29 and 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of 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 with a safe and comfortable home. EVIDENCE: The manager sent us information that said, “We employ a part time handyman which enables minor repairs and faults to be rectified in the least possible time and also a plan of redecoration to be established. All service users’ bedrooms have been redecorated and some new furnishing added with the service users taking the lead role in choosing colours and materials, bathrooms have been retiled as well as the kitchen. Living room remains the last part to be completed, utilise and improve space outside”. Seabank House DS0000018938.V376982.R01.S.doc Version 5.2 Page 22 The owner/manager showed us around the home and one person offered to show us their bedroom during our visit. They showed us their new wardrobes and the manager told us that she had plans to replace one wardrobe a month so that everybody has this style of wardrobe. The people living at Seabank House told us they liked their bedrooms and had everything they needed including personal belongings they had purchased and chosen. The owner was the only person on duty up until 2pm then 2 staff came on duty. Most areas were clean but some needing tidying and hoovering to help give a better standard of cleanliness at all times of the day. The lounge had been decorated following our last visit but the carpet in there worn and stained, as noted at our last visit to the home. The owner/manager told us that there were plans for replacing the carpet in the lounge and in other parts of the home including the bedrooms, replacement of flooring and bedroom furniture and decoration of the toilets and bathrooms. Some improvements to the home’s environment had been made since our previous visit and the manager has been sending us various update letters to explain what works have been carried out. She told us of various problems over the last 12 months when carpet suppliers had let her down which was the reason why the carpets and flooring had not yet been replaced. In one bathroom and toilet the flooring was still waiting to be replaced as it was loose around its edges and coming up on its seal; this also meant it remained a potential trip hazard. Some rooms had uncovered radiators. On the first day of our visit, there were no risk assessments about this despite our requirement that there should be assessments done to make sure that any risks in the environment at the home were being managed to reduce the risk of harm or injury to people living and working there. On the second day of our visit, the manager had developed risk assessments and the one for the uncovered radiators stated that radiators were to be replaced with ones that were not hot to the touch. However, some of these assessments had no dates or details of the plans of when the replacement programme would happen. There was no maintenance, decoration or development plan to let people know when their room or bedroom would be refurbished with carpets and new furniture. There was no evidence of a planned approach to the upkeep of the environment and no evidence of what funds were available to bring the home into a good standard of décor throughout. On the second day of our visit, the manager had produced a list of the maintenance and redecoration that had already been carried out and a list of work that still outstanding. It was suggested that this could be used to inform people about planned developments in their home. Seabank House DS0000018938.V376982.R01.S.doc Version 5.2 Page 23 The kitchen at the home is a domestic type kitchen, which is accessible to most of the people who live there and provides a large open space which was clean, tidy and organised at the time of our visit. Staff had not been using the “food matters” manual which had been supplied by the environmental health department to help people keep records to show safe practices of food hygiene are carried out at the service. There is a separate laundry room with one washing machine. At the time of our visit, washing was being dried in the room and it was quite full and cramped. There was still no risk assessment for this area despite the manager telling us in October 2009 that a health and safety audit had been carried out by external consultants. We discussed this statement as there was no evidence of a health and safety audit being carried out. The risk assessments the manager had worked on before the second day of our visit needs to be developed to include all hazards, including the laundry. These should be dated to show when they were made and updated when action is taken to show that steps are being taken to reduce risks within Seabank House and people living and working there are safe. From the outside, Seabank House looked neglected, with paint peeling from the walls, gardens that were unkempt with weeds giving a poor outlook and poor view from bedrooms and from the dining room. The hard surfaces were cracked with weeds growing through them. There was nowhere for people to sit outside in the better weather although the manager told us that staff took the dining table and chairs outside if people wanted to sit out. We did not see any risk assessment for this but noticed on the second day of our visit that work had started to be done to the front garden to clear it and provide a better maintained garden for people to enjoy. We looked at a sample of maintenance and contractor checks which showed updated certificates for the facilities, installations and equipment in the home. This showed us that these were being maintained so they were safe. Seabank House DS0000018938.V376982.