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Inspection on 11/09/08 for Speakers Court

Also see our care home review for Speakers Court for more information

This inspection was carried out on 11th September 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

All the written and verbal feedback we received from the occupants was in the main very positive about the attitude of staff and the leadership approach of the new acting manager. Typical comments included, staff always show us the greatest respect, and the personal care and the quality of the meals is excellent here. Throughout the course of this inspection we saw all the staff interacting with the occupants in an extremely kind and caring manner. The service continues to be good at respecting the privacy of the occupants, who each have their own front doors, and promoting their rights to choose how they live their lives.

What has improved since the last inspection?

All the occupants and staff met told us they liked the approachable leadership style of the new acting manager and were pleased someone was now available on site for them to talk to if they had a problem. The new managers open approach to running the service has clearly had a positive affect on the morale of both the occupants and staff, which had been adversely affected by the uncertainty surrounding the registered managers continued absence. All the requirements identified at the services last inspection report have been met (see below): All staff are now expected to complete a thorough induction before working unsupervised with the occupant`s and the services quality assurance systems have been improved.

What the care home could do better:

All the positive comments made above notwithstanding their remains a number of areas of practice where further improvement is required in order to enhance the lives of the occupants, as well as keep them safe. Medication recording practices of staff need to be improved. This will ensure there is a clear audit trail for authorized persons to determine whether or not the services medication handling practices are sufficiently robust to keep the occupants safe from avoidable harm. Staffing levels should be reviewed and made more flexible to ensure there are always sufficient numbers of staff on duty to meet the personal, social and health needs of the occupants. This will ensure the occupants receive the correct levels of staff supervision and support to meet their needs. We require further written clarification regarding the arrangements Scope have put in place for the day-to-day running of the care home during the permanent managers absence to, including more details about the temporary acting managers qualifications and experience. This will enable us to determine the suitability of these interim arrangements. The services fire alarm system must be tested on a weekly basis and the outcome of the test recorded, including any defects identified with the equipment. We also recommend the service reviews all its fire safety procedures as a matter of urgency to ensure staff always adhere to them. This will ensure the safety of the occupants, their guests, and staff.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Speakers Court St James`s Road Croydon Surrey CR0 2AU The quality rating for this care home is: two star good 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: Lee Willis Date: 0 6 1 0 2 0 0 8 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 Page 2 of 31 Care Homes for Adults (18-65 years) 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 31 Information about the care home Name of care home: Address: Speakers Court St James`s Road Croydon Surrey CR0 2AU 02086650745 02086650745 laura.baker@scope.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : SCOPE care home 7 Number of places (if applicable): Under 65 Over 65 7 0 physical disability Additional conditions: The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Physical disability ? Code PD The maximum number of service users who can be accommodated is: 7 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 31 A bit about the care home Speakers Court offers accommodation and personal support for up to seven adults with Cerebral Palsy and associated physical disabilities. The five self-contained flats that make up Speakers are owned by Croydon Churchs Housing Association, but are managed and staffed by the registered charity Scope. Laura Baker, who is currently on long-term sick leave, has been in operational control of the service for nearly four years. Laura Baker is also responsible for running another service in the area, which is also managed by Scope. Located in the Broad Green area of Croydon the service is relatively close to a wide variety of good leisure and community facilities. The service is also close to a number of very good bus, tram, and rail links with excellent connections to London and the areas surrounding Croydon. The five selfcontained flats that make up Speakers all have there own front doors which open out onto a well maintained old converted church courtyard. Each flat has a large open plan lounge/kitchen area, separate bedroom, and en-suite toilet and bathing facilities. The flats have also been suitably adapted to meet the individually assessed needs and wishes of the occupants and maximise their independence. All the flats are wheelchair accessible. There is a separate office located within the complex, which has its own kitchen, toilet and shower facilities, and sleep-in room for staff. All the occupants are provided with copies of the homes Statement of Purpose and Guide. Scope currently charges between £39,000£59,000 a year for each placement for facilities and services provided. Care Homes for Adults (18-65 years) Page 5 of 31 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: two star good 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 31 How we did our inspection: This is what the inspector did when they were at the care home The quality rating for this service is two stars. This means the occupants experience good quality outcomes. From all the available evidence we gathered during the inspection process it was clear the service has more strengths than areas of weakness. We spent four hours at the service. During the visit we spoke at length to two occupants who currently reside at Speakers Court, and four support workers, including two relatively new members of staff. We also spoke to the services new temporary acting manager, Michael Stone, over the telephone. We received three have your say comment cards about the service, two of which were completed by the occupants and the other by a friend. Various records and documents, including the care plans for the two occupants who cases we chose to track, were all examined in depth. The remainder of this site visit was spent touring two flats with the occupants permission and the office. Finally, the service completed our Annual Quality Assurance Assessment, which tells us what the manager thinks they are doing well, and what they could do better. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well What has got better from the last inspection All the occupants and staff met told us they liked the approachable leadership style of the new acting manager and were pleased someone was now available on site for them to talk to if they had a problem. The new managers open approach to running the service has clearly had a positive affect on the morale of both the occupants and staff, which had been adversely affected by the uncertainty surrounding the registered managers Care Homes for Adults (18-65 years) Page 8 of 31 continued absence. All the requirements identified at the services last inspection report have been met (see below): All staff are now expected to complete a thorough induction before working unsupervised with the occupants and the services quality assurance systems have been improved. What the care home could do better All the positive comments made above notwithstanding their remains a number of areas of practice where further improvement is required in order to enhance the lives of the occupants, as well as keep them safe. Medication recording practices of staff need to be improved. This will ensure there is a clear audit trail for authorized persons to determine whether or not the services medication handling practices are sufficiently robust to keep the occupants safe from avoidable harm. Staffing levels should be reviewed and made more flexible to ensure there are always sufficient numbers of staff on duty to meet the personal, social and health needs of the occupants. This will ensure the occupants receive the correct levels of staff supervision and support to meet their Care Homes for Adults (18-65 years) Page 9 of 31 needs. We require further written clarification regarding the arrangements Scope have put in place for the day-to-day running of the care home during the permanent managers absence to, including more details about the temporary acting managers qualifications and experience. This will enable us to determine the suitability of these interim arrangements. The services fire alarm system must be tested on a weekly basis and the outcome of the test recorded, including any defects identified with the equipment. We also recommend the service reviews all its fire safety procedures as a matter of urgency to ensure staff always adhere to them. This will ensure the safety of the occupants, their guests, and staff. 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 Care Homes for Adults (18-65 years) Page 10 of 31 please contact Lee Willis 33 Greycoat Street London SW1P 2QF 02079792000 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 11 of 31 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 12 of 31 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 . Occupants have all the information they need to make an informed decision about whether or not the service is right for them. The needs, strengths, and wishes of all prospective new occupants are fully assessed prior to their admission so the individual, their representatives, and the provider can be sure (so far as reasonably practicable) the placement is suitable. Evidence: A member of staff spoken with at length confirmed the service did not currently have any flats vacant. Consequently, the service had not received any new referrals for sometime. The member of staff met demonstrated a good understanding of what constituted best practice with regards accepting new admissions. One occupant told us they got on really well with all the other occupants currently residing at Speakers Court and felt sure they would be consulted about the admission of any new people. Care Homes for Adults (18-65 years) Page 13 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Overall, the service has some good systems in place to ensure the occupants have the opportunities to get involved in decisions about their lives, and can play an active role in planning the care and support they receive. Evidence: The two occupants met told us the service involves them in the planning of the care they receive. A keyworker system allows staff to work on a one to one basis with occupants which ensures they are fully involved in developing their own care plans. Since the last inspection a new care plan format has been develop that is far more person centred and easy to understand. Staff met told us the new format made the information contained in care plans more accessible therefore making them better working documents. Staff told us the process of introducing the new care plan format is on going. Progress made to complete this task will be assessed at the services next inspection. All the care plans examined contained completed risk assessments, but these were on the whole very basic, and rather generic e.g. No individualized risk assessment and Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: the associated management plan could be located at the time of this site visit which would ensure staff had access to all the inforamation they required to deal with a specific occupants changing health needs. Care plans and risk assessments are being reviewed, but the inforamation contained in these documents is often out of date because staff are not reviewing them at regular enough intervals. All the occupants met told us the staff always listen to them and take into account their views and wishes. One occupant spoken with at length told us the manager would always ask them about