Inspection on 31/01/08 for South West Independence

This inspection was carried out on 31st January 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 28 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

South West Independence 07/08/08

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 South West Independence Gordon Villa 15 Taunton Road Bridgwater Somerset TA6 3LP Lead Inspector Sally Murphy Unannounced Inspection 31st January 2008 and 7 February 2008 1:00 th South West Independence DS0000070448.V358273.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 South West Independence DS0000070448.V358273.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. South West Independence DS0000070448.V358273.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service South West Independence Address Gordon Villa 15 Taunton Road Bridgwater Somerset TA6 3LP 01278 458018 01278 458018 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 Sarah Jane Minton Mr Ben Chidgey Care Home 3 Category(ies) of Learning disability (3) registration, with number of places South West Independence DS0000070448.V358273.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 either gender whose primary care needs on admission to the home are within the following category: 2. 3. Learning disability (Code LD) The maximum number of service users who can be accommodated is 3. The age range for admission to the service is for persons aged 16-25 years only. Date of last inspection Brief Description of the Service: South West Independence is a small service providing care to people who have a learning disability. The home is situated close to Bridgwater town centre and close to shops and amenities. Accommodation is provided over four floors. There is a selfcontained flat for one person, with a staff sleep-in room on the ground floor, and further accommodation for a further two people arranged over the upper floors. Accommodation is spacious and there is a large garden at the rear of the premises. South West Independence is registered to provide personal care for three people who have a learning disability who are aged 16-25 years. The Registered Provider is Sarah Minton and Ben Chidgley is the Registered Manager. Weekly fees range between £3867.15 and £2726.54. detailed within individual peoples’ contracts. Additional costs will be South West Independence DS0000070448.V358273.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 0 stars. This means the people who use this service experience poor quality outcomes. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. Registration of this service was completed on 25 September 2007. The home was previously a foster placement providing care to one young person. The home applied to be registered with CSCI when this person reached 18 years of age. The focus of this key inspection was to inspect relevant key standards under the Commission for Social Care Inspections ‘Inspecting for Better lives Framework. This focuses on outcomes for residents and measures the quality the service under for general headings. These are; excellent, good, adequate and poor. This inspection was completed over two days. The home was visited on 31 January 2008 when the Inspector spent time with one person and their advocate. Some documentation including recruitment records was examined. A further visit was completed by two Inspectors on 7th February 2008 to examine the remaining documentation. The second person currently receiving support from this service was present during this visit, but stated that they did not wish to speak with the inspectors regarding the home. Prior to the inspection an Annual Quality Assurance Assessment (AQAA) was sent to the home. Comment cards (surveys) were also sent to people living at the home, their relatives, health and social care professionals involved in their care, and staff members. The findings from these documents have been incorporated within this report. What the service does well: Surveys were received by CSCI from three staff members. These provided positive feedback regarding the home. Staff stated that they felt that the home provided a ‘stable and supportive environment for young adults’, and that that they supported people towards independence. One relative stated that the believed that staff try to give a good standard of care. One person spoken with during the inspection stated that the food is good and staff are helpful. South West Independence DS0000070448.V358273.R01.S.doc Version 5.2 Page 6 The home seeks to gain the view of people living at the home. These are recorded within their 1:1 book. Records evidenced that discussions had been held regarding meals, activities. Monthly summaries had been completed. Records relating to people living at the home had been stored securely. One person has a key to the home and now goes out without staff supervision for agreed periods of time. Staff are in the process of preparing a notice board to go in another persons’ room to provide further information for them regarding their daily plans. Care records included evidence of regular contact with family members. One person is receiving support from staff so that they will be able to make the journey to visit their family independently. For the other person, staff arranged a holiday near to their relatives so that they could spend time together. People are able to choose clothes that reflect their age and personal preferences. People are able to determine who becomes their key worker. The home provides spacious accommodation, close to the town centre. There are sufficient bathrooms and communal space to meet peoples’ needs. Staff complete 48 hour shifts, with further staff working dayshifts to provide a 2:1 staff ratio during the day. Those staff spoken with during the inspection stated that the Registered Manager was approachable. All staff had been provided