Inspection on 11/05/06 for Starboard House

This inspection was carried out on 11th May 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Starboard House 31/07/07

Starboard House 26/10/05

Starboard House 17/05/05

Starboard House 23/09/04

Starboard House 13/07/04

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Kestrel House, St Anne`s Opportunity Centre,

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

CARE HOMES FOR OLDER PEOPLE Starboard House 105 Obelisk Road Woolston Southampton Hampshire SO19 9DN Lead Inspector Janet Ktomi Unannounced Inspection 11th May 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Starboard House DS0000042317.V289166.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Starboard House DS0000042317.V289166.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Starboard House Address 105 Obelisk Road Woolston Southampton Hampshire SO19 9DN 0208 2554433 023 8043 4317 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Regard Partnership Limited Mr John Creek Care Home 10 Category(ies) of Learning disability (10), Learning disability over registration, with number 65 years of age (10) of places Starboard House DS0000042317.V289166.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users in the LD category must be at least 45 years of age. Date of last inspection 26th October 2005 Brief Description of the Service: Starboard House is a unique detached home built over several floors including a basement (currently laundry, storage and office) and has a separate selfcontained bungalow within the grounds of the home. Bedrooms are equipped with wash basins and are either single or for twin occupation. Communal space is appropriate for the number of service users. The garden is an adequate size for the number and needs of the people living at the home and provides a pleasant area to relax in, undertake hobbies and interests and provides shaded areas and a covered area for people who smoke. Starboard House is registered to accommodate up to ten service users from 45 years of age who have a learning disability. At the time of the inspection seven people were living at the home, most were over the age of sixty-five years. Starboard House is situated within a short walk of the shopping centre of Woolston and within a ten-minute drive from the city of Southampton, which has a range of shopping and leisure facilities. The home is owned by the Regard Partnership and managed by the Registered Manager, Mr John Creek. Starboard House DS0000042317.V289166.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Starboard House is registered to accommodate ten service users from 45 years of age who have a learning disability. However as the majority of service users are currently over the age of 65 years the home was inspected against the older persons standards. The inspector would like to thank the people who live at the home, the manager and all staff for their full assistance and co-operation with the unannounced inspection. The inspection was undertaken by one inspector and lasted approximately seven hours, commencing at 10.00 in the morning and being completed at 5.00 p.m. A tour of the home, including a number of bedrooms and the bungalow in the grounds was undertaken. All core standards and a number of additional standards were assessed and compliance with requirements made at the previous inspection in October 2005 was assessed. The inspector was able to spend time with all staff employed in the home and was given free access to all areas, records and documentation required. Prior to the inspection information as detailed in the report was requested from the home and received following the unannounced inspection. Comment cards were completed by all service users prior to the inspection. What the service does well: Service users all appeared, and stated, they were happy and well cared for. Interactions with care staff were warm and positive with care staff having a good knowledge of service users and their needs. The home provides a wide range of in-house and community activities. These provide leisure and social opportunities that service users enjoy. All service users recently enjoyed a holiday and are now planning for another holiday later in the year. Service users are provided with choice about aspects of their lives and are fully involved in decisions about the home. Meals appeared well cooked, nutritious and are enjoyed by the service users who are involved in menu planning, shopping and in the preparing of meals and snacks. The manager is aware of the changing needs of the people who live at the home as a result of their increasing age and is seeking support from social services concerning one service user whose increasing physical needs may no longer be fully met at the home. Starboard House DS0000042317.V289166.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: It is acknowledged that the home has met many of the previous requirements, however some remain outstanding and additional requirements have been made following this unannounced inspection. The service users’ guide contains all the required information, however it is not in a suitable format for the people who live at the home. The people who live at the home are familiar with pictograms and it is required that a simplified service users’ guide using pictograms is provided. Bedrooms are not numbered and therefore the rooms individual people occupy are not stated on contracts or terms of residence. The home must be able to show which room service users are to occupy (e.g. a letter or number). This does not need to be stated on bedroom doors but should be provided on a plan with a copy sent to the Commission. A basic terms and conditions document in a format suitable for the service users should be produced and signed by service users. The care manager or placement organiser should sign the typed legal contract. The home has improved some areas of the environment however the majority of the remaining parts of the home require modernisation and redecoration. The inspector was especially concerned about the absence of a wash basin in one WC, towel rails located immediately above radiators, rusty radiator covers, poor quality floor covering in all WCs and bathrooms, which is not adequately sealed at the edges and in one bathroom is lifting. Paper towels and dispensers must be provided in all WCs and bathrooms. Individual toiletries and toothbrushes must not be kept together on the bathroom shelf identified to the Starboard House DS0000042317.V289166.R01.S.doc Version 5.1 Page 7 manager. A toilet roll holder and mirror must be provided in the ground floor WC. Plastic disposable gloves must be provided in the laundry. Old furniture, disused fridges and waste from carpet replacement must be disposed of. The reference request form must be amended to ensure the person providing the reference dates the form to confirm that the reference has been received prior to the new employee commencing work at the home. Care staff must have further training in adult protection procedures as they were unable to correctly state the action they would take if a service user informed them they had been the victim of abuse. The manager must ensure that adult protection is included in the induction work undertaken by new employees. A suitable video should be purchased. Written evidence of staff supervision must be maintained and available for inspection. The home must provide the Commission with details of how it plans to charge service users for transport costs. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Starboard House DS0000042317.V289166.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Starboard House DS0000042317.V289166.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3. Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. The home has a service users’ guide, however this is not in a format suitable for the people who live at the home or potential service users. The home must produce a service users’ guide in a format suitable for the people who do or may live at the home. Bedrooms are not numbered and therefore are not specified on individual contracts or terms of residency. The manager must provide a plan detailing room numbers (or other identification system). A contract/terms of residency using pictograms must be provided for service users without literacy skills. No new service users have been admitted to the home however the inspector believes the manager would only admit suitable people to the home. Standard 6 is not applicable as intermediate care is not provided at Starboard House. Starboard House DS0000042317.V289166.R01.S.doc Version 5.1 Page 10 EVIDENCE: The manager showed the inspector the home’s service users’ guide. This contains all the required information but is not in a format suitable for the people who currently live at the home or those likely to be considered for admission. The manager had a number of pictograms in the office. The manager stated that the people who live at the home are familiar with the pictograms. The manager must produce a service users’ guide in a format suitable for the people who currently live at the home and those who may be admitted in the future. The manager is advised to consult other Regard Partnership homes who already have such a service users’ guide and adapt this appropriately for the service provided at Starboard House. A copy of the new format service users’ guide must be provided to everyone living at the home and to the Commission. This was required following the previous inspection. Further failure to comply may result in enforcement action. Each service user has a contract stating the terms and conditions of residence. These are typed format documents and have been signed by the service user. Following the previous inspection the manager was required to ensure that the contract details the room the service user will occupy whilst living at the home. This has not been done. Discussions with the manager and a tour of the building showed that the home’s bedrooms are not numbered or identifiable. The manager must produce a plan of the home and identify each bedroom (by number or letter would be appropriate). The identification does not need to be put on bedroom doors which could create an institutional feeling in an otherwise homely environment, however the rooms must be identified on the plan, with a copy of the plan available in the home and sent to the Commission. A simplified contract in pictorial format for service users to sign should be provided with their care manager or placement organiser signing the more complex legal contract. There have been no new admissions to the home for approximately three years. The manager showed the inspector the home’s admission policy and procedure. Discussions with the manager indicated that he was clear about the home’s categories and conditions of registration and the level of need the home could provide a service for. The manager was clear that any prospective service users would be fully assessed prior to admission, would be provided with opportunities for a number of visits to the home and that the views of the existing service users would be fully taken into consideration before a new person was admitted to the home. During the inspection there was a discussion between the manager and the inspector about the number of people the home is registered to accommodate. The home is registered to accommodate up to ten people. This would require three bedrooms to be shared by two people. At the time of the inspection only Starboard House DS0000042317.V289166.R01.S.doc Version 5.1 Page 11 one bedroom was being used for shared occupation. The manager plans to discuss with the providers, the Regard Partnership, a reduction in the number of registered beds. Starboard House DS0000042317.V289166.R01.S.doc Version 5.1 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. All service users have individual care plans, the home continues to work on developing a person centred approach to care planning. A record of a meeting between the key worker and service user to discuss their care plan should be documented each month. Service users’ health care needs would appear to be appropriately monitored and met. Medication is appropriately managed within the home. Service users feel they are treated with respect and their right to privacy is upheld. EVIDENCE: The home is in the process of adopting a person centred approach to identifying individual service users’ needs, wishes and desires. This work has Starboard House DS0000042317.V289166.R01.S.doc Version 5.1 Page 13 been undertaken in conjunction with the person centred plan co-ordinator for Southampton who has provided guidance and advice. The home has almost completed the first person centred plan and following completion will commence working on the person centred plans for other people living at the home. The Commission for Social Care Inspection recognises that this is a big piece of work if done correctly, therefore progress will be reviewed during the next visit to the home. Four of the care plans for people living in the home were viewed. These were seen to contain all the required information including a service user profile, missing persons profile, photograph, likes and dislikes, strengths and needs, action plan, evaluation, short term health care needs, health care check list and record of health appointments. Care plans were noted to be reviewed every six months. This is the required timescale for homes being assessed under the younger adults standards. The home predominately provides a service to people over the age of sixty-five and as such has been assessed under the older persons standards. The inspector feels that a full review of care plans every six months is appropriate however the home should consider how the new person centered plans could be reviewed between the service user and their key worker every month. This need not result in re-writing of the plans but a record of a meeting between the key worker and