the suitability of any new staff. Care Homes for Adults (18-65 years) Page 15 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The service has very good arrangements in place that enable the occupants to make informed choices about their life style, and are actively encouraged and supported to develop their life skills. In the main the social, recreational, and cultural activities available to the occupants matches most of their expectations. The meals are nutritionally well balanced and cater for the varying dietary needs and preferences of the occupants. Evidence: During the course of this site visit a number of the occupants accessed the wider community to get involved in various daytime activities of their choosing. One occupant is actively encouraged to use public transport to get around. This individual told us they regularly use the train. Another occupant told us they often go food shopping with staff. Entries made in the two care plans being case tracked revealed Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: these occupants participated in a wide variety of meaningful activities in the wider community in recent months. However, one occupant told us there was not always enough staff on duty to support them when they went out. Feedback received from several members of staff confirmed that with the manager on long term sick leave and the fact that there was sometimes only two members of staff on duty this meant the occupants could not always pursue their chosen leisure interests. All issues relating to staffing are discussed in greater depth in outcome area 7 - Staffing. Staff told us there are no restrictions on what time the family and friends of the occupants can visit. Two occupants spoken with at length confirmed the service has an open visitors policy. Staff demonstrated a good understanding of the services security measures and required us to sign the visitors book on arrival. Both occupants met told us they had been provided with keys to their flats and that staff encouraged them to help prepare their meals. One occupant told us staff always helped them prepare the food they liked. The food and drink preferences of the occupants are included in the new care plan format. As all the occupants are helped to prepare their own meals in their flats staff do not publish menus, although up to date records of all the food and drink chosen by the occupants is kept. Care Homes for Adults (18-65 years) Page 17 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The services arrangements for ensuring the health and personal care the occupants receive, including their unique moving and transferring support, is based on individual requirements and preferences, as well as the principles of privacy and dignity. Lack of adequate medication recording is putting the occupants at risk of harm and must be improved as a matter of urgency. Evidence: The two occupants met told us they always choose what clothes they wear each day and often go shopping with staff for new ones. All the occupants met were suitably dressed for the season in well maintained age appropriate attire. The new care plan format sets out in detail each occupants unique health care needs and the support they require from staff to have them met. Both care plans being case tracked contained up to date manual handling risk assessments that accurately reflected these individuals unique physical needs, and capacities. One occupant told us their key worker is a good listener and always supports them with any health care matters. Records showed advice and input from the relevant health care professionals is always sought, as and when required. Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: The services accident and incident books is appropriately maintained by staff. The two most significant events involving the occupants since the last inspection were both recorded. We were notified about both incidents without delay at the time of there occurrence. Staff on duty at the tiem of this site visit demonstrated a good understanding of what constituted a significant incident and which external agencys, including the CSCI, should be notified about there occurrence. An unacceptable number of errors were noted on medication records sampled at random where staff had left gaps when they failed to sign for medicines administered. Staff receiving medication into the service had also failed to sign any record to show they had thoroughly checked the medication they had received was correct. Staff told us that whenever an occupant was willing and capable of looking after their own medication they would be encouraged and supported to do so. Occupants who self medicate keep their medication in a looked safe in their flats. Staff told us the occupants wishes regarding what arrangements they want to be put in place after their death is always ascertained. One occupant has sadly passed away since the service was last inspected and staff told us this individuals dying wishes were carried out as recorded in their care plan. Care Homes for Adults (18-65 years) Page 19 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The service has suitable arrangements in place to ensure the occupants are able to express their concerns, have their rights protected, and are protected from abuse. Evidence: The services complaints log revealed three formal concerns had been made since the last inspection. The nature of all the complaints made and the actions taken in response to them had all been recorded. Staff met told us Scope takes all complaints seriously and will fully investigate them. Both the occupants met told us the service has an open culture and that they felt able to share any concerns they may have. One occupant told us they would talk to their keyworker if they were dissatisfied. Everybody met told us they had been given a copy of Scopes complaints procedures. Staff on duty at the time of this site visit all demonstrated a good understanding of what constituted abuse and which external bodies should be notified without delay if they suspected or witnessed the occupants being harmed, abused and/or neglected. No allegations of abuse involving the occupants have been disclosed within the service since it was last inspected. Care Homes for