Inspection on 17/02/09 for Southwold House

This inspection was carried out on 17th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Southwold House 04/12/07

Southwold House 16/01/07

Southwold House 13/11/05

Southwold House 04/07/05

Southwold House 08/11/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Southwold House 16-18 Cliff Road Leigh-on-Sea Essex SS9 1HJ The quality rating for this care home is: zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Ann Davey Date: 1 7 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Care Homes for Adults (18-65 years) Page 2 of 38 Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 38 Information about the care home Name of care home: Address: Southwold House 16-18 Cliff Road Leigh-on-Sea Essex SS9 1HJ 01702715240 Telephone number: Fax number: Email address: Provider web address: southwold@consensushealthcare.org Name of registered provider(s): Name of registered manager (if applicable) Mrs Jennifer Anne Dixon Type of registration: Number of places registered: Consensus Community Support Ltd care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 12 0 learning disability Additional conditions: Care and accommodation to be provided to persons between the age of 18 and 65 with a learning disability. Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 38 A bit about the care home Southwold House is a 12bedded establishment that provides personal care for 12 young adults with a learning disability. The home has 3 floors and provides 12 bedrooms, all with ensuite facilities. The home is situated within a residential area of Leigh on Sea and is within walking distance of the seafront, local shops and public transport links. There is a good-sized garden/patio area to the rear of the home, and to the front there are limited car parking Care Homes for Adults (18-65 years) Page 5 of 38 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 38 How we did our inspection: This is what the inspector did when they were at the care home This was a key inspection that took place over 8.5 hours. The visit started at 09.15 and finished at 17.45. The deputy manager and the area manager helped us throughout the inspection. The registered manager was on holiday. The homes Annual Quality Assurance Assessment (AQQA) had been completed and returned to us in July 2008. This document provided the home with the opportunity of recording what it did well, what it could do better, what had improved in the previous twelve months and its future plans for improving the service. We sent surveys to the home asking that they be distributed and returned to us so that we could have an understanding of Care Homes for Adults (18-65 years) Page 7 of 38 how residents, staff, relatives and health/social care professionals felt about the provision. We received three completed surveys from health/social care professionals, six completed surveys from staff, five completed surveys from residents and four completed surveys from relatives. We were able to use some of the comments we received within this report. The vast majority of residents surveys were completed in a tick box manner. No areas of concern were raised or noted. We have commented on the resident’s ability to complete these surveys within the report. We did not display a notice advising any visitors that an inspection was in progress as the deputy manager said that none were expected The notice would have invited any visitors who wished to speak with us to make Care Homes for Adults (18-65 years) Page 8 of 38 themselves known. The day spent in the home was pleasant and everybody was helpful. The inspection process was undertaken without any difficulty. We spoke with staff and residents. All matters relating to the outcome of the inspection were discussed with the deputy manager and the area manager who took notes so that development work could be started immediately where appropriate. The weekly fee for the home ranged from 1616.70 - 2082.34 pounds. The actual fee depends on individual residents assessed care needs and the funding provided by various local authorities. There are additional costs for items of a personal nature. Care Homes for Adults (18-65 years) Page 9 of 38 What the care home does well Throughout the inspection, staff on duty were very helpful and co-operative. Residents were encouraged by staff to participate in the inspection process according to individual ability. We noted that the deputy manager Care Homes for Adults (18-65 years) Page 10 of 38 introduced us to residents in a very friendly manner and explained to them what we were going to do. The office although a very busy area of the home, was orderly and much of the information we requested and available, was well indexed. Much of the documentation likely to be read by residents was in a clear easily read format. It was positive to note that the registered provider had made the decision not to admit any more residents until the care outcomes for residents have improved. What has got better from the last inspection There were records in place to show that staff training had been improved since the last inspection. Staff told us that they had enjoyed the sessions. The Care Homes for Adults (18-65 years) Page 11 of 38 area manager showed us reports that had been completed following their statutory monthly visits to the home. These reports had provided the registered provider with an overview of the day to day management of the home and identified the shortfalls. The area manager is now visiting the home up to three times a week to oversee the day to day management of the home. This is to review, raise standards and monitor practice within the home. The current area manager had been in post since November 2008 and told us that they were fully committed to improving the outcomes of care for residents. What the care home could do better This inspection identified a number of major shortfalls that must be addressed to improve the care outcomes for current residents. Some aspects of the Care Homes for Adults (18-65 years) Page 12 of 38 shortfalls were identified at the last inspection and had not been addressed in full. Individual residents assessed care needs must be clearly documented, with information about who is going to meet them, how the needs are going to be meet and