with fire safety training and fire drill records were up to date. What has improved since the last inspection? What they could do better: The Statement of Purpose requires a thorough review to ensure that it includes the appropriate information and that the information is easily accessible. The Service User Guide is only available in written form and therefore is not accessible to all of the people living at the home. These documents must also be thoroughly reviewed to ensure that they reflect a service for adults. Neither of the people currently living at the service had been provided with a written contract. This must be provided so that people are aware of what is included in the weekly fee, and which items they must pay for separately. Care records require re-organisation to ensure that staff are able to access guidance on how to meet each persons needs. Care plans should include South West Independence DS0000070448.V358273.R01.S.doc Version 5.2 Page 7 goals for each person and regular review of the support being provided by staff to assist people in achieving these. There must be clear guidance available to staff where people may display challenging behaviour. Appropriate strategies must be developed to support people with situations that frequency causes anxiety or challenging behaviour. Where staff provide assistance in managing peoples’ finances, appropriate records must be maintained. Care records must include information on how people will be assisted to meet their cultural needs. There must be appropriate equipment proivded to enable all people living at the home to be able to contact family members, friends or Social Workers independently. There was not evidence of interpreters being routinely booked to accompany one person. People living at the home should be able to speak with healthcare professionals independently and be provided with appropriate support to access these services. The complaints procedure must be available in a format that is accessible to people living at the home. The complaints procedure must be updated to provide information on the timescales for response, to include the contact details of CSCI and advise people that they may contact an external agency such as CSCI at any time. A copy of the whistle blowing policy must be made available to each staff member. There have been 15 recorded incidents at the home since it was registered on 25 September 2007, but these had not been notified to CSCI or the peoples’ Social Worker. An immediate requirement was issued to state that all incidents must be reported to CSCI in accordance with Regulation 37 of the Care Home Regulations 2001. The home must provide evidence that people have been involved in choosing colours and soft furnishings for their accommodation. Appropriate equipment must be provided to ensure peoples safety and to maximise their independence. This should include a flashing light linked to the door bell to alert this person that others are entering the flat. All equipment and furniture must be maintained in good working order. The registered persons should review the outside space available to one person at the home. Staff must not continue to smoke within this person’s outside space. Staff must not commence employment at the home until appropriate information is obtained regarding them. An immediate requirement was issued which stated that staff may start work once two satisfactory references and a POVA First check has been obtained. They must be fully supervised until the enhanced CRB disclosure is obtained. Recruitment files must include a full employment history and any gaps in employment explored and recorded. A health declaration and proof of identity must be obtained. References must be sought from the persons’ last employer wherever possible. When a CRB records a conviction a risk assessment must be completed in relation to the work that they undertake. South West Independence DS0000070448.V358273.R01.S.doc Version 5.2 Page 8 All staff must receive induction training that meets the Common Induction Standards and an appropriate record maintained. Staff must receive regular updates in health and safety, and food hygiene, and clear records maintained. The home has not been effectively managed. During the course of the inspection areas of significant concern were identified including: staff recruitment, complaints procedures, provison of equipment and reporting of incidents. Some of the polices and procedures require review to ensure that they relate to a service that is provided to adults, and that they reflect best practice. The Registered Provider must visit the home on a monthly basis in accordance with Regulation 26 of the Care Home Regulations 2001, and forward a copy of these reports to CSCI. The fire risk assessment must be updated to include risks relating to one person being deaf and therefore unable to hear the fire alarm. Appropriate equipment must be provided to alert the person who is deaf to the fire alarm. Fire evacuation information must be available in a format that is accessible to all of the people living at the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. South West Independence DS0000070448.V358273.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 South West Independence DS0000070448.V358273.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 & 5. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The Statement of Purpose and Service User Guide do not provide prospective service users with appropriate information to make an informed choice regarding the home. People have not been provided with written contracts and therefore are not aware of the terms and conditions of their stay. EVIDENCE: The home has produced a Statement of Purpose and Service User Guide. Copies of these were provided. The Statement of Purpose requires a thorough review to ensure that it includes the appropriate information and that the information is easily accessible. The document does not include details of the qualifications of the manager or other staff members and the organisation structure does not reflect the registered managers responsibilities. The information on the range of needs to be met does not accurately reflect the conditions of registration. The information required prior to admission, appears to relate to children’s services and does not reflect the requirements of Standard 2 of the National Minimum Standards for Younger Adults. The Statement of Purpose also makes reference to the procedures for restraint, the South West Independence DS0000070448.V358273.R01.S.doc Version 5.2 Page 11 Children’s Home Regulations 2001, and child protection. The issues must be reviewed to reflect that the home is a service for adults. The complaints procedure is not appropriate. (This is further discussed under Complaints and Protection). The Service User Guide contains a summary of the Statement of Purpose. The information within this document is more accessible. This documentation must also be thoroughly reviewed to ensure that it reflects an adult service. For example this currently makes reference to ‘a curfew at 10:30pm’ and states that people living at the home may only entertain visitors in their room with prior agreement from the Registered Manager. The Service User Guide is only available in written form and therefore is not accessible to all of the people living at the home. Within the AQAA it states that people are encouraged to visit the home prior to moving in and that a referral protocol has been established. The Registered Manager advised that one person had been able to visit the home a few days before moving in. Their move had occurred quickly and many of the staff team had previously supported this person at their last placement. People are admitted to the home on a trial basis. Neither of the people currently living at the service had been provided with a written contract outlining the terms and conditions of their stay. One person had been required to replace items damaged within the home, and the other buys their own food, however documentation did not evidence that this had been agreed by the person and their placing authority. A written contract must be provided so that people are aware of what is included in the weekly fee, and which items they must pay for separately. South West Independence DS0000070448.V358273.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 & 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff have not been provided with appropriate guidance to assist people when they display challenging behaviour. Failure to respond in a consistent and appropriate manner may place both people living at the home and staff at risk. Care plans did not always reflect current practice. There were not appropriate records available to support financial transactions and protect people from financial abuse. EVIDENCE: Care records were completed for each person. Care plans had been developed by the placing authorities and reviewed regularly. Monthly summaries had been completed. Care plans contained some historic information and it was difficult to easily access up to date information such as the persons’ GP. Some information such as daily activities and meals taken were recorded in several South West Independence DS0000070448.V358273.R01.S.doc Version 5.2 Page 13 places. Care records require re-organisation to ensure that staff are able to access guidance on how to meet each persons needs. Care plans should include goals for each person and regular review of the support being provided by staff to assist people in achieving these. Daily records are maintained. A record had been maintained of discussions with people living at the home within their 1:1 book. These included discussions with people regarding meals, activities and where they wished to live. These provided evidence of staff seeking peoples’ views. For one person there were a number of incidents recorded, and within one of these records there was reference to a ‘single sided embrace’. The Inspectors requested copies of the behavioural guidelines for this person and the strategies for managing challenging behaviour, but were informed that these had not been developed. From examination of the incident records it was evident that there were some identifiable triggers for challenging behaviour such as regarding the delivery of post. However there were not established guidelines in place to ensure that staff respond in an appropriate and consistent manner to meet peoples’ needs. As previously stated key documentation is not available in a format that is accessible to all of the people living at the home. The home should ensure that important information such as their care plan, the complaints procedure and actions to be taken in the event of a fire is provided in an accessible format. One person living at the home has an advocate. Risk assessments had been completed for each person. Within the records for one person it states that they should always receive support from two staff during day time hours. On the day of the second visit the Inspectors observed this person leaving the home with support from one staff member. This was discussed with the Registered Manager who advised that a second member of staff was already at the shop that they were going to and would be available to provide support if required. There was also a complaint recorded regarding a member of staff taking this person out alone for several hours to Taunton. This occurrence had not been notified to the persons’ Social Worker or CSCI. The Registered Manager advised that the person preferred to be accompanied by one staff member and that this was acceptable for trips out near to the home, as there would always be