service user to discuss the plan should be documented. The home records daily the support service users have received and any activities they have taken part in. Following the previous inspection the home was required to identify in greater detail how individual care needs are to be met. This was discussed with the manager and deputy manager whilst viewing the care plans and daily records. The individual strength and needs state what service users are able to do and what they need help to accomplish. The inspector was shown the care/risk assessments for two service users who are unable to use the upstairs bathrooms and must use the shower room in the bungalow in the garden to maintain their person care needs. These detailed the level of support they require to ensure this activity is conducted in safety. Discussions with staff and service users indicated that individual health care needs are understood and met at the home. As stated above, care plans contained a record of health care appointments and outcomes of visits. This was required following the previous inspection. At the time of the inspection a chiropodist was visiting the home. The chiropodist was undertaking foot care for some of the women who live at the home in the home’s lounge. When asked the service users stated they were happy for the chiropodist to see them in the lounge. Other service users were seen by the chiropodist in their bedrooms as they preferred. Care plans were also seen to identify short term health care needs and a health care check list. The service users currently living within the home are all older people with learning disabilities. They are experiencing a number of health needs related to age and increasing mobility needs. The home is not appropriate for people with significant mobility needs. Starboard House DS0000042317.V289166.R01.S.doc Version 5.1 Page 14 The two bathrooms are both upstairs and although one is equipped with a bath hoist this is not accessible to people who are unable to safely manage the home’s stairs. The manager explained to the inspector the problems he is experiencing in accessing social services care managers to re-assess one service user whose personal care needs the home is now unable to fully meet due to physical deterioration of the service user. The inspector was shown a copy of the letter sent to the Southampton social services requesting a reassessment of the lady for consideration of a placement review. The inspector agrees with the manager that the home is no longer able to meet this person’s care needs due to increasing mobility needs. The home is trying to access the necessary support for this service user to ensure that a move to a more appropriate residential placement may be accessed as part of a planned programme. The inspector acknowledges that the home is working to ensure a smooth transition for this person and therefore no requirements are made in respect of the home not being able to meet the needs of a person living at the home. The home must ensure the Commission is kept informed of activity to identify a more appropriate placement for this service user. The inspector will notify the Commission’s Business Relationship Manager of the problems the home has experienced in accessing social work support and care managers for the people living at Starboard House. Information detailing the GPs and district nurses who provide a service to the home was not available prior to the inspection. This information is now available on file and prior to the next inspection their opinions will be sought as to how the home supports the health care needs of service users. During the inspection staff were observed to respect service users’ rights to make decisions within the limitations of their abilities. Staff were noted to ask service users questions and give appropriate time for them to respond in either verbal or non-verbal communication. Care staff were seen to seek service users’ permission before entering their bedrooms. Throughout the inspection it was clear that service users have control over many aspects of their own lives and in the organisation and running of the home. There are regular service user meetings, the minutes of which were seen by the inspector and provided as part of the information requested by the inspector prior to the inspection. During these meetings service users are encouraged to discuss a variety of issues such as menus, holidays and changes to bedrooms. The minutes of the meeting held in January contained a request from one service user to move back to his previous bedroom. It was noted during the inspection that this wish had been complied with. It was also evident from these minutes that service users had been fully involved in the decision about where the home took their recent holiday. Service user meetings also allow the manager to keep service users up to date with anything that is to happen within the home. The home is small and therefore service users have much control over the day-to-day decisions made within the Starboard House DS0000042317.V289166.R01.S.doc Version 5.1 Page 15 home. Service users are encouraged to participate in a variety of domestic activities within their rooms and the home, helping with shopping, gardening, meal preparation and cleaning as they wish. Service users spoken with during the inspection confirmed that their views and opinions are sought and that they felt able to express their opinions to the care staff and manager. Following the previous inspection there was a requirement that manager must implement a recording procedure for making routine checks on the administration and recording procedures for medication. This was seen within the folder containing the MAR sheets. The arrangements for the storage, booking in, administration and disposal of medication within the home were viewed and discussed and were found to be appropriate. The manager provided the inspector with a copy of the home’s training matrix for 2005. This indicated that staff received medications training via the in house trainer for the regard partnership. Staff have also received training from the Lloyds pharmacist who provides the medication to the home. Care staff spoken with confirmed that they had received medication training. The inspector did not observe the home administering medication, the procedure was discussed with the manager and deputy manager. The procedure described would appear appropriate. The deputy manager discussed some concerns presented by one service user during the administration of medications in that he finds waiting his turn difficult and can be distracting to the person administering the medication. The inspector advised that in order to ensure safe administration this person should receive his medication first and that the issue of developing his ability to wait and take his turn could more safely be tackled during other activities, however all staff will need to behave in the same way or his behaviour at medication time could become worse. The important