a review date. There must be an adequate risk assessment in place to support care plans. Should residents need to be cared for by staff who are not familiar with the home, they would have difficulty in knowing what the care needs of individual residents were. This places residents at some risk. Records evidenced that staff training on a number of care related practices had been provided. There was no evidence in place of any staff competence assessments following this training. The shortfalls we identified in practices such as medication administration recording and care planning would suggest that staff are not competent. This places Care Homes for Adults (18-65 years) Page 13 of 38 residents at some risk. Residents rights as detailed within this report had been infringed. There was no documentation available to support the current practice and we noted that no staff training had been provided on this area of care. Staff had been employed and are currently working in the home without adequate recruitment documentation being in place. These practices place residents at some risk. Referrals to the local authority about safeguarding vulnerable adults from harm issues are relatively high. The local authority is now currently working closely with the management of the home about this matter. Care Homes for Adults (18-65 years) Page 14 of 38 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Ann Davey CPC1 Capital Park Fulbourne CB21 5XE 01223 771300 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 15 of 38 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 16 of 38 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Policies and procedures are in place to ensure that residents care needs are fully assessed before admission to make sure that they can be met by the home. Evidence: The home has a Statement of Purpose and a pictorial style Service Users Guide. Both documents require updating as the Statement of Purpose made reference to a previous manager and the current contact details in both documents for the Commission were fifteen months out of date. The deputy manager told us that no residents had been admitted to the home since the last inspection. Therefore, we were not able to assess the quality of any admission documentation. We saw that there were policies and procedures in place to assist the home in ensuring that a full pre admission assessment is undertaken before a decision is made to admit a resident in the future. The area manager told us that a decision had been made last year by the owner of the home not to admit any further residents until the day to day management systems within the home are robust. Further details about this are recorded within the report. Care Homes for Adults (18-65 years) Page 17 of 38 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents are at some risk because the recording systems in place are not always clear about individual care needs and known individual choices are not always acted upon. Evidence: Residents living in Southwold House have complex and diverse care needs. We selected three care plans (referred to as A, B and C for the purpose of this report) and their associated documentation such as risk assessments at random to look at. Each resident had a file which contained a person centered care plan format in place. We could see that there had been input from the respective resident, key worker and other professionals. Parts of the care plan were in a user friendly style that means that it was possible and according to personal limitations and ability for individual residents to understand what had been written about them. We could see that residents had been consulted about their personal wishes and preferences according to their individual ability. However, these wishes had not been acted upon as detailed within this report. Care plan A - This record had a document entitled assessment package which was undated and had no point of further reference or referral within the file. This resident had been admitted to hospital and following discharge, there was no evidence that the care plan had been updated to reflect the changed care needs. On the front of this file was an undated document providing details of a restricted fluid intake. There was no hospital discharge letter to support these instructions. The deputy manager advised that the instruction had been given verbally to a support care member of staff. Also on this file we found information on a typed document which had been issued by the home as a consequence of unacceptable behaviour. The sanctions of the document Care Homes for Adults (18-65 years) Page 18 of 38 Evidence: were punitive in nature. The sanctions infringed the residents’ rights, their freedom of movement within the home and their choice of food and diet at mealtimes. The deputy manager told us that these sanctions had been put in place following discussions with a behavioural modification therapist who was employed by the company which owns the home. The deputy manager could not locate any supportive documentation or recorded rationale for the sanctions and there was no infringement of rights record. On this file was a document residents individual preferences checklist dated 1st June 2008. Where residents had been asked would you like the name or contact details of an independent advocacy service the answer was written as yes. It was recorded that this record had been reviewed by the home on a further four dated occasions, all with the written response no change. The deputy manager told us that this had not been acted upon by the home. At the bottom on this document it was typed please ensure that preferences expressed by the resident are acted upon and records maintained. On this file we saw records (care plans and risk assessment) that related to the residents previous placement. The resident had moved to Southwold House twenty months ago. The deputy manager explained that the residents social worker had already raised this issue and that in their opinion, case records were too bulky and not easy to access. The outcome of this practice is not acceptable as it leaves this resident at some risk because their care needs had not been properly recorded or updated, their recorded wishes had not been addressed and their rights had been