someone nearby to assist. However the care records had not been updated to reflect this change in practice. The Registered Provider is Appointee for one person at the home. This practice potentially puts both the provider and person at risk, and should be discussed with the placing authority to ensure that appropriate procedures are in place. Care records stated that the person receives a weekly budget to spend on magazines, drinks and other items, but it was not clear how this amount had been determined. Staff assist this person in managing their personal budget, however there were no records available to support financial South West Independence DS0000070448.V358273.R01.S.doc Version 5.2 Page 14 transactions that had taken place. The Inspectors were advised that this person receives £5 per day for work experience completed on a farm owned by the Registered Provider. The Registered Manager stated that they believe that this payment came from the money received through benefits rather than as an additional payment. This matter must be discussed with the persons’ placing authority. Another person at the home manages their weekly menu and the monies to purchase food as part of their program for developing daily living skills. They pay for food from the benefits they receive. Residential care would normally include the cost of food, therefore this practice should be clearly identified within the contract for this person. Records relating to people living at the home had been kept securely. South West Independence DS0000070448.V358273.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15 16 & 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at the home are able to participate in some age, peer and culturally appropriate activities. People have received support to develop some daily living skills. People have received support to spend time with family members EVIDENCE: One person has a key to the home and now goes out without staff supervision for agreed periods of time. They attend college for several days each week. The other person participates in work experience at a farm owned by the Registered Provider for four days a week and washes cars at the police station for half a day each week. Staff are in the process of preparing a notice board to go in this persons’ room to provide further information for them regarding their daily plans. South West Independence DS0000070448.V358273.R01.S.doc Version 5.2 Page 16 One person at the home is deaf. They are supported by staff to access the Deaf Club locally once a week. It was not evident from the care records what further opportunities they have to meet their cultural needs as a Deaf person or engage with peers. People living at the home access local facilities including going swimming, bowling, and to the shops and pubs locally. Care records included evidence of regular contact with family members. One person is receiving support from staff so that they will be able to make the journey to visit their family independently. For the other person, staff arranged a holiday near to their relatives so that they could spend time together. Within the information provided to CSCI prior to the inspection it states that ‘All clients are allowed visitors with prior agreement and can make calls to family, social services, etc when they want’. One person living at the home is Deaf and therefore cannot use a telephone for communication with family members. At present they must ask staff if they can access the computer to communicate by email. There is also fax available within the home, but this is within separate accomodation to the self contained flat and is accessed via a key pad. There must be appropriate equipment proivded to enable all people living at the home to be able to contact family members, friends or Social Workers independently. Within surveys received regarding the home one person wrote that ‘Communication between home and relative varies sometimes good and sometimes no information at all’. There are strategies in place for the home, and each person living there. These outline the ethos for the home, and the activities that each person may participate in. Within the strategies for the home it states that there must be no alcohol within the home, however it was evident from care records that people are able to visit pubs. The strategies should be reviewed to ensure that they are person- centred and are reflective of a care home for young adults. As previously stated one person develops their weekly menu and manages the purchase of food. The other person living at the home participates in cooking once a week with support from staff members. One person at the home has informed staff that they wish to lose weight. Staff have been assisting them in choosing healthy options and eating a balanced diet. One person spoken with during the inspection stated that the food is good. South West Independence DS0000070448.V358273.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People receive support to access healthcare services. Further action must be taken to promote the dignity and privacy of some people at the home. The home has a safe system for recording medication. Medication practices require review to ensure that they reflect best practice. EVIDENCE: The people living at this home require minimal assistance to undertake their personal care needs. People are able to choose clothes that reflect their age and personal preferences. People are able to determine who becomes their key worker. One person has equipment fitted to the back of their bedroom door that flashes to alert them that someone has knocked the door and is going to enter the room. This equipment was not working at either of the visits to the home. Within care records there was evidence of people attending healthcare appointments. People had been registered with a local GP and referrals