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Seabank House are supported by staff who are knowledgeable about their needs to help make sure that they get the support they need in the way they prefer. EVIDENCE: In the information sent to us before our visit, the manager told us, “Care hours provided 318. District nurses are utilised for injections and any nursing procedure required. We provide a consistent staff team no leavers in the past twelve months. Each member of staff displays a person centred approach to each service user and demonstrates high values in respect and dignity. All personal care is undertaken by the appropriate gender. Staff have achieved NVQ x 5, 2 working towards 3, 1 staff about to achieve level 4. We encourage staff to contribute to the development of the home and peoples lives”. The plans identified for the next twelve months were to “Identify and conduct specialist training identify staff to complete NVQ level 3”. Seabank House DS0000018938.V376982.R01.S.doc Version 5.2 Page 25 The rotas were seen for a two week period. They showed 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 live at Seabank House attend a day service most days with some people having days off during the week which can leave 2 to 3 people at the home in the day 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 continues to work excessive hours including nights and day shifts at the home. The rota for the week of our visit showed the manager was working in excess of 79 hours per week. The majority of these hours are made up of waking night duties. The manager carries out care tasks and domestic tasks when she works alone at the service during the day. We discussed this at our last visit and pointed out that working alone at the home and working excessive hours does not support the wellbeing of the people who live at Seabank house, as this does not give the manager sufficient time to complete managerial tasks and could lead to the manager not completing her duties satisfactorily. This was evident through our visit due to the number of requirements that had not been fully completed or put in place by the manager. There was no evidence to show how the staffing calculations had been worked out to show whether there are sufficient numbers of staff to meet each person’s needs especially when people have a day off from the day service during the week. There must be sufficient amount of staff available at all times to meet the needs of the people who live at Seabank House. Since our last visit to the service the majority of staff have attended various mandatory training and the manager has developed a training plan that is displayed on the office wall to help show what each person has attended and what training they are next due. Some of the staff are currently working on a distance learning course around the safe handling of medication. This training plan and staff files identified some outdated training and gaps in present training offered to staff. Dates must be obtained for refresher and outstanding training including, e.g., safeguarding and rectal diazepam, moving and handling, and Makaton. This is needed to demonstrate that staff are being continually provided with training that is suitable for the work they perform and they are kept up to date with the right skills to do the job. 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. Seabank House DS0000018938.V376982.R01.S.doc Version 5.2 Page 26 We received 4 surveys from staff and 2 felt their induction “mostly “covered everything they needed to do their job, 2 people felt their induction, “very well” covered what they needed. We met some of the staff on duty during the two days we visited the home. Staff told us that they enjoy working at the home and that they really had a good time at the recent holiday they had organised. Staff were very enthusiastic about their work and felt they had received all relevant and necessary training to help them do their job. They had good rapport with each person and we noticed the friendly and warm friendships they had with the people they helped support. Each person was individually greeted by the staff on coming back from their day service and placement and helped to get comfortable while waiting for their evening meal. The four surveys we received from staff were mostly positive about the service provided to the people they support. Some comments made included, “A homely, friendly environment for service users and staff. very low turnover of staffing levels”, “Any concerns, our manager is in most days or at the end of a phone”, “Residents and staff have good relationships” and “…provides a comfortable and homely environment for each service user to live in”. People living at Seabank House told us they liked living at the home and they liked their rooms. They talked about were they had been in the day and about their recent holiday. During our visit we noticed that some people had been supported with helping to make cakes for everyone and others had been supported by staff with their health care appointments. Staff had been able to plan the support needed for each individual during our visit especially when they were staying at home for the day. We looked at the recruitment records for three staff working at the home. These records had been developed and updated following our last visit and were much more organised with the right checks in place to most of the staff files. One file did not have evidence of a picture for identification or any evidence of any necessary training to help them support the people living at Seabank House. Recruitment checks for all staff must be thorough and show that they cover all the necessary checks and records including evidence of training so that people living at Seabank House can be assured they are being safely supported. Seabank House DS0000018938.V376982.