infringed without supportive documentation being in place. The deputy manager explained that the allocated social worker for this resident has regular contact with the home about the placement and had expressed no concern about the delivery of care. Care plan B - We saw an undated and unsigned review on file which contained significant information relating to the residents care needs. The deputy manager said it was possibly completed in July 2008, but could not be sure. The document gave some very particular views expressed by the resident. We asked how this information had been gathered as the resident had very limited communication skills. The deputy manager was unable to explain the process and there was no documentation in place providing detail of how the information was gained. Furthermore, the information as recorded as being provided by the resident had not been reviewed or considered further. In one of the residents care plans, one of specific complex care needs had been recorded and the consequence of it noted. There was no evidence that any attempt had been made by the home to contact associate health care or social care agency who may have been able to assist the home in providing specific care or health related support. Within one care plan it was recorded on 20th May 2008 staff to undertake (identified condition related) training. Since then it had been recorded that this care plan had been reviewed on 3rd February 2009 and no change was noted. The deputy manager said that staff had not undertaken this identified training. Within this file was a document residents individual preferences checklist dated 1st June 2008. When the resident was asked would you like the name or contact details of an independent advocacy service the answer was written as yes. The deputy manager told us that this had not been acted upon by the home. We asked the deputy manager to explain how the answers to all twenty four questions had been obtained given the fact that the resident would not have had the ability to respond in the manner in which the record suggested. The deputy manager said that there would have been a degree of assumption made by the member of staff who had completed the document. There had been no further review of the preferences or wishes made by the resident. At the bottom on this document it was typed please ensure that preferences expressed by the resident are acted upon and records maintained. The outcome of this practice is not acceptable as it leaves this resident is at some risk because staff had not been trained in how to meet known care needs and inadequate systems were in place to ensure that the residents wishes and preferences were acted upon. Care plan C - On the front of this file there was a support file document which was undated. The deputy manager said that this resident was engaging in more activities now. On the care plan dated 24th January Care Homes for Adults (18-65 years) Page 19 of 38 Evidence: 2009, it was recorded there was a need for activities but there was no detail about what activities are provided or what progress there had been. The most recent review stated that there had been no change. The deputy manager told us that this resident attends a place of worship every Sunday with a member of staff. This was not recorded on the care plan. We spoke to as many residents as possible about the care they receive. This was difficult as the majority had limited or non verbal communication skills. We were able to communicate quite well with two residents who told us that they were happy with their care. We also spoke to the majority of staff on duty. Some residents receive one to one care support from staff. Staff we spoke with were able to tell us about the care needs of the respective residents they were supporting. All said that they had access to care plans. Their response was encouraging. Staff on duty were familiar with residents care needs however, should there be a situation where residents needed to be cared for by unfamiliar staff, the information on some care plans would be inadequate to provide safe care. All staff said that they had access to care plans. We spent time in the company of residents in the presence of staff members. It was difficult to assess the emotions and feelings of the majority of residents because of their complex care needs and behavioural patterns. We received the following comments from relatives within their surveys x is happy living in Southwold House...I am impressed with the improvement to give x a quality of life...I have never seen x so happy since (they) been in Southwold House. One health professional stated I have no concerns at all around the standard of care at Southwold House. Care Homes for Adults (18-65 years) Page 20 of 38 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents experience a varied lifestyle according to ability and enjoy a good diet but may experience inadequate management of their rights. Evidence: Social events, leisure pursuits and occupational activities we were informed tend to be arranged by the home on an individual resident basis. This was because of the diverse and complex care needs of residents. Some residents were being supported on a one to one basis by care staff. The records we viewed at random evidenced that residents participate according to ability in a wide range of activity and social events. These included college, art and craft workshops, swimming, day centres, evening social clubs and church related activities. The home had its own mini bus to transport residents within the community. During the day we saw residents going out with staff, playing board games, assisting in the kitchen and were generally being supported in a positive way. One resident told us that they like going to the supermarket with staff and also how much they enjoy meals out. The deputy manager told us that all residents have some degree of contact with their respective family. As noted within the previous section of this report, it would be helpful to new staff if more information about resident’s social events and activities were to be recorded in more detail on care plans. As recorded within the previous section of this report, we had concerns about the homes ability to manage Care Homes for Adults (18-65 years) Page 21 of 