Adults (18-65 years) Page 20 of 31 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 . The physical design and layout of all the self contained flats enables the occupants to live in a very homely, well maintained and comfortable environment, which promotes their privacy and encourages Independence. Evidence: One occupant who invited us to view their flat told us they were very happy living at Speakers Court and had everything they needed. The two other flats viewed were both maintained to a relatively good standard and had been kept very clean and tidy. one occupant told us they had chosen the colour of their carpet and the lounge walls. Both flats contained a lot of pictures, photographs and ornaments, which made them look and feel very personalized. Furthermore, furnishings and fittings remain domestic in style, and all the adjustable work surfaces, lowered light switches, and long cords on call bells ensure the occupants independence is maximized. All the flats are open plan and very wheelchair accessible. Overhead tracking equipment is also supplied making moving and transferring tasks easier for the occupants and staff. The temperature of hot water emanating from a bath in a flat viewed was found to be a safe 42 degrees Celsius. Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: Each flat has its own washing machine, which is capable of dirty laundry at appropriate temperatures in line with infection control standards. Care Homes for Adults (18-65 years) Page 22 of 31 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 . The services staff recruitment checks and training arrangements ensures the occupants are supported and kept safe by suitably fit and competent carers. However, poor supervision arrangements and changes in staffing levels means the occupants are not always being supported by sufficient numbers of suitably informed staff. Evidence: Duty rosters sampled at random confirmed there were always at least two members of staff on duty during the day, with an additional third member sometimes employed to cover peak periods of activity. At night staffing levels have been reduced since the last inspection from two sleeping in members to just one. As previously mentioned in this report occupants and staff have both expressed concern about current staffing levels. Several occupants and staff told us they felt there were not always enough staff on duty during the day to meet the occupants requests to be supported whilst out in the wider community. One member of staff told us they were worried that reductions in night time staffing levels meant occupants who had clearly expressed a wish to receive same sex personal care would be denied this right. It was also not clear on duty rosters which members of staff were designed as on call and if they would be able to reach Speakers Court within twenty minutes to deal with an emergency. The services relatively new night time staffing and on call arrangements need to be Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: clarified as a matter of urgency. All the occupants and staff met confirmed that morale at Speakers Court had been adversely affected by the uncertainty surrounding the registered managers long term absence and the use of too many temporary staff in recent months. All the negative comments made above notwithstanding it was positively noted that all the staff on duty during the visit were observed interacting with the occupants in a very caring and respectful manner. Typical comments made by several of the occupants included, I like my new keyworker, and a lot of the staff have worked here for years and i consider them my close friends. A relatively new member of staff spoken with at length told us they had been required by Scope to supply them with an up to date a Criminal records Bureau and Protection of Vulnerable Adults checks, two written references from their last employers, and complete a thorough induction before being allowed to work supervised with the occupants. All staff met told us the training they received from Scope gave them a lot of the knowledge and skills they required to meet the occupants needs. Staff training will be assessed in greater depth at the services next inspection. In the interim we recommend the services team leader, a new Senior position recently created by Scope to run the service in the managers absence, receives additional support and training to Carry out their new role and responsibilities. All the staff on duty during this site visit told us they were not being formally supervised by their line manager at regular intervals (i.e. at least once every two months) or being invited to attend staff meetings. Minutes of staff meetings revealed the last one had been held over six months ago in April 2008. Both relatively new staff on duty at the tiem of this visit told us they had never attended a staff meeting at Speakers Court. The new acting manager acknowledged over the telephone that supervision of staff was an area of practice that could be significantly improved. We feel staff morale would benefit from more opportunities for staff to meet in groups and/or on a one to one basis with their line managers to discuss any concerns they may have. Care Homes for Adults (18-65 years) Page 24 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The management and administration of the service has begun to improve since the appointment, albeit temporarily, of a new acting manager who is suitably competent and experienced. The service has established effective quality assurance and monitoring systems that ensures all the major stakeholders, including the occupants and their representatives, can influence how Speakers is run and develops. The health and welfare of the occupants, their guests, and staff have all been placed at unnecessary risk of harm because the services fire safety procedures are not always being practiced. Evidence: Michael Stone took over from the registered manager of Speakers Court, Laura Baker, in October 2008 as an interim measure while she remains on indefinite sick leave. As mentioned throughout this report all the occupants and staff spoken with during this site visit expressed concern about Lauras continued absence and felt this was having an adverse affect on