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 42 and 43 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and safety of people at Seabank House is not always safely or adequately managed so people living at the home may be put at risk. EVIDENCE: The manager is a qualified nurse. The manager began an NVQ Level 4 in management in March 2007 and is still working towards this qualification. Following concerns and requirements made at our last visit we met the manager/owner to discuss the outstanding issues. We also issued “a serious warning letter” to the manager/owner to ensure they were clear as to what Seabank House DS0000018938.V376982.R01.S.doc Version 5.2 Page 28 actions needed to be taken to improve services at Seabank house to enable full compliance with the Care Home Regulations 2001. We requested that the manager submit a detailed action plan to the commission stating exactly what actions she would take to improve services at Seabank House. The manager told us that she had done various actions to help meet requirements made. She submitted an improvement plan to the commission on 27 October 2008. She told us she had developed questionnaires/surveys to help get regular opinions from people regarding the service to offer people the chance to make comments about Seabank House. However during our visit the manager admitted she had not yet carried this out yet. This is something that must be carried out. Any information supplied to the commission must always be truthful and accurate and any changes must be supplied to the commission to keep us up to date with necessary developments and requirements within the home. During this visit we identified some developments and improvements by the manager with the training, personnel files, statement of purpose and care plans. However we also noticed various outstanding issues that had still not been completed fully such as the management of health and safety and financial assessments for large purchases. As already indicated the manager works long hours at the home, generally alone supporting people 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 people 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. This was highlighted and discussed with the manager at our previous visit. The manager has reduced her hours by approximately 5 hours per week and is now taking regular holidays but in reviewing staff rotas she is still working in excess of 79 hours per week covering days and nights. The shortfalls in the record keeping around health and safety, staff files, staff training, risk assessments and finances indicate that the management of the home is still not as effective as it needs to be to promote the welfare of the people living there. During the second day of our visit we discussed the outstanding requirements and the areas of concern that needed to be addressed. The manager had developed some records and presented these during day two of our visit including environmental risk assessments, and a list of maintenance that she had carried out and plans to develop. The manager had also organised a house meeting which she is now keeping minutes of. These minutes help to evidence of how people are being included and kept informed about the developments of their home. Seabank House DS0000018938.V376982.R01.S.doc Version 5.2 Page 29 The accident records were examined and indicated appropriate information had been recorded and appropriate actions had been taken to help keep people safe. As already indicated, some risk assessment records relating to the safety of the environment were not available on day one of our visit. During day two of our visit the manager showed that she had since developed and produced some environmental risk assessments to help show how she was safely managing the home. Some risk assessments still needed to be developed so they include identified risk areas such as the laundry, toiletries stored in the shared bathrooms, and the garden area and uneven external flooring. The manager had updated maintenance checks at the service and showed regular checks by contractors to keep facilities maintained and safe. During day one the staff could not find an updated check for the heating; however this was carried out following our visit and was produced during day 2 of our visit. Seabank House DS0000018938.V376982.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 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 3 23 2 ENVIRONMENT Standard No Score 24 2 25 x 26 2 27 2 28 X 29 2 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 2 2 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 2 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 2 x X 2 2 Version 5.2 Page 31 Seabank House DS0000018938.V376982.R01.S.doc Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA9 Regulation 13 (4) (c)13 (5) Requirement The manager must ensure that risk assessments are in place and up to date for all hazards. This includes uncovered radiators throughout the service, loose fitting bathroom and toilet flooring, toiletries in the bathroom, uneven flooring to external areas in the garden and risks of air borne infections in the laundry. This will help to show what actions the manager will be taking to reduce and eliminate identified risks to make the service a lot safer to be in. (This requirement remains outstanding from the previous inspection.) People must have clear and accurate financial records and financial assessments that are available to evidence that any purchases staff make on behalf of people are documented to show they are in their best interests. This will ensure that they can be safeguarded from risks of financial abuse and can be supported to make decisions DS0000018938.V376982.R01.S.doc Timescale for action 23/10/09 2 YA23 13 (6) 23/10/09 Seabank House Version 5.2 Page 32 about what they want to spend their money on regarding large purchase such as holidays, personal furniture and equipment. (This requirement remains outstanding from the previous inspection.) 