thing is to ensure all service users get the correct medication and staff are at risk of maladministration or poor recording if they are being distracted. Starboard House DS0000042317.V289166.R01.S.doc Version 5.1 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. Service users enjoy a varied lifestyle with lots of opportunities for community and leisure activities. The home supports and maintains links with family members. Service users are involved in planning a varied nutritious diet. EVIDENCE: Care staff, service users and care records confirmed that service users often enjoy ad hoc community activities as the weather permits. Service users stated they enjoy going out for meals, shopping, church, social clubs, for drives or to pubs for drinks. Each service user has an individual weekly programme of activities that includes a range of day services and leisure activities, intended to help develop and maintain life skills and provides opportunities for socialisation away from the home. Care plans and daily records contained records of individual weekly routines and ad hoc social outings and activities organised by care staff. Service users are encouraged to participate in domestic activities as their cognitive and physical abilities allow. The home has a house car. At the time of the inspection service users were not being charged for using the house car. There was a discussion with the manager and deputy manager as the home will soon have to start charging service users for petrol Starboard House DS0000042317.V289166.R01.S.doc Version 5.1 Page 17 costs. The manager is to devise a fair system whereby service users will pay a percentage of the petrol costs dependant on the amount they have used the car. This will need to be reflected in the service users’ guide. The home needs to start charging service users due to the rising fuel costs and also because transport to day services will soon be stopped by social services. Service users attend day centres for part of the week. Staffing levels within the home are sufficient to enable service users to enjoy community activities during evenings or weekends. Care staff were observed interacting appropriately with service users during the inspection. During a tour of the home the lounge and a number of service users’ bedrooms were seen to contain appropriate home entertainment options including televisions and music centres. Service users spoken with confirmed that they enjoyed a range of appropriate leisure activities. All service users have recently enjoyed a week’s holiday to the Isle of Wight. Service users and meeting minutes confirmed that they are involved in the decisions as to holiday locations. Service users talked to the inspector about their recent holiday and had clearly really enjoyed themselves. The manager stated that service users had paid for the holiday themselves and financial records seen would confirm this. The holiday had been self-catering with the home paying for food whilst on holiday. Service users informed the inspector that they are able to have visitors at the home. Individual care plans reflected service user likes and dislikes in respect of activities and daily routine, with the home’s routines being flexible to meet individual needs. Choices are only limited on safety grounds and are covered by appropriate risk assessments. Staff were noted to knock on service user doors before entering with some service users having the keys to the locks on their bedroom doors. Service users stated that they are given their private mail to open and care staff then support service users in reading, understanding and responding to mail appropriately. During the unannounced inspection service users were seen interacting positively with care staff and service users were seen moving about the home as they wished. The home has a no smoking policy. One service user smokes and he has been provided with a shelter in the garden to protect him from extremes in the weather. Service users spoken with during the inspection said that they liked the food available at the home and that plenty of choice was available. Each week a different service user chooses the menu for the week with guidance from care staff. Service users had full access to fresh fruit and snacks and confirmed they were able to make themselves drinks, or request help to do so, whenever they wished. When service users attend day services they take a packed lunch and Starboard House DS0000042317.V289166.R01.S.doc Version 5.1 Page 18 have a main meal in the evening. Most meals are taken in the dining room which is bright and large enough for all service users and staff to sit together to eat, although service users could have their meals elsewhere if they wished. Starboard House DS0000042317.V289166.R01.S.doc Version 5.1 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. Service users are able to complain should they be unhappy with the service provided at the home. Service users feel safe at the home. Staff have received adult protection training, however staff were unclear as to the actions they should take should a service user report an incident of abuse. Reference request forms must include a date to confirm that references have been requested and received prior to commencement of employment. EVIDENCE: Comment cards received from service users prior to the inspection stated that they felt safe and well cared for at the home. They indicated that they knew who to talk to if they were unhappy about something, many naming their key worker. The home has a complaints procedure that was seen on the wall in the hallway of the home. Also noted in the hall was a complaints/suggestions box on which service users, visitors or staff could place complaints or suggestions anonymously if they wished to do so. Service users stated during the inspection that they would tell the staff or the manager if they had any concerns or complaints about the service provided at Starboard House. During the inspection staff were seen asking service users’ views and opinions about a variety of day-to-day events, with service users clearly confident to give an Starboard House DS0000042317.V289166.R01.S.doc Version 5.1 Page 20 honest answer to the staff or manager. Most of the service users attend day services for one or more days per week and would also be able to complain via their day services if they wished to do so. A representative of the provider visits the home every month to undertake the Regulation 26 visits. Reports of these visits indicate that service users’ views of the service are sought. The home holds monthly residents’ meetings, the minutes of which were seen during the inspection and supplied to the inspector as part of the information requested. These indicated that service users are offered opportunities during these meetings to say if they have any complaints. The minutes seen indicate that service users are confident to give their opinions during these meetings. The manager stated that the home has received no complaints in