38 Evidence: resident’s rights. There was evidence that the rights of some residents had been infringed without adequate supportive documentation in place. We also noted that residents had to ask a member of staff if they wished to use a communal bathroom or toilet. Toilets are locked to prevent some residents harming themselves. One member of staff told us that the big lounge is not used very much by named residents, because they are scared of another resident’s behaviour towards them. There was no documentation in place to demonstrate that the rights of all residents had been considered. Risk assessments were in place in respect of the resident at particular risk, but this was often to the detriment of other residents. Apart from the main lounge and dining areas, all other rooms and areas in the home were locked. Whilst the environment must be kept safe, we asked the deputy manager if it was unreasonable that all residents have to experience such restrictions of movement and access within the home. The area manager acknowledged that this was an outstanding area of staff development and training. We did not have the opportunity to observe a mealtime in the home. We did look at individual residents meal records. These records evidenced that the home provides a variety of food at each mealtime. The home was also able to evidence that cultural diet preferences are managed well. Two residents told us that they liked the food and could choose what they had. We recommended to the deputy manager that quantity of food eaten at each mealtime by individual residents is also recorded. For example full portion, half portion or poor attitude. This would assist the home in having a greater overview of residents changing needs. Care Homes for Adults (18-65 years) Page 22 of 38 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents may be at risk because the systems and processes in place do not necessarily support a robust basis from which good personal and health care support is managed and delivered. Evidence: It has previously been noted within this report that although residents had been consulted about their personal wishes and these had been recorded, they had not been acted upon. In addition, there was no evidence that processes were in place to assist staff in communicating with identified residents who had limited ability to make sure that their respective views and opinions about their personal care was to their liking or agreement. The home does have a key worker system in place which provides some continuity of care for residents. Some residents living in Southwold House according to the homes documentation, do have the capacity to state a view or opinion about their personal care, but others do not. On one occasion (care plan B) the deputy told us that assumptions had been made about the residents views and wishes. These assumptions had been recorded in a manner which gave us the impression that they were the true views of the resident. The deputy manager told us that all residents are registered with a local group practice. We were told that residents had a choice of male or female doctors in the surgery. The deputy manager reported that the home had a good professional working relationship with the group practice. We were told that residents have access to all community health care professionals. On care plan A, the resident had been in hospital recently but the home did not have a discharge letter and the care plan had not been amended to reflect their changed needs. As noted previously in this report, there was a record on the front of this file giving details of continuing care which had been provided verbally between a member of care and the hospital. There was no health care or hospital documentation to support the instructions given. The deputy manager told us that they thought the Care Homes for Adults (18-65 years) Page 23 of 38 Evidence: hospital discharge letter may have gone to the homes head office. On this file there was a behaviour modification programme which was punitive in nature and had been signed by the respective resident. The area manager and deputy manager told us that this had been put in place by a behavioural therapist. There was no evidence of any letter or communication to support the sanction and we were told that there had been no advocacy input. On care plan B, it was recorded that one resident had multiple and complex care needs. There was no evidence that the home had sought professional advice as to how these could be appropriately met in the best interest of the resident. The deputy manager agreed that this should have been done. We sampled various aspects of the current medication administration, storage and recording system. This aspect of our inspection took considerable time with the assistance of the deputy manager because of the complex issues we found. We initially looked at the MAR (medication administration record) which were orderly and showed no gaps in recording. We noted in the controlled medicines register that the home had Diazepam 2mg, Diazepam 5mg, Diazepam 1mg and Diazepam 10 mg on the premises. The current guidance is that these medicines must be stored in a controlled medicines cupboard and it is good practice to maintain a record of their administration in the controlled medicines register. In the controlled medicines register we noted that on one page it was written Lorazepam 1mg, there was no date or the name of the resident. The deputy manager later found an entry within the returned medicines record that this medication had been returned to the pharmacy in December 2008. On another page where Temazepam 10 mg name of resident had been recorded we saw four sets of crossings out and additional handwritten lines had been put in by a member of staff. At the bottom of this page there was no entry to show where the recording had been continued. There was no explanation of why these entries were in such disorder and there was no cross reference to where the continuation of the record had been made. There was an error on this record as it showed that there were nineteen tablets still in stock, but there were actually twenty. There was an error in the accumulative total as all these tablets were accounted for. There was a bottle of Diazepam 5mg ( named resident) containing