3 YA25 23 (2) (b) The service must be kept in a good state of repair and the current worn stained carpets and loose flooring throughout the home must be repaired and replaced in order to ensure that the people live in a wellmaintained, dignified and comfortable home. (This requirement remains outstanding from the previous inspection.) 23/10/09 4 YA35 18 (1) (a) 23/10/09 The service must have suitably qualified and competent staff and experienced persons working at the home in such numbers that are appropriate for the health and welfare of people living at Seabank House. The service must demonstrate that that there are sufficient numbers of staff available at all times to meet the needs of people living there. (This requirement remains outstanding from the previous inspection.) 23/10/09 The service must have suitably qualified and competent staff and experienced persons working at the home in such numbers that are appropriate for the health and welfare of people living at Seabank House. Staff must be up to date and have the right skills and training to support people with safeguarding and abuse awareness. This is needed to demonstrate that staff DS0000018938.V376982.R01.S.doc Version 5.2 Page 33 5 YA35 18 (1) (a) Seabank House are being provided with training to safeguard people at Seabank House. 6 YA35 18 (1) (a) The service must have suitably qualified and competent staff and experienced persons working at the home in such numbers that are appropriate for the health and welfare of people living at Seabank house. Staff must be up to date and have the right skills and training to safely support people with specialised administration of rectal diazepam. The manager person must ensure that there is a system in place including consulting with people living at the service and their representatives to help improve the quality of the services provided in order to ensure that good standards in all aspects of care provision are maintained at all times. (This requirement remains outstanding from the previous inspections.) 23/10/09 7 YA39 24 (1) 23/10/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA1 Good Practice Recommendations The statement of purpose must be updated to that people have the most up to date information to help them make decisions about the home. The statement of purpose should be up to date with the staffing levels that people can expect to find at the home, the commission’s address and contact details in case anybody wants to contact us, DS0000018938.V376982.R01.S.doc Version 5.2 Page 34 Seabank House details on the fees charged, activities offered and supported, staff training and qualifications and menus and meals offered. 2 YA7 Further information on the preferred methods of communication of people living at the home should be documented and developed to include symbols and preferred signs e.g. using makaton for some people who choose to use it. This will ensure the staff team are able to communicate effectively with the people living at the home. The care plans also need to be updated for those people receiving additional 1 to 1 funding so that the plan can clearly demonstrate to people how they will be supported with additional support. This will also help to provide staff with the information they need to fully support people. Contracts need to be developed to be clear and accurate so that people have the right information to make choices about the service. The contract should provide information about any goods and additional services the owner expects people to additional pay for separate from the weekly fees charged. A development plan for Seabank House should be produced and shared with the people who live there and include staff and relatives to show what plans are taking place regarding developing their home including decoration, refurbishment and maintenance of the home. The maintenance plan should include the external building so the home’s paintwork is improved and well maintained. The garden area should be developed so that it is safe and offers a safe seating area for people to enjoy when they choose to sit out in the gardens and should offer an improved and more attractive view to look out to. The service must ensure that an accurate and updated record is maintained of all training. This is needed to demonstrate that staff are being provided with updated training that is suitable for the work they perform. The manager should not work excessive hours at the home and should have specific time allocated for management tasks to make sure that the home is run in the best interests of the people who live there. Staff should have pictures for identification and evidence of training and skills to be able to do the job. This will DS0000018938.V376982.R01.S.doc Version 5.2 Page 35 3 YA5 4 YA24 5 YA32 6 YA33 7 YA34 Seabank House ensure there is a thorough management of the recruitment and support of staff to be able to safely do their job. 8 YA37 The manager should obtain an NVQ Level 4 (or equivalent) in management. This will help her to develop the skills necessary for the ongoing safe management of Seabank House. Seabank House DS0000018938.V376982.R01.S.doc Version 5.2 Page 36 Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Seabank House DS0000018938.V376982.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!