had South West Independence DS0000070448.V358273.R01.S.doc Version 5.2 Page 18 been made to specialist services as required. There was not evidence of interpreters being routinely booked to accompany one person. People living at the home should be able to speak with healthcare professionals independently and be provided with appropriate support to access these services. The home maintains a record of all medication received into the home. The system for recording the administration of medication is complex and may lead to errors. Discussions were held with the Registered Manager regarding the use of pre-printed medication administration records (MARs) that can be obtained from pharmacists, which may provide a clearer system. One person at the home has been supported to manage their medication. At present staff give this person seven days supply of medication and monitor their administration of these. An appropriate risk assessment had been completed. This is good practice in terms of promoting the independence of people living at the home. Staff have been transferring medication into a weekly dossette box for this person. This task must be completed by the prescribing pharmacist. South West Independence DS0000070448.V358273.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People are not provided with appropriate information to raise their concerns. The home has not shared information or concerns with CSCI or placing authorities, and therefore has not acted appropriately in response to issues raised. Failure to operate a robust recruitment procedure may place people at serious risk of harm. EVIDENCE: The home has a complaints procedure. This is included within the Statement of Purpose and Service User Guide. As previously stated these documents are not accessible to all of the people living at the home. The lack of equipment of enable people to be able to contact family members, or Social Workers independently may place people at serious risk of harm. The complaints procedure does not provide information on the timescales for response, does not include the contact details of CSCI or advise people that they may contact an external agency such as CSCI at any time. As previously stated there had been a complaint regarding the conduct of one staff member and the care provided. However this had not been notified to CSCI or their Social Worker. South West Independence DS0000070448.V358273.R01.S.doc Version 5.2 Page 20 There have been 15 recorded incidents at the home since it was registered on 25 September 2007, but these too had not been notified to CSCI or the peoples Social Worker. An immediate requirement was issued to state that incidents must be reported to CSCI in accordance with Regulation 37 of the Care Home Regulations 2001. All staff have been provided with training on the Non Abusive Physical Intervention (NAPPI) procedures. The home has a copy of the Somerset County Council guidance on ‘Safeguarding Adults’. The Registered Manager advised that the Whistle blowing policy is included within the Statement of Purpose. This document does not include the policy. A copy of the whistle blowing policy must be made available to each staff member. The Registered Manager has failed to obtain appropriate documentation prior to staff commencing work at the home. Two references, a POVA first check and Enhanced CRB must be received to ensure that people who have been deemed unsuitable to work with vulnerable people do not work at the home. Failure to operate a robust recruitment procedure may place people at serious risk of harm. South West Independence DS0000070448.V358273.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29 & 30. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home provides spacious accommodation, close to Bridgwater town centre. There are sufficient bathrooms and communal space to meet peoples’ needs. The home has not provided the necessary equipment to meet peoples’ needs and maximise their independence. EVIDENCE: The home is a large semi-detached property situated close to Bridgwater town centre. There is a self-contained flat for one person on the lower floor, and accommodation available for two further people on the upper floors. Within the self contained flat there is a lounge, kitchen, large bathroom, staff sleep-in room and large bedroom. This area has been decorated and furnished to a good standard, but has not been personalised to reflect the choices of the South West Independence DS0000070448.V358273.R01.S.doc Version 5.2 Page 22 person living there. For example they have not been involved in choosing colours of soft furnishings, or wall colours. Staff were in the process of preparing notice boards containing photographs for this persons’ room. There were some handles missing from furniture and this person did not have a bedside light. As previously stated equipment has not been provided to enable this person to access others independently, the flashing light attached to their bedroom door was not working at either visit. There is not a flashing light linked to the door bell to alert this person that others are entering the flat, and there is no means of alerting this person to the fire alarm. There is access to the rest of the property via a keypad. A small outside space can be accessed from this accommodation. This is the passage way between this four-storey house and the one next door. Therefore the area is shaded for much of the day. The area is enclosed with large gates, has concrete flooring and one wooden bench. There is a cigarette butt bin attached to the wall, as staff use this area to smoke. Discussions were held with the Registered Manager regarding the outside space provided for this person. Staff must not continue to smoke within this person’s outside space. There is accommodation for two people on the upper floors. There is a large