morale. One member of staff told us they felt the service was just Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: about muddling through in the absence of a manager. The new acting manager told us over the telephone that while he is in day to day control of both Speakers Court and another Scope service in the area he will be relinquishing his duties as manager of a day centre on the south coast. Michael demonstrated a good understanding of what his interim role was, which areas of practice the service had begun to fail in, and how he intended to improve things. Typical comments made by the occupants about the new acting manager were extremely favourably. One occupant told us, I like the new manager, he listens to me. Staff met also told us it would be good to have a manager on site again. Scope have been required to send us written clarification about what exactly the arrangements are for running both Speakers and Blake Court are during the continued absence of the registered manager. The service has established an effective quality assurance system that uses the findings of our annual quality assurance assessment, reports compiled by managers from of other Scope services following their monthly visits, and various stakeholder satisfaction surveys to continually monitor and improve develop Speakers Court According to the services annual quality assurance assessment a large proportion of its policies and procedures have not been reviewed for well over three years and therefore have not been up dated accordingly to reflect changes in best practice and related legislation. We recommended all Scopes policies and procedures are reviewed. Fire records showed the services fire alarm system was only tested four times in 2008. Staff told us they believed the system was checked more regularly than records suggested, but conceded it was probably not done on a weekly basis in line with good fire safety practice. Staff told us they had all attended fire safety training in April 2008. The services last fire drill was carried out in May 2008. The record did not identify which staff had participated in the drill and also showed only one practice had been carried out in 2007. Scope are reminded that fire drills should be carried out at least once every six months. The aforementioned poor fire safety practices are placing the occupants and staff at unnecessary risk of harm. An up to date fire risk assessment of the premises was produced on request by staff on duty at the time of this site visit. Care Homes for Adults (18-65 years) Page 26 of 31 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 27 of 31 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 Standard Regulation Description Timescale for action 1 20 13 When medication is administered to occupants it must be clearly recorded. 01/11/2008 This will enable anyone authorized to inspect medication records to determine whether or not the occupants are receiving the correct levels of medication. 2 33 18 Staffing levels must be 01/11/2008 reviewed and made more flexible to ensure there are always sufficient numbers of support workers on duty during the day and at night to meet the personal, social, and health care needs and wishes of all the occupants. This will ensure the occupants always receive the personal, social, and health care support they require and in a way they prefer Care Homes for Adults (18-65 years) Page 28 of 31 both during the day and at night. 3 37 38 When there are changes made to the running of a service we must be supplied with details about the qualifications of the new manager and what exactly the new arrangements are. 01/11/2008 This information will enable us to make a judgment about the effectiveness of the services new interim managerial arrangements. 4 42 23 The services fire alarm 01/11/2008 system must be tested on a weekly basis and a record of the test conducted kept, including any action taken t remedy defects in the fire alarm equipment. This will ensure any defects in the alarm system are identified promptly. 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 Refer to Standard Good Practice Recommendations 1 6 The way in which the service up dates care plans and risk assessments should be reviewed as current arrangements do not ensure these working documents accurately reflect occupants changing needs and wishes. This will ensure the occupants receive the person centred support that meets their needs and keeps them safe. The way in which the service monitors the receipt, recording, administration and disposal of medication should be reviewed to make the process far more transparent. This will minimize the risk of medication errors occurring. Page 29 of 31 2 20 Care Homes for Adults (18-65 years) 3 35 All staff appointed team leaders should be appropriately trained in their new managerial responsibilities. This will ensure they have all the necessary knowledge and skills to perform their new duties effectively, especially during the managers absence. The way in which the service supervises and offers the staff team support, either through group meetings and or formal one to one sessions, should be reviewed. This will ensure the occupants receive support from staff who have far more opportunities to express their views and up date their existing knowledge and skills. 4 36 5 40 The way in which the service up dates its policies and procedures should be reviewed to ensure they accurately reflect current best practice. Staff should also have access to up-to-date copies of all Scopes policies and procedures and be able to produce them on request. This will ensure the rights and best interests of the occupants are safeguarded. The way in which the service implements and records its fire safety procedures should be reviewed as a matter of urgency. e.g. Fire drills should be carried out at regular intervals and the names of everyone who participates be recorded. This will enable anyone authorized to inspect these records to determine whether or not the service fire safety arrangements are are effective. 6 42 Care Homes for Adults (18-65 years) Page 30 of 31 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. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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