Inspection on 17/07/06 for Silver Birches

This inspection was carried out on 17th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 21 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Silver Birches 23/04/09

Silver Birches 14/05/08

Silver Birches 03/05/07

Silver Birches 08/11/06

Silver Birches 12/01/06

Silver Birches 09/02/05

Silver Birches 12/09/04

Silver Birches 19/02/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Silver Birches 2-6 Marchmont Road Richmond Surrey TW10 6HH Lead Inspector Sharon Newman Unannounced Inspection 17th July 2006 10:00 Silver Birches DS0000017394.V298841.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 Silver Birches DS0000017394.V298841.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. Silver Birches DS0000017394.V298841.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Silver Birches Address 2-6 Marchmont Road Richmond Surrey TW10 6HH 0208 948 5423 0283327286 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) Elizabeth Fitzroy Support Ms Catherine Sullivan Care Home 15 Category(ies) of Learning disability (15), Physical disability (15) registration, with number of places Silver Birches DS0000017394.V298841.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th January 2006 Brief Description of the Service: Silver Birches is registered to provide accommodation and personal care for fifteen people who have a severe learning disability or a physical disability. The service is owned and managed by Elizabeth Fitzroy Support and is situated in a residential area in Richmond. The home is divided into three separate flats and a day centre that is part of the service. The Community Team for People with Learning Difficulties and healthcare practitioners offer support. No details about fees charged were provided by the home despite two written requests for this information. Silver Birches DS0000017394.V298841.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One regulation inspector and a pharmacy inspector conducted this unannounced inspection. Records looked at included staff files, health and safety documentation and residents’ care plans. The pharmacy inspector looked at medication documentation and procedures. The findings of his inspection are included in this report. This home is divided into three flats and the inspection visit concentrated on flat 2 and flat 3. Surveys were left at the home for residents, relatives, health/social care professionals and staff to complete. The staff were welcoming and helpful, and the inspector thanks them for their time and suggestions. This home is registered for fifteen residents and there were thirteen residents living at the home on the day of inspection. The manager is no longer in post and staff reported that a new manager is due to start at the home in September. Concerning issues were raised during the inspection visit, these are documented within the main body of this report. Some of the issues raised concerned complaints and protection and must be addressed. What the service does well: What has improved since the last inspection? The portable appliance testing and gas safety certificates have now been obtained. Silver Birches DS0000017394.V298841.R01.S.doc Version 5.2 Page 6 What they could do better: The Service User Guide needs to be updated so that it contains an up-to-date copy of the resident’s terms and conditions. Also, contracts need to be in place for all residents so that they or their representative are aware of the terms and conditions of the home. Care plans and risk assessments need to be kept up-to-date to ensure that residents’ needs are met. The pharmacy inspector found that record keeping, storage and auditing of medication needs to be improved. The allergies section on the medication administration records needs to be completed; if the individual does not have an allergy then this should also be documented. This will help to ensure that residents are not placed at risk. All allegations of abuse must be reported to the London Borough of Richmond in line with local procedures to ensure the safety of the residents. Staff must be aware of local policies and procedures in relation to the protection of vulnerable adults and the home must ensure that a copy of the London Borough of Richmond’s adult protection procedures is obtained and is accessible to all staff. All staff must receive up-to-date training in abuse awareness to ensure that residents are not placed at risk of harm. The complaints log must be fully completed with actions taken and outcomes reached to ensure that this information can be audited. It will also help to demonstrate that the home has an open and fair complaints procedure. All maintenance issues outlined in this report must be addressed. This includes the broken bathroom extractor fan and the broken drawer on the washing machine. There were many staffing issues raised during the inspection visit. These included training, one- to-one supervision, lack of meetings, staffing levels and records. All these areas must be addressed. All staff must receive up-to-date training in all mandatory areas including first aid, food hygiene and moving and handling. Staff must receive regular one-to-one supervision to ensure they have the support they need to carry out their roles. Staff meetings must be held to ensure all staff are aware of current issues within the organisation and can exchange ideas. Adequate numbers of competent and trained staff must be on duty at all times. It is important that staffing levels are sufficient to ensure the safety of the residents and that their needs can be met. Staffing records must be complete to demonstrate that staff have had all necessary pre-employment checks to make sure that residents are not placed at risk. Staff must receive formal training with regard to looking after people with challenging behaviours so that they have adequate knowledge in this area and can meet residents’ needs. Silver Birches DS0000017394.V298841.R01.S.doc Version 5.2 Page 7 A manager needs to be in place at the home and they must register with the Commission for Social Care Inspection. A quality assurance programme needs to be put into place to ensure that the opinions of the residents and/or their relatives or advocates are taken into consideration regarding life at the home. The Commission for Social Care Inspection must be notified of any deaths or incidents where residents may be at risk of harm. Up-to-date certificates must be obtained with regard to legionella testing and the five yearly electrical checks to ensure the environment is safe. 