twenty four tablets, none had been administered since August 2008. There was no evidence of a medicines review. There was a bottle of Diazepam 2mg ( named resident), the deputy manager said that none had been administered since August 2008. On the record it was recorded that twenty were in stock, the deputy manager could only account for eighteen tablets. We were told that this resident no longer needed this medicine. We were told that this medicine had been administered on an as or when basis, the deputy manager was unable to show us the protocol that had been used. The deputy manager told us that they or the registered manager had carried out regular monthly medicines audits. The deputy manager was unable to locate any audits to show us. We saw a record recording that staff had undertaken medication training. The area manager said that they thought this was a system training session rather than a safe medication administration training course. There was no evidence that a competence assessment on staff who administer medication had been carried out. The area manager was asked to review the storage for controlled medicines as it does not comply with current requirements. We discussed our findings with the duty manager and the area manager who acknowledged that the systems in place to promote, manage and deliver robust personal care and health care are not adequate leaving residents at some risk. Care Homes for Adults (18-65 years) Page 24 of 38 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents may be at risk because the management systems and processes in place do not support a robust basis from which the wellbeing and protection of residents is managed and delivered. Evidence: There was a pictorial complaints procedure in place. The majority of residents would not have the ability to follow the process and are reliant therefore in the main on staff communication skills. The deputy manager reported that the home has contact with two advocacy agencys who visit the home upon request. It was established that the request had come from the home itself, as residents would not have the ability to make a self referral. The deputy manager reported the residents are getting a good service now and have a supportive role. The deputy manager could not show us any records to support that advocacy support had been provided in respect of Care Plan A or Care plan B. The deputy manager told us that the home had received no complaints from residents, staff, relatives or other stakeholders since the last inspection. However, in one health care processionals survey it was recorded I have written a letter of complaint about this (matter was detailed) to the area manager on 11th September 2008 and am waiting a response. We were informed that all residents have contact to varying degrees with their respective families. We expressed our concern about the lack of independent advocacy input provided for residents living in the home with a number who had non verbal or limited verbal communication abilities. Within one relatives survey it was noted that the writer did have some concerns about practice within the home. The survey was completed in October 2008. We did not identify the relative to the home but we did speak to the deputy manager about the processes in place enabling relatives to discuss any issues that were of concern. The deputy manager told us that since last year, all relatives have had the opportunity to discuss any concerns and that the relationship the home now had with all immediate relatives was positive. Since the last inspection the area manager and deputy manager reported that nine safeguarding referrals had Care Homes for Adults (18-65 years) Page 25 of 38 Evidence: been made to the local authority and agreed that in each referral, elements had been substantiated. Last year we received a notification which suggested to us that there was a further safeguarding matter. When we made enquiries about this we were told that the incident had not been reported to the local authority because there had been some misunderstanding on a senior management level about what should be done. This matter was still in the process of being dealt with by the local authority. At this inspection we asked the area manager to make a referral in accordance with their safeguarding adults from harm procedures in respect of the information we noted in care plan A. We have since spoken with the local authority about this who were dealing with the matter. One health care professional stated there have been POVA issues this year, manager is always transparent and these are dealt with immediately, all new support plans and risk assessment have been put in place and these are working well. Southwold House has admitted residents with diverse and multiple care needs. The area manager agreed that it was the day to day management of these needs that appeared to be the problem. We talked about the possible reasons for such a high number of referrals and agreed that inadequate line management, inadequate staff training, inadequate management of documentation, inadequate advocacy systems and poor judgement of individual staff were all key factors. The area manager acknowledged the seriousness of the situation and agreed to fully co-operate with the local authority as well as carry out a full management audit. The area manager further acknowledged that whilst the referrals are indeed being made, it is the management of resident’s care that needs review. The support care staff we spoke with were able to explain the correct reporting procedures according to their respective role and responsibilities. They said that if they suspected an incident which needed referral, they would inform the manager or deputy manager. The deputy manager was aware that all suspected safeguarding matters must be reported to the local authority. Care Homes for Adults (18-65 years) Page 26 of 38 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents live in a home that is functional with some areas requiring repair and redecoration. Residents will experience access restrictions to many areas of the home. Evidence: With the deputy manager we viewed three bedrooms and all communal areas or rooms in the home. We noted that one bedroom, the staircase and a number of other