kitchen, lounge, two bathrooms and additional toilet facilities. There are two bedrooms for people living at the home, and two staff sleep-in rooms and an office. There was evidence that this person had been involved in choosing items for the home. There is a large garden at the rear of the property that is accessed via steps from the kitchen on the first floor. Work has recently been completed to improve the surface material of the steps and to make them less slippery. There is parking available at the rear of the property for several cars. The home had been maintained to a high standard of cleanliness. The Inspectors visited the home during the afternoon on two separate days and it was found on both occasions that the bed within one room had been stripped, and left with the duvet on top of an uncovered mattress. The Inspectors were advised that bedding was being washed due to the person being incontinent. Staff should ensure that a waterproof mattress cover is fitted, and that further bedding is available so that the bed can be re-made to promote the dignity of this person. Staff must have a clear plan in place to assist this person with their continence needs. South West Independence DS0000070448.V358273.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35 & 36. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff offer a high level of support to people living at the home. Through failure to operate a robust recruitment procedure the registered persons have placed people living at the home at significant risk of harm. Training records have not been maintained therefore it is not possible to determine whether staff have received appropriate training to undertake their role. EVIDENCE: Duty rotas are maintained. Staff offer a high level of support to people living at the home. There are staffing levels of 2 staff to each person during the day and 1 staff to each person during the night. Staff complete 48 hour shifts, with further staff providing cover during the day to give the 2:1 ratio. South West Independence DS0000070448.V358273.R01.S.doc Version 5.2 Page 24 During the visit to the home on 31st January 2008 recruitment files were examined. It was found that application forms had been completed, but these often did not contain a full employment history. Gaps in employment had not been explored and recorded. Only one file contained two references. Two references must be obtained for all staff. This must include a reference from their last employer wherever possible. Some files did not include proof of identity including a photograph. A health/medical declaration must be completed for each staff member. Within four of out the eight recruitment files examined there was evidence that staff had started work at the home prior to an enhanced CRB and POVA First check being completed by South West Independence. For two of these staff members a CRB disclosure had subsequently been obtained. However for two staff there was no evidence of a CRB disclosure or POVA First check being completed by the home. The Registered Manager advised the Inspector that the recruitment record for a further staff member was with the registered provider, and therefore not available to be examined, but that a CRB disclosure had not been obtained for this staff member either. The recruitment file for this person was examined at the further visit to the home, and it was found that a conviction had been recorded. The home had not completed a risk assessment in relation to the tasks undertaken by this person, and they had been working unsupervised within the home, prior to the inspection. An immediate requirement was issued on 29/1/08 which stated that any staff who do not have an enhanced CRB disclosure and POVA First check completed by South West Independence may not work at the home until this is obtained. Staff may work under supervision once two references and a POVA First check have been obtained. It was required that the Registered Manager must complete an audit of staff recruitment files and take action to obtain the further missing documentation by 5pm on the 4th February 2008. Written confirmation was provided to CSCI that this had been completed within the given timescale. Training records were examined. It was found that not all staff had completed induction training that meets with the Common Induction Standards. Some staff had completed this, but the records were not dated. Training records were not appropriately maintained. There were some dates recorded within individual staff members training records, and others recorded in relation to the course attended. For some courses there were no dates recorded. Staff spoken with confirmed that there are always enough staff and that they had received training on Aspergers syndrome, autism, NAPPI and person centred story making. Training records indicated that two out of the nine staff have completed the NVQ level 2 qualification and that six are working towards this. South West Independence DS0000070448.V358273.R01.S.doc Version 5.2 Page 25 Two members of staff have completed the BSL (British Sign Language) level 1 qualification, the Registered Provider has BSL level 2 and a further member of staff has obtained Somerset Total Communication level 2. Feedback obtained from the person living at the home who uses BSL stated that they wished that staff had better signing skills and that communication sometimes breakdown. All staff working with someone who communicates using BSL must have or be working towards BSL 1 and it is recommended that at least one person on each shift has BSL 2. As previously stated there was a record of a complaint regarding the conduct of one staff member within a recruitment file. It was not evident whether this was addressed via the disciplinary procedures or what further action was taken. Staff spoken with confirmed that they receive regular supervision. Completed supervision records were seen within staff files. South West Independence DS0000070448.V358273.