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. Silver Birches DS0000017394.V298841.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 Silver Birches DS0000017394.V298841.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents are assessed prior to coming to the home and this is a thorough process. This enables residents to decide if the home can meet their needs. However, a lack of contracts does not enable residents or their relatives to be fully aware of the terms and conditions of the home. EVIDENCE: A staff member reported that the Service User Guide has not been yet been updated, this requirement remains outstanding from the previous inspection visit. This document requires further review to ensure it contains a statement of the home’s main terms and conditions so that residents and/or their relatives are fully informed about these. Residents’ contracts were not available for inspection and this requirement remains outstanding from the previous inspection report. All residents must be issued with a contract and these should be available for inspection. Initial pre-admission assessments of need completed by health and social care professionals were in place in the three out of four residents’ files seen. However, comprehensive information regarding needs was available in the file of the resident who did not have preadmission assessment in place. A staff member reported that the assessment process may take place over a few Silver Birches DS0000017394.V298841.R01.S.doc Version 5.2 Page 10 months to ensure that the home is suitable for the prospective resident. They said that an initial assessment and referral information is sent to the home and then one of the staff members goes to assess the individual in their own surroundings. This individual is then invited to spend time at the home to meet staff and residents and may also stay overnight to see if they would like to stay. Silver Birches DS0000017394.V298841.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. A more user friendly care planning format will be of benefit to residents and staff. There is comprehensive and detailed information in the care plans. However, not all care plans and risk assessments are up-to-date and this may affect the care of residents. Staff continue to demonstrate a good knowledge of residents support needs. EVIDENCE: Information seen in the residents’ files was comprehensive and covered health/medical needs, social needs, leisure, nutrition, likes and dislikes. However, it was at times hard to extract useful information as the files contained out-of-date material that should be archived. There was also documentation in place such as bowel charts that had not been completed. All out-of-date and unused documentation should be removed to ensure these files are more user friendly and easier for staff to use. This will help staff to follow the care plans more easily to meet the needs of the residents. Some resident’s files require updating and staff said they were addressing this issue. Silver Birches DS0000017394.V298841.R01.S.doc Version 5.2 Page 12 Staff reported that new person centred ‘support plans’ are now being phased in at the home. These were seen to be informative and consisted of pictures and symbols to help residents understand them more easily and participate in planning their care. They contained information including personal details, medical contacts and details about relationships, communication, leisure, community living skills and the care required by each individual. Some staff commented that they felt the care plan documentation should be consistent throughout the home. They suggested that this new format would lead to consistency in the care planning format throughout the home. Risk assessments were in place in the files sampled and covered issues including: walking in the community, environmental and health risks. Some had not been fully completed and although most were up-to-date some required review. All risk assessments must be regularly reviewed to ensure residents are not placed at risk. Silver Birches DS0000017394.V298841.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Links with the community remain good and this helps to provide residents with effective social and educational opportunities. Staff continue to encourage and support residents to be as independent as possible. EVIDENCE: Residents seen on the day of inspection were appropriately dressed and clean in appearance. Staff were observed to assist a resident to paint their nails and then support them to go to the hairdressers. They spoke to the resident in a caring manner and helped them make a choice as to the style of haircut they would like. Staff spoken to demonstrated a very good knowledge of the residents that they look after. They were able to describe their likes and dislikes and give a detailed history about the residents. This knowledge helps to make sure that residents needs can be met. One resident likes a particular type of music and Silver Birches DS0000017394.V298841.R01.S.doc Version 5.2 Page 14 staff have helpfully placed a sticker on their radio