the year preceding the unannounced inspection. It is the inspector’s opinion that service users would complain if they wished to do so and that their complaint would be taken seriously and action taken to resolve the issue. Training records indicated that all care staff had received adult protection training in March 2006, approximately two months before the unannounced inspection. The training was provided by the Regard Partnership in house trainer. The inspector spoke about adult protection with one member of care staff. Although the carer was clear about what might indicate that a service user has been the victim of abuse she was less clear about the actions she should take if a service user reported an incident of abuse. The couse of action suggested by the carer might compromise any future investigation as it involved contacting the alleged abuser. The manager must provide additional training and guidelines for care staff about the correct action they should take if they suspect or have an allegation of abuse made to them. The home’ s recruitment procedures should ensure that unsuitable people do not work at the home. Staff files contained all the required pre-employment checks and the manager was clear about the recruitment procedure he must use. The inspector noted that the Regard Partnership provides potential referees with a form to complete. The form covers all the appropriate areas but does not contain a request for the respondent to date when they are supplying the reference. Therefore the manager could not demonstrate that the reference had been sought and received prior to the staff member commencing employment. The manager must bring this to the attention of the Regard Partnership personnel department and a date must be added under the signature of the person supplying the reference. The inspector discussed the support the home provides to service users in respect of their personal finances. The deputy manager is primarily responsible for this. Discussions with the deputy manager indicate that the procedures should ensure that service users receive all the interest due on their own money. Benefits are initially paid into a Regard Partnership account; at the start of each month the deputy manager withdraws the personal allowance for the service users for the whole of the month to come. This is then paid into the service user personal account where individual interest is accrued. Cash is Starboard House DS0000042317.V289166.R01.S.doc Version 5.1 Page 21 withdrawn with or on behalf of the service user as they require it and a small float held in individual tins in a locked facility in the home. Access is restricted to the manager and deputy. If money is required at other times the home’s petty cash is used and then reimbursed by the deputy. Full individual records are held and were seen, indicating that money is appropriately spent on behalf of the individual service users. Service users confirmed that they are involved in discussions about how they spend their money. Due to rising petrol costs the home will soon have to start charging service users for their share of petrol used in the house car. The manager is to forward a copy of the procedure to the Commission and will amend the service users’ guide to reflect that the service users will now be charged for the petrol they use in the house car. Starboard House DS0000042317.V289166.R01.S.doc Version 5.1 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, and 26. Quality in this outcome area is poor. This judgement has been made using the available evidence including a visit to this service. The home is in need of modernisation and redecorating throughout, the home has commenced this programme but much work remains. Bathrooms and WCs present a fire and infection risk. Towel rails over radiators must be immediately removed and paper towels and dispensers must be provided in all bathrooms and WCs. The WC without a washbasin must be provided with facilities to enable service users to clean their hands after using the toilet. Disposable gloves must be available in the laundry. Floor coverings in bathrooms and WCS must be replaced with non-slip flooring that is sealed around the edges such that water or contaminates cannot seep into the floor boards. The providers must consider how bathroom facilities may be provided on the ground floor. Starboard House DS0000042317.V289166.R01.S.doc Version 5.1 Page 23 EVIDENCE: Starboard House is an older property and provides a homely, domestic style home for the service users. The house is old and tired in many places especially the bathrooms, WCs and kitchen. Many of the bedrooms are also in need of redecoration and updating. Service users stated they like the home and that is was comfortable and clean. At the time of the unannounced inspection a decorator was repainting the hall, the manager stating that the plan was to repaint the hall, stairs and landing. The colour chosen was light and should create a pleasant bright feeling to these areas. A new carpet has already been laid. Whilst the service users were on a recent holiday the home’s lounge was redecorated. Service users stated they liked the new colours and informed the inspector that new curtains had been ordered and would be put up once the final parts of redecoration had been completed. The rest of the home remains in a poor state of redecoration and is in urgent need of attention. The manager showed the inspector the quotes for the refurbishment of the kitchen, which had been provided by a local company. These appeared very reasonable considering the size of the kitchen and included providing hand washing facilities as people enter the kitchen which would be required by environmental health under infection control. No start date for the replacement of the kitchen had been identified at the time of the unannounced inspection, although the manager hoped this would occur before the end of the summer. Following the previous inspection in October 2005 the home was required to refurbish the kitchen. The manager must inform the Commission when a date for the kitchen to be replaced is confirmed. The inspector felt the home’s bathrooms and WCS were of a poor standard. The home has two bathrooms, both located on the first floor of the home, one with a bath hoist, however three service users are now unable to use the stairs. Two service users use a shower in a bungalow located in the grounds and require the support of two staff to do so safely. Access to the shower is via the bed/sitting room used by the more independent service user who lives in the bungalow. The remaining service user unable to manage the stairs is currently unable to bath or shower. The home is seeking social services support to identify a more appropriate residential option for this person. Both the first floor bathrooms are equipped with a bath, WC and washbasin. One was noted not to have any towels, paper or otherwise, which people could dry their hands after washing them following use of the WC. The other bathroom