aspects in the home require either repair or redecoration. The deputy manager told us that this work has been outstanding for some time. We were told that a maintenance man comes in once a month for two days to carry out all maintenance and redecoration tasks and the allocation of time for all tasks in Southwold House was not adequate. This view was expressed by other staff that we spoke with. The deputy manager told us that the passenger lift had been out of order for over a month. They said that a part was on order but it was ok because all residents were mobile. There were no risk assessments in place on behalf of residents or staff who may use the lift under normal circumstances. For example, carrying heavy loads up the stairs. The bedrooms that we saw were functional and clean and reflected the respective occupants interests. The communal areas of the home were clean and tidy but very basic in decoration and furnishings. We were told that this was because of the nature and consequence of care needs in the home. We noted that apart from the lounge and dining areas, all other areas including the toilets were locked. We were told that this was because it would not be safe for all residents to have unsupervised access to these areas. We discussed this further with the area manager and the deputy manager as we felt that some resident’s rights were being infringed as a consequence of ensuring the safety of others. We told the area manager that in our view this was a management of care issue. For example, all residents needed to ask a member of staff to unlock a toilet if they wished to use one and it was locked again after. We saw one female resident ask the deputy manager to unlock the toilet door as they wished to use it. The deputy manager stood outside the door until the resident Care Homes for Adults (18-65 years) Page 27 of 38 Evidence: came out and the door was again locked. One member of staff told us that female residents did not use one of the lounge areas because they were afraid of the behavioural patterns of another resident. We also made the point that residents who have an assessed greater need of staff supervision had been provided with one to one staffing during the day. One resident was receiving this level of staff support and care twenty fours hours a day. Therefore to restrict the movement of all residents within the home is not acceptable. There were no infringement of rights records in place to support current practice within the home. We noted the following comment in a health care professionals survey present manager is trying to make positive changes within the hone for the clients good, however, the wider company are very restrictive. The garden and patio area was pleasant and we could see by the items of garden furniture that it was used by residents. The deputy manager told us that this area is going to be improved by the summer of 2009 and will contain a sensory and herb area. The deputy manager unlocked the kitchen and laundry areas for us to see. Both areas were clean and tidy. We noted that the floor tiles in one part of the kitchen were broken and pieces were missing. The extent and nature of the damage would prevent that particular part of the kitchen area from being adequately cleaned. The area was directly under one of the work surfaces where food is prepared on a daily basis. The atmosphere in the home was very noisy at times. This was because of the behavioural patterns of some residents. We noted that one resident during one of the noisy periods was cowered in a corner in the hallway. We asked a member of staff about this and we were told that they feel safe there when x is kicking off. Southwold House has admitted residents with a diversity of complex care needs and management systems must be in place to meet them. Current practice is not acceptable as movement restrictions within the home are being placed on some residents who seemingly do not require them. Care Homes for Adults (18-65 years) Page 28 of 38 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents may be at some risk because staff are not trained to meet all care needs and the recruitment process is not robust. Evidence: The deputy manager showed us the current weeks staff rota. The rota was clear and orderly. We were told by the deputy manager that every day there are no less than six care support staff on duty and the manager or deputy manager. This makes a total of not less than seven staff on duty during the day at any one time. At night we were told that there are three waking night staff on duty, one of whom is a senior. Some residents require one to one staff support at any one time. Domestic and cooking duties are undertaken by care support staff with the assistance of residents, ability permitting. We were told by the deputy manager and two members of staff that up to about six months ago, the staff compliment had been unstable with staff leaving and new staff joining. We were told that the current staffing establishment was now more stable and consistent. The deputy manager told us that the use of agency staff is now minimal, sickness levels are good and the morale in the home had improved. We were told that the home uses its own team of bank staff or existing staff undertake extra shifts to cover holidays and staff training. This information was confirmed to us by the staff we spoke with. We asked to look at the recruitment files of three of the most recent members of staff who now work in the home. We have referred to them within this report as staff A, B and C. On staff As file the deputy manager confirmed that only one reference had been received. On staff Bs file we found a generic reference that had been completed in February 2007 and had been translated from another language. The deputy manager confirmed that there was nothing in place to verify the authenticity of this document. Staff A had commenced employment nearly two years after that letter had been written. On staff Cs file we saw that two references Care Homes for Adults (18-65 years) Page 29 of 38 Evidence: had been received. We saw that staff had undertaken a ten day induction programme. The area manager told us that the induction had been based on the Skills for Care model of common induction standards. The deputy manager showed us