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39, 41 & 42. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has not been effectively managed. There are a number of key areas within the home where improvements are required. Policies and procedures require updating to ensure that they relate to a service for adults and reflect best practice. Fire safety procedures and documentation do not adequately protect those people living at the home. EVIDENCE: The Registered Manager is Ben Chidgley. He has obtained the NVQ level 3 qualificaton. He is currently studying towards the NVQ level 4 and plans to complete the Registered Managers Award. South West Independence DS0000070448.V358273.R01.S.doc Version 5.2 Page 27 During the course of the inspection areas of significant concern were identified including: staff recruitment, complaints procedures, provison of equipment and reporting of incidents. These concerns indicate that the registered persons lack a thorough understanding of the Care Home Regulations 2001 and other relevant legislation. Failure to appropriately implement procedures in these key areas may have placed people living at the home at risk. The home aims to seek the views of people using the service through informal discussions that are recorded in their 1:1 book. They should also consider issuing surveys to relatives and others involved in the people’s care. Those staff spoken with during the inspection stated that the Registered Manager was approachable. The home displays appropriate Employers Liability insurance. As previously mentioned some of the polices and procedures require review to ensure that they relate to a service provided to adults, and that they reflect best practice. From examining the monthly reports within the home it was evident that some visits had been completed by the Registered Manager. The Registered Provider must visit the home on a monthly basis in accordance with Regulations 26 of the Care Home Regulatiosn 2001, and forward a copy of these reports to CSCI. As previosuly stated CSCI had not been notified of incidents iwhtin the home, in accordance with Regulation 37 of the Care Home Reuglations 2001. Fire safety records were examined. It was found that equipment had been tested and serviced as required. Within the information provided to CSCI prior to the inspection it states that ‘The Company is committed to ensuring that the risks of fire are properly recognised and understood by all members of staff and by the young people/adults in its care’. However the fire evacuation information is not in a form that is accessible to all of the people living at the home, the fire risk assessment does not include risks relating to one person being deaf and therefore unable to hear the fire alarm, and there has been no equipment provided to alert them to the fire alarm. Within the fire risk assessment risk were scored, but there was no information to advise what these meant. All staff had been provided with fire safety training and fire drill records were up to date. South West Independence DS0000070448.V358273.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 1 2 2 3 3 4 3 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 1 ENVIRONMENT Standard No Score 24 3 25 3 26 2 27 3 28 1 29 1 30 2 STAFFING Standard No Score 31 X 32 3 33 2 34 1 35 1 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 2 1 3 LIFESTYLES Standard No Score 11 3 12 2 13 3 14 3 15 2 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 1 2 x 1 X 1 2 3 1 x South West Independence DS0000070448.V358273.R01.S.doc Version 5.2 Page 29 Not applicable 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 4 (1) & 5 (1) Requirement The Statement of Purpose and Service User Guide must be thoroughly reviewed to ensure that it contains the relevant information. This must reflect that the home provides a service to adults. Each person must be provided with a written contract outlining the terms and conditions of their stay. Care records require reorganisation to ensure that staff are able to access guidance on how to meet each persons needs. Care plans must include goals for each person and regular review of the support being provided by staff to assist people in achieving these. 4. YA6 17 & schedule 4 (3) [m] & [p]. There must be clear guidance available to staff where people may display challenging behaviour. 11/04/08 Timescale for action 05/05/08 2. YA5 5(1) [b] & 5 (3) & sch4 (8) 15 (1) 11/04/08 3. YA6 11/04/08 South West Independence DS0000070448.V358273.R01.S.doc Version 5.2 Page 30 13 (7) Appropriate strategies must be developed to support people with situations that frequency causes anxiety or challenging behaviour. Where staff provide assistance in managing peoples’ finances, appropriate records must be maintained. Care plans and risk assessments must be updated to reflect people’s current needs and the level and type of assistance that is to be provided by staff members. Care records must include information on how people will be assisted to meet their cultural needs. There must be appropriate equipment proivded to enable all people living at the home to be able to contact family members, friends or Social Workers independently. The registered person must ensure that equipment fitted to the back of their bedroom door that flashes to alert them that someone has knocked the door and is going to enter the room is maintained in working order. Where people do not have English as their first language, records must be maintained to evidence that interpreters have been offered and made available to accompany them to health care appointments. People living at the home should be able to speak with healthcare professionals independently and 11/04/08 5. YA7 13 (6) 6. YA9 15 (2) [b] 11/04/08 7. YA12 12 (4) [b] 11/04/08 8. YA15 17 (1) & sch 3 (3) [l[ 21/03/08 9. YA18 23 (2) [c] 21/03/08 10. YA19 12 (4) [a] & [b] 21/03/08 South West Independence DS0000070448.V358273.R01.S.doc Version 5.2 Page 31 be provided with appropriate support to access these services. 