contained a shelf on which a variety of toiletries, toothbrushes had been left. There was no indication who these belonged to. Toothbrushes should not be left lying on shelves and present an infection risk if another person uses them. The floor coverings in both bathrooms were not non-slip and were noted to be lifting round the edges of the bath and walls. Floor coverings in bathrooms and Starboard House DS0000042317.V289166.R01.S.doc Version 5.1 Page 24 WCs should be non-slip and sealed to prevent water or contaminants passing into the floor boards. Damp floorboards under lino in bathrooms present an infection risk and over time may rot the wood affecting the safety of those using the bathroom and rooms below. Also noted in bathrooms were fabric bath mats that are not removed and washed after use, again these present an infection risk and slip risk. Minutes of a residents’ meeting included a concern raised by a service user that the bathroom floor was often wet when she went into the bathroom. Bathrooms and WCs had radiators that had been covered. One cover identified to the manager was now very rusty with sharp edges. This must be replaced. Immediately above the radiators were towel rails. It is not appropriate to place items over heat sources and may present a fire risk. Towel rails over radiators must be removed to alternative locations immediately. There is no need for towel rails in WCs as paper towels and dispensers must be provided, not fabric towels. The upstairs WC was noted not to have a washbasin. Service users must be provided with facilities to wash their hands following use of the WC. The ground floor bathroom was seen not to have a toilet roll holder, with toilet tissue balanced on the hand rail, and also no mirror. The people living within the home are ageing and experiencing increasing health and mobility problems as a result. The home has provided a bath hoist in one upstairs bathroom however three service users are no longer able to manage the stairs. The home has a bungalow in the grounds where one more independent service user lives. This is equipped with a bed sitting room, kitchenette and shower room. The home has a small WC on the ground floor of the main house. This is inadequate in size to enable staff to support service users who may require assistance with using the toilet or changing continence pads. The home must consider how a ground floor bath/shower room and improved facilities for less mobile people may be provided. A possible option may be a small extension to the side of the home through the existing ground floor WC providing a walk in shower, WC and washbasin. The manager and providers must provide an action plan in respect of providing a ground floor bathroom. The home is registered to provide accommodation for up to ten people. At the time of the unannounced inspection seven people were living at the home. They were accommodated in five single and one shared bedroom. The service users who share a bedroom confirmed to the inspector that they were happy with this arrangement and got on well with the person they share with. Many of the service users were happy to show the inspector their bedroom. These were seen to be individually personalised by their occupants. Most of the rooms seen require redecoration. One bedroom was seen to have a large crack extending across and down a wall. The cause of this must be identified and rectified prior to the room being redecorated. The manager and key workers are replacing some of the older furniture in the bedrooms. One lady currently lives in a self-contained bungalow in the garden although she spends all her Starboard House DS0000042317.V289166.R01.S.doc Version 5.1 Page 25 time in the home, even using the bathroom on the first floor in preference to the shower in her bungalow. Residents’ meeting minutes indicated that she is considering moving from the bungalow to a vacant room in the main house. The inspector saw a letter inviting her relative to a meeting at the home to help her decide if she should move into the main house. Risk assessments were in place with her leaving the house at night to go to the bungalow and garden lights and call system are in place. Service users all stated they liked their bedrooms that are equipped with washbasins. As previously stated the rooms are not numbered or identifiable. The manager is to produce a plan identifying rooms so that these identifiers can be included on the contracts. It is not considered necessary to put room identifiers on bedroom doors as this might provide an institutional feeling in an otherwise homely environment. Overall the home was found to be clean, tidy and free from offensive odours at the time of the unannounced inspection. Care staff have undertaken training in infection control as required following the previous inspection. The home has replaced the domestic washing machine with an industrial grade machine capable of washing to the necessary temperatures to eliminate the risk of cross infection. Plastic disposable gloves must be available in the laundry at all times and were not present when the laundry was viewed as part of the inspection. The inspector has already raised a number of concerns about the control of infection in the WCs and bathrooms and requirements have been made in connection with these concerns. Starboard House DS0000042317.V289166.R01.S.doc Version 5.1 Page 26 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. The home provides appropriate numbers of staff to meet service users’ health, social and leisure needs. Care staff are appropriately trained with above 50 having at least NVQ level 2 in care. Written records of staff supervision must be maintained and available for inspection. The recruitment reference request forms must specify the date they were completed and adult protection must be included during induction. The home should consider adding photographs to the board detailing which staff are on duty each day. EVIDENCE: Duty rotas were seen during the inspection and copies of March rotas were provided with information requested prior to the inspection. Service users, staff and the manager confirmed the staffing levels were as per the rotas. The home provided two staff throughout the day and one awake and one sleep-in staff at night. In addition to care staff on duty the manager works five days per week, sometimes included in the two staff (as on the day of the inspection) and sometimes extra to the two staff on duty. Considering that the home has seven service users, most fairly independent, the staffing levels would appear to be appropriate. Service users, staff and records of care indicate that these staffing levels enable service users to attend health appointments and have an Starboard House DS0000042317.V289166.R01.S.doc Version 5.1 Page 27 active leisure and social life either individually or in small groups. Service users attend a variety of external day services most days each week reducing the number of people at home providing more opportunities