to indicate to all staff members the radio station that this individual prefers to listen to. A staff member said that many residents have formed friendships within the home. Some residents like to go out to evening clubs and meet outside friends and one resident is supported to email friends and relatives. Residents are supported to participate in activities that they enjoy. This includes attending football matches, motor shows, visiting relatives, going to concerts and having hand and foot massages. A staff member reported that four of the residents are going on holiday soon and will be accompanied by staff members. One resident chooses to attend a place of worship each week. There is a Resource Centre attached to the home that is available for the use of residents. Computers are available in this centre and these have widget programmes and touch screens for easier use by the residents. A range of music, television and video equipment is in place for residents use in the three lounge areas. There was a lot of information in the care plans concerning residents’ food likes and dislikes. There was also information about their nutritional needs. This helps to make staff aware of the appropriate diet and correct consistency of the food for each resident. Staff reported that each resident is asked daily what food they would like to eat. They said that if weekly choices are given then residents may forget what they have requested so it is less confusing for the residents if they are given a daily choice. They also reported that they are exploring different ways of presenting the food choices to residents. Staff are trying to use models of food in some cases as they said many residents do not like to look at menus in either word or symbol format. Each resident has their own shopping list that reflects their individual needs and choices. A range of fruit and vegetables is offered daily. Silver Birches DS0000017394.V298841.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. There is evidence of good communication with community health and social care professionals. Minor errors in record keeping, omissions in the policy and inappropriate storage of medication were found. These did not put the health or welfare of residents at immediate risk. However, allergies are not recorded on medication records and this may place residents at risk. EVIDENCE: The local community Learning Disability Specialist team provides support to residents. Care plans seen contained evidence of input from health and social care professionals such as nurses, GP’s and dentists. Hospital appointments are documented and residents have a medical ‘grab sheet’ which contains health and information that residents take to appointments. All records relating to receipt, storage, administration and disposal were examined and compared to the current medication on two of the three units. Three staff members were interviewed. Medication not supplied in the Silver Birches DS0000017394.V298841.R01.S.doc Version 5.2 Page 16 monitored dosage system was counted and compared to the records. This was to check that medication was being given as directed. All the medication in stock agreed with the list of medications on the administration records. Each resident has a medication profile detailing discontinuations and alterations to medication. The profile also has a section for recording allergies. A stock control record was seen on each unit detailing all medication coming in to and going out of the home. The allergy section had only been completed for one resident. Staff said that no other resident had allergies to medication. This was not clear from the records. In five instances the medication on the profile did not correspond with the current medication administration records. In one instance the start date of the medication had not been recorded on the profile. One resident had been recorded as receiving a medication twice a day when the medication was prescribed once a day. The medication is supplied in a monitored dosage system and was being given correctly. New procedures have been developed following medication administration errors. The policy does not fully detail the procedure for supplying medication to residents on leave from the home. Discussion with staff and records showed that medication is supplied appropriately to residents when they go on leave from the home. The cupboard for medication on one unit was not attached to the wall and could be lifted and carried. All other medication was stored securely and in the correct conditions. Most medication is given from a monitored dosage container. Staff are able to check if medication has been given or not. Directions for administration for two items were not clear. Staff were all aware of the procedure for checking and handling medication and have received appropriate training. The communication records showed that staff identified issues with medication and that appropriate action was taken. It was not possible to audit two medications not supplied in the monitored dosage system as the amount of medication carried over from one month to next had not been recorded. Detailed stock control records could e used to track the use of the medication but it would be easier if the quantity each month is recorded. A monthly check is done on the current medication and the provider performs a visit. A recent report highlighted that photos of residents needed to be in place. This had been done by the time of the visit. The reports did not indicate what was checked when medication is looked at. It was not clear whether the actual administration of medication is audited. Silver Birches DS0000017394.V298841.R01.S.doc Version 5.2 Page 17 Silver Birches DS0000017394.V298841.