a staff training matrix which recorded that staff had attended training courses on aspects such as fire safety, first aid, infection control, record reporting, medication, conflict management and safeguarding adults from harm. We spoke to the area manager about this as although it had been recorded that staff had received training on aspects such as medication and record management, the findings of the inspection indicated that, individual staff competence levels in these matters had not been assessed to ensure that individual practice was good. The area manager acknowledged that there are no competence assessment systems in place. The area manager also acknowledged that there were other areas of training required such as ensuring that residents rights are protected and upheld, restrictions of liberty and movement placed on current residents and training to ensure the needs of individual residents are met in full as detailed within care plans A and B. We asked the deputy manager and the area manager about staff supervision sessions. We were told that the manager had just undertaken a training session on this and that a schedule of proposed supervision sessions for all staff had been requested by the area manager. The area manager told us that they are currently providing some regular and in depth supervision sessions for the manager. We saw records to demonstrate that regular staff meetings take place to which all staff are expected to attend. We spoke to staff about current practices in the home. All those spoken with reported that they felt supported by management to do their job. All intimated that they enjoyed their work and worked well together as a team. We observed staff engaging with residents on various levels and in different degrees depending on the care needs of individual residents. We did note that of the three residents who required one to one staff support, only one member of staff was entering into any meaningful activity. The other two members of staff were sitting opposite their respective residents observing them. There was no interaction during the period of time we were in both rooms. One resident was in the dining area with a member of staff whilst the other two residents were in different lounge areas. The staff we spoke with were very friendly and helpful to us. Within relatives surveys the following comments were noted staff appear very caring and helpful’...’staff do their very best...I am sure that the staff that I have met and spoken to know their job. Care Homes for Adults (18-65 years) Page 30 of 38 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents who live in this home may be at some risk because the day to day management of their care is not robust. Evidence: The area manager told us that they had been in post since November 2008. Since our last inspection in December 2007 and November 2008, we were told that there had been several changes in the post of area manger. The current area manager now visits the home two to three times a week to oversee the day to day management of care. We saw their monthly reports (regulation 26 visits) to support this. We were told that since November 2008, a radical review of practice within the home had been underway. We could see where changes had been made. For example, training for supervision sessions, identifying training needs and implementing a management performance programme. The new style of their monthly reports identifies action points for improvements in practice and timescales for compliance. We could see that they undertake a review of compliance on each visit. This has already had a degree of positive input on the outcome for residents because the day to day management of their care is being overseen by an area manager. In our previous inspection reports we recorded very similar statements of intent but any positive outcomes for residents has not been sustained or maintained. In a letter sent to us in October 2008 a previous peripatetic manager wrote .....to support the present management structure to ensure the home has additional resources and is able to undergo a prolonged period of success, providing quality care and support to all of our service users. The current area manager assured us that he has the ability and authority to make changes through review of practice, staff training and competence assessments, example and monitoring. They acknowledged that the poor or inadequate practices we found during the day were not providing good quality outcomes for Care Homes for Adults (18-65 years) Page 31 of 38 Evidence: residents living in the home. The area manager assured us that they would maintain an active presence in the home for the foreseeable future. The manager of the home was on holiday at the time of the inspection but had recorded in the AQAA that since the last inspection that had achieved their Registered Managers Award and completed their NVQ level 4 training. It was also recorded that the manager had completed their Professional Trainer Certificate, although it did not say in which subject or area of practice. Staff told us that they felt the line management in the home was supportive and approachable. Within one staff survey it was noted manager is always extremely supportive and will do her best to ensure the best for her service users and staff. One relative within their surveys commented the manager and the staff do a wonderful job. We saw that since the last inspection work had been achieved with the quality assurance system. We did not inspect this work in any detail but we could see that stakeholders questionnaires had been completed. We did comment that without a robust advice system in place, it would have been difficult to seek the views of many service users. Within the surveys we had been sent by the home on behalf of residents we had noted that when asked if the resident had completed the surveys themselves or with support, the self box had been ticked. When we asked the deputy manager about this we were told that assumptions had been made on some occasions. We asked to see the homes polices and procedures. We noted that the health and safety policies were dated 2005, with a review date of 2006. There were medication administration and recording policies in place together with care planning