for one to one time for service users. Care staff also undertake all domestic tasks in the home, involving where possible service users. During the inspection the manager discussed the night staffing arrangements. At present one awake and one sleep-in staff are provided in the home. The manager is considering reviewing this to provide one awake and an on call (but not in the home) staff member with the manager or deputy continuing to provide management advice by telephone when neither is in the home. Few of the service users require support at night and none would ordinarily require the assistance of more than one person. The manager is to discuss his plans with the providers and submit his plans for changing the night staffing arrangements to the Commission. On the evidence seen during this inspection one awake staff member in the home with an on call available would appear to be appropriate. The home informs service users who is on duty via a white board on the hall wall. Names of staff are written on for the day/night. Consideration should be given to the addition of photographs that may be attached under the names to inform service users who have poor literacy skills which staff they may expect on duty. The manager informed the inspector that, including bank staff, the home employs fifteen care staff. Of these ten have at least NVQ level 2. This equates to 60 . The manager and care staff confirmed that three more staff are currently undertaking NVQ level 3, these staff have progressed straight to level 3 as it was not considered necessary for them to do level 2 before undertaking level 3. The manager has worked hard to ensure that all the staff files contain all Schedule 2 information as evidence of a thorough recruitment process. This was required following the previous inspection when a number of gaps in information were identified. All files randomly selected and those of new employees contained all the required information. The inspector was concerned that the reference form supplied by the Regard Partnership does not contain a request for a date on which the reference has been provided. Therefore the inspector could not confirm if references had been requested or received prior to a new employee commencing work at the home. The form must be amended to ensure that it is dated by the person providing the reference. The manager has also undertaken a review of the induction process and records. Where these were missing or incomplete he has repeated the induction process and evidence was now available in the staff files to confirm that all staff have received an appropriate induction. Staff induction is recorded in an induction booklet and involves information provided by the manager and Starboard House DS0000042317.V289166.R01.S.doc Version 5.1 Page 28 viewing a number of videos. The manager listed the videos which all appear relevant however it should be noted that adult protection was not included. The inspector is aware that there are a number of good videos about adult protection in a residential setting and this should be included in the induction undertaken by care staff. The manager supplied a copy of training undertaken by staff in 2005 with preinspection information. During the inspection a list of planned training was seen which indicated that care staff had received update training in April 2006 on health and safety, first aid and fire awareness. Care staff confirmed they had received training as specified in April and that lots of training is provided by the home. Training is provided by the Regard Partnership in house training. The manager confirmed that he can request training specific to individual needs of the service users from the in house trainer. Starboard House DS0000042317.V289166.R01.S.doc Version 5.1 Page 29 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38. Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. The home now has a registered manager who is working hard to improve the service and facilities provided at the home. Service users’ views are fully taken into consideration. The manager and the providers undertake quality audits of the service provided at the home. The arrangements for service users’ personal finances are appropriate. The manager must ensure written records of all supervision are maintained and available for inspection. Records were generally found to be well completed and appropriately stored with the exception of supervision records and the absence of a date on the reference request form for new employees. The home generally provides a safe place for service users, staff and visitors with the exception of the concerns raised within this report about the infection risks posed by the home’s WCs and bathrooms. Starboard House DS0000042317.V289166.R01.S.doc Version 5.1 Page 30 EVIDENCE: The manager was required to apply to the Commission for registration following the previous inspection. This he has done and was registered in April 2006 shortly before the inspection. Throughout the inspection the manager demonstrated a clear knowledge of his role and the challenges the service is facing as the people living at the home age. The manager was aware of how to access the necessary support for the people who live at the home. The manager confirmed that since his appointment he has been requested by the Regard Partnership to undertake investigations and specialist work in other homes owned by the organisation that has taken him away from his duties at Starboard House. This had been suspected by the Commission. The manager stated that the providers have now employed someone to fulfil this role and he did not expect that he would be asked to undertake similar activities in the future. It is important that the manager spends sufficient time within the home to address the number of requirements made following this inspection and to manage the home. The manager confirmed that he has now completed his Registered Manager’s Award that is now with external verifiers. The hours the manager works are detailed on the duty rotas and indicated that he works five days per week and undertakes four sleep in duties per week. The manager confirmed he works some weekends and has contact with all service users. Service users and staff stated that they could approach the manager about any concerns and felt he would sort issues out. The manager is support by an experienced deputy manager and a consistent staff team. The manager showed the inspector the quality assurance form he has used to seek the views of the people living at the home and their relatives or visitors. The manager has yet to formally review the completed forms and stated that he would supply the Commission with a copy of the audit once this has been completed. The manager also supplied a copy of the quality assurance undertaken by the Regard Partnership into all their services. The manager informed the inspector that the home has had a health and safety audit undertaken by a representative of the providers. This had raised several concerns