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. There are many concerning issues at this home regarding complaints and protection. Complaints are not appropriately recorded or easy to follow or audit and this does not create an open and transparent climate at the home. A copy of the Local Authority Procedures regarding abuse and adult protection were not in place and these are not followed. Appropriate checks have not been made on all staff and they have not all received up-to-date information or training on recognising and reporting abuse. Residents may be placed at risk. EVIDENCE: The complaints log contained details of one complaint and also a complaint letter. Staff said they did not know where previous complaints had been logged. This information should be available to ensure it can be audited which can help to demonstrate an open and fair system of dealing with complaints. One of the above complaints had not been logged and there was no indication of the action taken. The complaints log must contain full details of action taken and outcomes. One complaint involved a resident whose wishes had not been respected by staff. The inspector was informed that action would be taken to prevent this happening again. This type of behaviour is not acceptable and can be seen as abusive. Residents must be listened too and their choices respected. Silver Birches DS0000017394.V298841.R01.S.doc Version 5.2 Page 19 Staff on duty said they did not know if there was a copy of the London Borough of Richmond’s Protection of Vulnerable Adult Procedures at the home. This must be obtained. All staff must be aware of these procedures and this home must follow these procedures to ensure that residents are not placed at risk. The Commission for Social Care Inspection has been informed of two Protection of Vulnerable Adults allegations at this home this year. The inspector was informed that one resulted in the dismissal of a staff member and the other was referred to social services for investigation. However, during the inspection visit the inspector was informed that further allegations had been made that were not referred to the London Borough of Richmond in line with adult protection procedures. This is not acceptable; the correct procedures must be followed to ensure residents are not placed at risk of harm. There was insufficient evidence to demonstrate that staff and residents had been appropriately supported following these allegations. Also, not all staff have had formal up-to-date training in abuse awareness. It was discussed with a staff member that they should contact the London Borough of Richmond to find out if they will provide this training for staff at this home. Evidence could not be found to demonstrate that all staff have had appropriate training in caring for residents with challenging behaviours. One staff member reported that they had not received this training and that this would be beneficial to them. This training must be put in place as the inspector was informed that some residents have episodes of challenging behaviour and staff must be aware of how to respond appropriately. Staff spoken to had a good knowledge of the importance of whistleblowing in relation to reporting concerning issues. Staff files were incomplete and this issue is discussed in the ‘Staffing’ section within this report. Silver Birches DS0000017394.V298841.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The environment at this home is comfortable and homely. Residents’ bedrooms are well personalised and attractive. The home is clean and hygienic. EVIDENCE: The home is divided into three separate flats one of which is on the ground floor and two are situated on the first floor. There is a day centre that is also part of the service. The lounge and dining areas seen were spacious, bright and comfortable. There is a large open plan kitchen and lounge area in Flat 3 which is particularly large and attractive. Bedrooms seen on the day of inspection were personalised well to individual residents taste. They contained solid good quality wooden furniture, were well decorated and looked homely and comfortable. They also contained adaptations necessary to help promote the residents independence. These included ceiling hoists where needed and adapted sinks and beds. Silver Birches DS0000017394.V298841.R01.S.doc Version 5.2 Page 21 A new maintenance person is now in post and staff reported that this was an improvement. They were spoken to and provided helpful information during the inspection visit. Staff also said that necessary repairs and decoration were now taking place throughout the home and that they were a valued member of staff. On the day of inspection it was noted that it was a very hot day. Electric fans were being used throughout the home to help to cool the air. However, staff reported that an extractor fan in one of the bathrooms in Flat 2 was broken. They said that it was extremely hot in this room when they were assisting residents to have a bath. This fan must be repaired for the comfort of the residents and the staff. Toilet and bathroom facilities remain sufficient to meet the needs of the current service users. They contain adaptations including ceiling hoists and specialised baths to help meet the needs of the residents. There is also a walkin shower available for their use. One of the bathrooms on the ground floor had flooring which was marked and stained in places and this needs to be replaced to help create a more homely environment. The broken detergent drawer on the washing machine has not been repaired and this requirement remains outstanding from the last inspection. Staff reported that they are going to replace the washing machine with one designed for industrial use as they said this would be more practical. They had obtained two quotes with regard to this. The home was clean, hygienic and free from offensive odours on the day of inspection. Silver Birches DS0000017394.V298841.