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Inspection on 06/10/08 for St Mark`s Road Care Home - Block A

Also see our care home review for St Mark`s Road Care Home - Block A for more information

This inspection was carried out on 6th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 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.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: St Mark`s Road Care Home - Block A 24 St Marks Road Derby DE21 6AH The quality rating for this care home is: one star adequate 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: Jo Wright 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 29 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 29 Information about the care home Name of care home: Address: St Mark`s Road Care Home - Block A 24 St Marks Road Derby DE21 6AH 01332294066 01332242338 robinia.24stmarks@hotmail.co.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) : The Robinia Group PLC care home 8 Number of places (if applicable): Under 65 Over 65 8 0 learning disability Additional conditions: Date of last inspection A bit about the care home Robinia Care Group is the responsible provider for 24 St Marks Road. The home is located on the same site as another home owned by this organisation and the same Registered Manager is responsible for both homes. The home was purpose built to a high standard and registered in July 2005, to provide personal care and accommodation for up to 8 people in the category of learning disability, aged between 18 and 65 years of age. At the present time the group of people living at the home are all aged under 30 years. The home is situated in Chaddesden just Care Homes for Adults (18-65 years) Page 4 of 29 outside Derby City centre and is close to local amenities. A car park in available at the front of the premises and a garden at the rear. The home provides a spacious environment with all rooms being of single occupancy with en-suite shower facilities. Care Homes for Adults (18-65 years) Page 5 of 29 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: one star adequate 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 29 How we did our inspection: This is what the inspector did when they were at the care home We arrived at the home without an appointment. We looked at some of the policies and procedures in the office. Policies are rules about how to do things. Procedures tell people how to follow the rules. We talked to people living at the home and watched what people did each day. We also met some of the staff working at the home. We have written down what was said in a report we did in October 2007. What the care home does well Care Homes for Adults (18-65 years) Page 7 of 29 People who live at the home could choose to go to different activities. The home was clean and comfortable. We saw that people who lived at the home got on well with staff. What has got better from the last inspection The information written down about people (care and support plan) is now up to date and tells staff what to do to keep people safe. Care Homes for Adults (18-65 years) Page 8 of 29 What the care home could do better Staff must give out medication properly so people are safe and receive their medication when they need it. Staff must listen to what people say about the things they do not like. A manager needs to be appointed and register with the Commission for Social Care Inspection. This person will have to tell the inspectors how they will make things better at the home. If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 9 of 29 If you want to speak to the inspector please contact Jo Wright CPC1 Capital Park Fulbourn Cambridge 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 10 of 29 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 11 of 29 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 . Detailed assessments of needs written in a user-friendly manner help to ensure that service user needs are met with input from the service user. Evidence: Three service users files were examined as a cross section of the five currently living at the home. Each of the files held detailed information relating to the needs of the service user and all were very person centred. The front page of each file was titled All About Me and contained user-friendly detailed information, either written or in picture format. The files all contained detailed care plans and risk assessments to address needs highlighted. Care Homes for Adults (18-65 years) Page 12 of 29 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 . Detailed care plans and risk assessments help to ensure that staff are able to meet the changing needs of the service users. Evidence: Service user plans are very detailed. Each of the files held details of the service user and were written in an easy format. The front page of each file held a description of the person along with a photograph. Files hold details regarding A good day and A bad day, this is me and my diet. The details within the plans clearly provide sufficient information to enable the staff team to meet the needs of the service users. Each of the service users has input from family members. There is evidence within the files that the families are contacted and kept up to date. One relative spoken with, said that staff do contact her if they need to. Service users are supported to take risks. Each of the files held detailed risk assessments including accessing the community and managing finances. They also held a skills assessment and a positive behavioural assessment. Information provided Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: by the provider states that due to communication difficulties, the organisation needs to develop ways of communicating better with service users, this will then enable them to source new experiences. All care files are kept in the office, however the home is currently without a Manager and clearly the person in charge on the day of the visit was unaware of the need to ensure they are kept secure. Files were in an unlocked, unattended office when we arrived. Care Homes for Adults (18-65 years) Page 14 of 29 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 . Detailed care plans and risk assessments assist staff to provide service users with a social life to meet their needs. However, shortage of staff potentially puts service users at risk of harm and prevents staff from meeting their needs. Evidence: Some of the service users access colleges and centres with support from the care staff. On the day of the visit one member of staff had called in sick, leaving four staff on duty, 2 of them being agency staff. When we arrived there were 3 staff and only one of them had completed training needed to manage behaviours safely. Due to the shortage of staff there was no evidence of activities taking place within the home. One service user was unable to attend college due to shortage of staff. (See Staffing Section). Care plans and risk assessments support people to access the community. There was evidence of holidays being booked for service users who chose to go. Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: The staff offer choices as far as possible to service user at mealtimes. They support service users to enjoy mealtimes in a relaxed manner, however on the day of the visit, they were not able to eat in a relaxed manner due to the shortage of staff. Service users were eating breakfast as they got up and were dressed, rather than being supported to eat breakfast together as a social group. Care Homes for Adults (18-65 years) Page 16 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Input from other professionals assists staff to meet changing needs, however shortage of staff and failure to audit medication potentially puts service users at a high risk of harm. Evidence: Each of the files examined had detailed information about how to meet the changing needs of the service users. There was evidence of input from the GP, Speech & Language and physiotherapy. Although there are no specific times for getting up in the morning or going to bed at night, however due to staff shortage on the day of the visit the service users had little choice about what time to get out of bed, they had to get up when staff were available to support them, due to the Person in charge on the day not recognising the need to fill a sickness vacancy (See Staffing Section). Each of the files held a medication risk assessment. Medication is documented as it arrives. CSCI have received a number of reports from the home since the last inspection, regarding issues around medication. As the home is without a Registered Manager the Operations Manager stated that monitoring medication was the Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: responsibility of a Team Leader. On the day of the visit the medication was examined and discrepancies were noted. The amount of two different types of medication was found to be short when compared to that amount that had been received against the amount administered. The Operations Manager stated at a later meeting with CSCI that she would address this issue as it was evident that medication is not being audited. Care Homes for Adults (18-65 years) Page 18 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Rigorous policies and procedures addressing complaints and safeguarding adults help to keep service users safe and listened to, however, poor staffing levels, inadequately trained staff and failure to follow procedures when appointing staff all potentially lead to staff being at risk of abuse. Evidence: The Organisation has a detailed policy and procedure to address complaints. There is a complaints book in the home, however there have been no complaints recorded since 12th March 2007. During a meeting with the Operations Manager after the inspection visit, she stated that there had been complaints made and that staff are aware that they should be documented accordingly. One relative spoken with said that she had been complaining about her son being at the home for 12 months, her complaint was with Social Services and not the home, however there was no evidence of the staff listening to her and responding. There is a rigorous Safeguarding Adults policy and procedure. The Organisation provides training for staff; Team Teach (managing behaviours safely) and Safeguarding Adults. However, on the day of the visit there were 4 staff on duty, 2 were agency who had not got Team Teach training and only 1 of the 2 regular staff had completed the training. Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: Care Homes for Adults (18-65 years) Page 20 of 29 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 . A clean and tidy home promotes a safe environment for service users and encourages pride within the home. Evidence: The environment is very spacious, clean and tidy. Each of the bedrooms had necessary equipment needed to ensure safe moving and handling practices and all were very individualised, with photos of families and friends around the walls and units. Some of the en-suite facilities were being used for storage, preventing them for being used for purpose. Furniture within the home is of good quality. There is a separate laundry with appropriate facilities. There were no offensive odours apparent on the day of the visit. Care Homes for Adults (18-65 years) Page 21 of 29 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 . Sufficient staff on duty at all times helps to ensure needs are met, however poor staff training and lack of regular staff supervision potentially prevents needs from being met. Evidence: As detailed earlier within this report there were omissions in staff files, this was discussed with the person in charge, who addressed it immediately. Although the organisation provides a range of training for staff, there are 5 staff still to complete Safeguarding Adults and 5 staff still to complete Team Teach. The person in charge stated that no staff have NVQ 2, 1 staff has NVQ 3 and 2 are completing it. There appeared to be enough staff on duty throughout the week to meet the needs of the service users. They hold regular staff meetings and although they do not have regular supervision there are plans to ensure that supervision is provided at least 8 times a year. It was evident on the day of the visit that staff have a very positive relationship with the service users and communicate well with them. Care Homes for Adults (18-65 years) Page 22 of 29 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 . The lack of a suitable qualified person to manage the home potentially puts service users at risk. Evidence: The home is currently without a Registered Manager and it is clear from this inspection report that a suitably qualified person is needed to manage the home urgently. The previous manager left the home earlier this year but the Organisation failed to inform CSCI. Fire drill have been carried out on three occasions this year, however the person in charge was unable to find evidence that the fire alarm system had been tested. The gas, electricity and care call system certificates were all up to date. Medication is clearly not audited as detailed earlier within this report. Family questionnaires had been completed January 2008, although there was no evidence that anything had been done with the information provided. Staff meetings are held on a monthly basis. Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: At a meeting with the Operations Manager following the inspection visit, she assured us that a manager had been appointed for the home and would be supported for some time by herself. Care Homes for Adults (18-65 years) Page 24 of 29 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 25 of 29 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 10 17 Care records must be kept securely within the home at all times. 31/12/2008 To ensure that service users privacy is maintained. 2 20 13 Medication must be administered, recorded and handled safely. 31/12/2008 To ensure that peoples medication needs are met safely. 3 22 22 All complaints must be fully recorded, investigated and feedback given to the complainant. 31/12/2008 To ensure that those making a complaint feel listened to and appropriate action is taken. Care Homes for Adults (18-65 years) Page 26 of 29 4 23 18 Staff must receive training on how to manage behaviours safely. 31/01/2009 To ensure that both people using the service and staff are safe. 5 33 18 Staff must receive training appropriate to the needs of the people who use the service. 30/01/2009 To ensure that staff have the skills and knowledge to meet the needs and preferences of the people who use the service. 6 37 9 A manager must be appointed and make an application to be registered with the Commission for Social Care Inspection 31/12/2008 To ensure there is a fit and competent person running the home. 7 42 23 Fire tests must be undertaken and recorded on a weekly basis. 12/12/2008 To ensure that the system is working and that people who use the service are safe. 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 Care Homes for Adults (18-65 years) Page 27 of 29 1 2 17 20 Staff should support people to enjoy relaxed mealtimes. Medication should be audited by a suitably qualified and competent person. Care Homes for Adults (18-65 years) Page 28 of 29 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. 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. Care Homes for Adults (18-65 years) Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!