including the location of the office (in the basement with a low ceiling and steep stairs). Service users’ views are formally sought on a monthly basis during residents’ meetings and staff views on the service are sought monthly during staff meetings. Evidence seen and interactions observed throughout the inspection would indicate that service users’ views are very much taken into account when decisions are made in the home. Starboard House DS0000042317.V289166.R01.S.doc Version 5.1 Page 31 The arrangements for service users’ personal finances were discussed and records viewed. The deputy manager is primarily responsible for this. Discussions with the deputy manager indicate that the procedures should ensure that service users receive all the interest due on their own money. Benefits are initially paid into a Regard Partnership account; at the start of each month the deputy manager withdraws the personal allowance for the service users for the whole of the month to come. This is then paid into the service user personal account where individual interest is accrued. Cash is withdrawn with or on behalf of the service user as required and a small float held in individual tins in a locked facility in the home. Access is restricted to the manager and deputy. If money is required at other times the home’s petty cash is used and then reimbursed by the deputy. Full individual records are held and were seen, indicating that money is appropriately spent on behalf of the individual service users. Service users confirmed that they are involved in discussions about how they spend their money. Due to rising petrol costs the home will soon have to start charging service users for their share of petrol used in the house car. The manager is to forward a copy of the procedure to the Commission and will amend the service users’ guide to reflect that the service users will now be charged for the petrol they use in the house car. Staff supervision is divided between the manager and the deputy manager. Staff confirmed that they receive supervision however the supervision records for a number of staff viewed were not complete and did not confirm that staff receive supervision approximately every two months. The manager must ensure written records of all supervision are maintained and available for inspection. Throughout the unannounced inspection a variety of records was viewed. These were generally found to be well completed and appropriately stored with the exception of supervision records and the absence of a date on the reference request form for new employees. The home generally provides a safe place for service users, staff and visitors with the exception of the concerns raised within this report about the infection risks posed by the home’s WCs and bathrooms. Service records for the home’s utilities (gas and electric) were supplied as part of the pre-inspection information requested. Starboard House DS0000042317.V289166.R01.S.doc Version 5.1 Page 32 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 1 1 3 2 X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 2 2 Starboard House DS0000042317.V289166.R01.S.doc Version 5.1 Page 33 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 5 (1) Requirement The home must produce a service users’ guide in a format suitable for the people who do or may live at the home. A copy must be provided to each service user and the Commission. This was required following the previous inspection. Further failure to comply may result in enforcement action. The manager must produce a plan identifying the home’s bedrooms. The bedroom occupied by each service user must be identified on their contract/terms and conditions of residency. A copy of the identification plan must be provided to the inspector. It was required at the previous inspection that the room to be occupied by each service user was stated on the contract. Further failure to comply may result on enforcement action. A basic terms and conditions document in a format suitable for the service users should be produced and signed by service DS0000042317.V289166.R01.S.doc Timescale for action 01/07/06 2. OP2 21 01/07/06 3. OP2 21 01/07/06 Starboard House Version 5.1 Page 34 4. OP18 13(6) 5. OP18 13(6) 6. OP18 13(6) 7. OP19 23(2)(b) 8. OP21 23 (2)(b) 23 (2)(d) 23 (2)(j) users. The care manager or placement organiser should sign the typed legal contract. Also Standard 38 The manager must ensure all care staff are aware of the correct action they must take should they suspect abuse may have occurred to a service user. Also standard 30 and 38 The manager must ensure that adult protection is included in the induction work undertaken by new employees. A suitable video should be purchased. Also standard 37 and 38 The reference request form must be amended to ensure the person providing the reference dates the form to confirm that the reference has been received prior to the new employee commencing work at the home. Also standard 38 The kitchen must be refurbished. The manager must inform the Commission when this will be done. This was required following the previous inspection. Further failure to comply may result in enforcement action. Also standard 26 and 38 All bathrooms and WCs must be upgraded, with new non-slip sealed floor coverings, redecoration, towel rails over radiators removed, paper towels and dispensers provided, fabric bath mats not used for more than one person, the rusty radiator cover removed, toiletries not left on shelves for anyone to use. Toilet roll holder and mirror must be provided in the ground floor WC. Wash basin must be provided in the WC without a wash basin. DS0000042317.V289166.R01.S.doc 01/06/06 01/08/06 01/06/06 01/07/06 01/07/06 Starboard House Version 5.1 Page 35 9. OP21 23(2)(j) 10. OP24 23(2)(b) 23(2)(d) 11. 12. OP26 OP36 13(3) 18(2) Also standards 26 and 38 The manager must consider how ground floor bathroom facilities may be provided for service users unable to use the stairs. An action plan must be submitted to the Commission. RE Regulations: 23(2)(b) 23(2)(d) Bedrooms identified to the manager must be redecorated and re-carpeted. The crack in the upstairs bedroom must be investigated and repaired. Disposable plastic gloves must be available in the laundry at all times. Also standard 37 All care staff must receive supervision at least two monthly with written records available for inspection. 01/07/06 01/09/06 01/06/06 01/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP27 Good Practice Recommendations A record of a meeting between the key worker and service user to discuss their care plan should be documented each month. Photos of staff on duty could be added to their names listed on the white board in the hall of staff due on duty each day. Starboard House DS0000042317.V289166.R01.S.doc Version 5.1 Page 36 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Starboard House DS0000042317.V289166.R01.S.doc Version 5.1 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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