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The staff have a good understanding of residents’ support needs and appear committed to providing good care. They are caring and enthusiastic. However, lack of one-to-one supervision for staff members does not enable staff to have the support and direction they need to carry out their roles. Staff training in mandatory areas such as manual handling, food hygiene and first aid is not upto-date for all staff members. Information in staff files was incomplete and lack of staff may place residents at risk. EVIDENCE: Staff were seen to talk to residents in a caring manner and those spoken to had a good knowledge of them and their likes and dislikes. All staff members spoken to said that they enjoyed working at the home. Three reported that communication within the home could be improved as they felt that staff did not always pass on important information about the residents. The inspector was informed that the home was ‘short-staffed’ on the day of inspection. Another staff member reported that they believed more care staff were needed on a regular basis. Two reported that on night duty there is only one member of staff to cover both flats on the first floor. They reported that in one of these flats there are residents who have challenging behaviour and that Silver Birches DS0000017394.V298841.R01.S.doc Version 5.2 Page 23 they require support. They said that in the other flat there is a resident who is known to get out of bed and wander during the night. They were concerned that the residents may be at risk of harm when there is no staff member in their flat. A health/social care professional also commented that they felt more care staff were needed at the home particularly at night. The staffing rota consisted of many alterations and staff admitted that it was difficult in places to see who was on duty. The home must ensure that adequate numbers of appropriately trained staff are on duty at all times to ensure the safety of the residents. Four staff files were looked at and were variable in content. The inspector was informed that much of the staffing information is kept at the organisation’s head office. However, if this is the case then a checklist which contains all the information about the pre-employment checks should be in place in the staff files. This checklist should be signed and dated by a Human Resources staff member to validate that this information has been seen before it is sent to the home. The checklists in place in the staff files did not indicate that appropriate checks had been made, many of the sections had not been completed and they had not been signed and dated. One of the files contained a reference from a friend of the staff member. Yet it clearly stated on the reference form that these should not be obtained from friends or relatives. The home must ensure that it follows it’s own procedures in relation to obtaining references to ensure the safety of the residents. Colour photographs of the staff members were not seen in the files sampled and these must be obtained. Some certificates were seen which indicate that some staff have recently attended training in food hygiene and fire protection. An up-to-date training log was not in place to demonstrate that all staff are up-to-date with mandatory training including first aid, food hygiene and moving and handling. This must be put in place to provide evidence to show that staff have received sufficient training to ensure the protection of the residents. The supervision log indicated that some staff are receiving regular on-to-one supervision. However, many staff are not and this must be put in place to ensure that staff are receiving appropriate support and direction. The inspector was informed that regular staff meetings are not taking place and this requirement remains outstanding from the previous inspection. It is important that these occur to improve communication within the home and so that information can be shared and important issues discussed. Staff commented that the induction process at the home was thorough and that they are issued with an ‘induction pack’ to complete during their first few weeks at the home. Silver Birches DS0000017394.V298841.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42, 43 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. There are many areas that need to be addressed at this home. There are inadequacies in areas including complaints, protection, staffing and management. The home will benefit from a manager being in post and also from full implementation of a quality assurance system. EVIDENCE: There is currently no manager in post at the home. Staff reported that a new manager has been recruited and is due to start in September. Staff said that the supervisors were dividing the management duties between them, one reported ‘we share the task.’ This seems to be unsatisfactory as there is no clear management structure within the home at present and lines of accountability are not clear. Staff reported that the previous manager had started to implement some good changes but all this ‘has been put on hold.’ One staff member said ‘we need a consistent manager.’ Silver Birches DS0000017394.V298841.R01.S.doc Version 5.2 Page 25 Staff expressed concern at the ‘lack of communication’ between staff members within the home in relation to passing on information within the home. They said that this area needs to improve as it could affect the care of the residents. The home must ensure that a manager is in place at the home and that they are registered with the Commission for Social care Inspection. Staff reported that they are well supported by the operations manager and that they provide them with one-to-one supervision that they find helpful. Staff were unaware if a quality assurance programme was taking place to obtain the views of the residents and their relatives/advocates. This needs to be put in place. Residents’ money was seen to be kept in individual marked tins and staff members check the contents three times a day. Each resident also has their own cash sheet and staff explained that if there were any discrepancy they would immediately inform their head office. Up-to-date certificates need to be obtained for the five yearly electrical installation check and legionella testing. These could not be produced on the day of inspection. Portable appliance testing and gas safety checks were up-todate. A fire drill took place on 14th May 2006 to help ensure the safety of the residents. In one file a form was seen to have been completed regarding an unexplained injury to a resident. It indicated that senior management had not been informed about this finding and there was also no follow up action plan in place. The Commission for Social care Inspection (CSCI) had not been informed. Clear evidence of action taken and follow up must be in place after any unexplained injury to ensure the safety of residents. The CSCI must be informed of all incidents that affect the well being of the residents. Silver Birches DS0000017394.V298841.R01.S.doc Version 5.2 Page 26 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 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 2 X X 2 2 Silver Birches DS0000017394.V298841.R01.S.doc Version 5.2 Page 27 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 YA1 Regulation 5 (1) Requirement The Registered Persons must ensure that the Service Users Guide contains all information as required by Regulation 5 (1). (Previous timescales of 01/10/05 and 01/04/06 not met). The Registered Persons must ensure that copies of Placement Agreements are obtained for any service user placed by a Local Authority. (Previous timescales of 01/11/05 and 01/05/06 not met). The Registered Persons must ensure that care plans and risk assessments are regularly reviewed and kept up-to-date. The Registered Persons must ensure that the allergies section on medication administration sections is fully completed. (Previous timescale of 01/02/06 not met) The registered person must ensure that all medication records are up to date and DS0000017394.V298841.R01.S.doc Timescale for action 01/09/06 2 YA5 5 (3) 01/09/06 3 YA6 15 (b) 01/08/06 4 YA20 13 (2) 17/07/06 5 YA20 13 (2) 01/08/06 Silver Birches Version 5.2 Page 28 maintained accurately. 6 YA20 13(2) The registered person must ensure clear directions for administration are available for all medication. The registered person must ensure there is a detailed procedure for the supply of medication to residents on leave from the home The Registered Persons must ensure that the broken drawer on the washing machine is repaired. (Previous timescale of 01/03/06 not met) The Registered Persons must ensure that the broken fan in the bathroom is repaired. The Registered Persons must ensure that there is a full complaints log in place with full details of action taken and outcome. The Registered Persons must ensure that there is an up-todate copy of the Local Authority Protection of Vulnerable Adults procedures at the home. Staff must be familiar with these procedures. The Registered Persons must ensure that all staff receive up-to-date training in abuse awareness and adult protection procedures. The Registered Persons must ensure that there are sufficient numbers of trained and experienced staff on duty at all times to meet the needs of the service users. The Registered Persons must ensure that staff files contain all the information required in Schedule 4 of the Care Homes Regulations 2001. DS0000017394.V298841.R01.S.doc 01/08/06 7 YA20 13(2) 01/08/06 8 YA24 23 (2) 01/08/06 9 10 YA24 YA22 23 (2) 22 Sch 4 01/08/06 01/08/06 11 YA23 13 (6) 01/08/06 12 YA23 13 (6) 01/09/06 13 YA33 18 (1) (a) 17/07/06 14 YA34 19 (4) 01/08/06 Silver Birches Version 5.2 Page 29 15 YA35 18 (1) 16 YA37 17 YA36 18 YA36 19 YA42 20 YA42 21 YA42 The Registered Persons must ensure that all mandatory staff training is up-to-date. Refresher training must be provided for staff as required with regard to Moving and Handling, First Aid and Food Hygiene. 9(1)12(1a&b) The Registered Persons must ensure that there is a manager in place who is registered with the Commission for Social Care Inspection. 21 The Registered Persons must ensure that regular staff meetings are fully recorded. (Previous timescale of 01/04/06 not met) 18 (2) The Registered Persons must ensure that all care staff receive one-to-one supervision at least six times a year. (Prorata for part-time staff). (Previous timescale of 01/03/06 not met.) 13 (4) The Registered Persons must ensure that up-to-date certificates are obtained for the five yearly electrical check. (Previous timescale of 01/03/06 not met) 13 (4) The Registered Persons must ensure that an up-to-date legionella certificate is obtained. 37 The Registered Person must ensure that the Commission for Social Care Inspection is notified of all events that affect the well being and safety of the service users. 01/09/06 01/11/06 01/08/06 01/08/06 01/08/06 01/09/06 01/08/06 Silver Birches DS0000017394.V298841.R01.S.doc Version 5.2 Page 30 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 YA20 YA20 Good Practice Recommendations It is recommended that a more detailed audit of medication be done regularly and recorded. It is recommended that the quantity of medication left each month is counted and recorded on the administration record for item not supplied in the monitored dosage system. Silver Birches DS0000017394.V298841.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Silver Birches DS0000017394.V298841.R01.S.doc Version 5.2 Page 32 - 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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