11. YA20 13 (2) Where medication is decanted into dossette boxes this process must be completed by the prescribing pharmacist. The complaints procedure must be available in a format that is accessible to people living at the home. The complaints procedure must include information on the timescales for action and the contact details for CSCI. 13. YA23 37 All incidents must be reported to CSCI in accordance with Regulation 37 of the Care Home Regulations 2001. Immediate Requirement. 14. YA23 13 (6) A copy of the whistle blowing policy must be made available to each staff member. The home must provide evidence that people have been involved in choosing colours and soft furnishings for their accommodation. Staff must not continue to smoke within this person’s outside space. Appropriate equipment must be provided to ensure peoples safety and to maximise their independence. This should include a flashing light linked to the door bell to alert this person that others are entering the flat and means of alerting this person to the fire alarm. DS0000070448.V358273.R01.S.doc 17/03/08 12. YA22 22 (2), (4) & & (7). 21/03/08 07/02/08 11/04/08 15. YA26 12 (2) & (3) 11/04/08 16. YA28 13 (4) [a] 21/03/08 17. YA29 23(2) [n] 11/04/08 South West Independence Version 5.2 Page 32 All equipment and furniture must be maintained in good working order. 18. YA30 13 (3) & 12 (4) [a] Where people have continence needs staff must ensure that a waterproof mattress cover is fitted, and that further bedding is available so that the bed can be re-made to promote the dignity of this person. Staff must have a clear plan in place to assist this person with their continence needs. 19. YA33 12 (4) [b] All staff working with someone who communicates using BSL must have or be working towards BSL 1. Staff must not commence employment at the home until appropriate information is obtained regarding them. Staff may start work once two satisfactory references and an enhanced CRB has been obtained. They must be fully supervised until the enhanced CRB disclosure is obtained. Immediate Requirement. 21. YA34 19, schedule 2 & 13 (6) Recruitment files must include a full employment history and any gaps in employment explored and recorded. A health declaration and proof of identity must be obtained. References must be sought from the persons’ last employer wherever possible. When a CRB records a conviction South West Independence DS0000070448.V358273.R01.S.doc Version 5.2 Page 33 21/03/08 06/06/08 20. YA34 18 (1) [c] 04/02/08 04/02/08 a risk assessment must be completed in relation to the work that they undertake. 22. YA35 18 (1) (c ) All staff must received induction training that meets the Common Induction Standards and an appropriate record maintained. 18 (1) (c ) Staff must receive regular & 13 (4) updates in health and safety, [c] and food hygiene, and clear records maintained. 13 (6) 11/04/08 23. YA35 11/04/08 24. YA36 When a concern is raised 21/03/08 regarding a staff members conduct records must evidence whether this has been considered under the disciplinary procedures and any actions taken. Where the concern involves their practice regarding the safety of a person living at the home, these matters must be reported to the persons Social worker and CSCI. The registered persons must develop further knowledge of the Care Home Regulations 2001, and relevant legislation relating to adult social care. The Registered Provider must visit the home on a monthly basis in accordance with Regulation 26 of the Care Home Regulations 2001, and forward a copy of these reports to CSCI. Some of the polices and procedures require review to ensure that they reflect a service that is provided to adults, and that they comply with relevant legislation. 25/04/08 25. YA37 10 (2) 26. YA39 26 21/03/08 27. YA40 24 (1) [a] & [b] 25/04/08 28. YA42 13 (4) [c] The fire risk assessment must be DS0000070448.V358273.R01.S.doc 21/03/08 Page 34 South West Independence Version 5.2 updated to include risks relating to one person being deaf and therefore unable to hear the fire alarm. Appropriate equipment must be provided to alert the person who is deaf to the fire alarm. Fire evacuation information must be available in a format that is accessible to all of the people living at the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA1 YA8 Good Practice Recommendations The Service User Guide should be available in formats suitable to people living at the home. The home should ensure that important information such as their care plan, the complaints procedure and actions to be taken in the event of a fire is provided in an accessible format. The strategies should be reviewed to ensure that they reflect the needs of each person and are reflective of a care home for young adults. The system for recording medication must be reviewed to ensure that it reflects best practice. The complaints procedures should state that people may contact an external organisation such as CSCI at any time. The registered persons should review the outside space available to one person at the home. It is recommended that at least one person on each shift has BSL 2. DS0000070448.V358273.R01.S.doc Version 5.2 Page 35 3. YA16 4. 5. 6. 7. YA20 YA22 YA29 YA33 South West Independence 8. YA39 The home should consider issuing surveys to relatives and others involved in the people’s care. South West Independence DS0000070448.V358273.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI South West Independence DS0000070448.V358273.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. 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