documentation policies and procedures. Our findings at this inspection indicated that guidance was not being followed and management had not been reviewing practice to identify shortfalls we saw. We saw a record to demonstrate that checks are carried out on the fire alarm system and fire door release system. We saw records of fire drills that had been undertaken. We saw various service and maintenance certificates such as a Gas Safety Check letter dated 4th March 2008 and an electrical portable appliance test certificate dated April 2008. We saw a letter issued by the Fire and Rescue dated 20th January 2009 stating a satisfactory standard of fire safety was evident. We saw a record of recent resident house meetings which we told take place every Sunday. There were environment and safe working practice risk assessment in place dated November 2008. We did not examine them. We have been kept informed about notifiable incidents that are required through Regulation 37 reports. For example, any safeguarding adults from harm matter. We also saw the records of the Regulation 26 reports that require the owner (or a representative) to complete monthly. This record demonstrates that the owner knows about the day to day management of the home and is satisfied that compliance with the Care Homes Regulations is being achieved. The current area manager has devised the format to clearly show what shortfalls they have identified and timescales have been issued to the person responsible for the identified piece of work. The home was looking after residents personal monies. The system for these financial transactions had a good audit trail process in place. We did not carry out an audit ourselves. We were not able on this occasion to speak with the manager about our findings of this inspection because of their holiday arrangements. Care Homes for Adults (18-65 years) Page 32 of 38 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 33 of 38 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No 1 Standard 6 Regulation 15 Description Timescale for action All residents must have care plans 31/03/2009 and risk assessments in place reflecting their current assessed care needs. This will enable staff to be aware of what the care needs are and how to meet them. 2 7 12 Systems must be in place to enable 31/03/2009 residents to make choices and decisions with respect to the care they are to receive and their welfare. Systems must also be in place to ensure that residents wishes and feelings are known and acted upon This is to ensure that residents views, opinions and wishes are acknowledged and managed appropriately 3 16 17 Arrangements must be made to ensure that resident’s rights are respected and upheld. 31/03/2009 This is to ensure that residents feel Care Homes for Adults (18-65 years) Page 34 of 38 valued. 4 18 12 The views, wishes and opinions of all residents must be recorded and acted upon. 31/03/2009 This will enable residents to have confidence that their feelings are fully considered and acted upon. 5 19 12 Arrangements must be in place to ensure that the physically and emotional needs of all residents are assessed, recorded and met. 31/03/2009 This is to ensure that the needs of individual residents are met. 6 20 13 Arrangements must be made for safe 31/03/2009 administration, handling, storage, administration records and disposal of medicines within the home. This is to ensure that medication practices within the home are safe and residents are protected. 7 20 13 Appropriate storage facilities must 30/06/2009 be provided for controlled medicines received into the home. This is to ensure the safe storage of controlled medicines 8 22 22 Arrangements must be put in place 30/03/2009 to enable every resident to raise or make a complaint if they wish. For those not able to do so independently, arrangements must be put in place for suitable advocacy systems or provided in a format which is suitable for meeting resident’s needs. This is to ensure that suitable processes are in place enable every resident to raise a concern. Care Homes for Adults (18-65 years) Page 35 of 38 9 23 23 Staff must understand all areas of potential abuse and be aware of the correct reporting procedures. This includes behavioural modification sanctions which have not been adequate recorded. 30/03/2009 This is to ensure that residents are cared for in a safe way. 10 32 18 All staff must have received adequate and suitable training to meet the care needs of all residents. 30/03/2009 This will enable residents to be cared for by staff who understand the assessed care needs and have the ability to meet them. 11 34 19 Staff must not work in the home until all the statutory recruitment requirements have been met. 30/03/2009 This is to ensure that residents are safe. 12 35 18 Staff must be trained to meet all residents’ needs and have been assessed as competent to do so. 30/03/2009 This is to ensure that staff have understood their training. 13 38 9 There must be a clear sense of direction and leadership within the home. 30/03/2009 This is to ensure that the care provided is in accordance with the aims and purpose of the home. 14 39 24 Systems and processes must be in place to ensure that the views and opinions of all residents are known and acted upon. 30/03/2009 Care Homes for Adults (18-65 years) Page 36 of 38 To enable this to happen, a robust advocacy system should be in place. 15 41 17 All records required by regulation 30/03/2009 must be up to date and in good order. This particularly relates to records held on residents. This is to ensure that all information and detail held on residents about their care, health and wellbeing is current. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No 1 Refer to Standard 1 Good Practice Recommendations Information within the Statement of Purpose and Service Users Guide should be reviewed and amended so that stakeholders are provided with current information about the home. There should be planned repair and redecoration programme in place to ensure that residents live in a home that is well maintained. 2 24 Care Homes for Adults (18-65 years) Page 37 of 38 Helpline: 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 We want people to be able to access this information. 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