Inspection on 17/05/05 for Starboard House

This inspection was carried out on 17th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 11/05/06

Starboard House 26/10/05

Starboard House 23/09/04

Starboard House 13/07/04

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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 SO19 9DN Lead Inspector Christine Hemmens Unannounced 17 & 18 May 2005 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 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 H55-H03 S42317 Starboard House V218914 170505.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Starboard House Address 105 Obelisk Road, Woolston, Southampton, SO19 9DN Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Care Home 10 The regard Partnership Limited 023 8043 4317 Category(ies) of LD - 10 registration, with number LD(E) - 10 of places Starboard House H55-H03 S42317 Starboard House V218914 170505.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Service users in the category LD must be at least 45 years of age. Date of last inspection 23/09/04 Brief Description of the Service: 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. Starboard House is a unique detached home built over several floors including a basement and has a separate self-contained bungalow within the grounds of the home. The garden is small for the size of the home, however it allows areas to relax in, undertake hobbies and interests such as gardening and provides shaded areas. 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. Since the end of May 2003 The Regard Partnership an expanding provider of learning disability services has owned the home. Starboard House H55-H03 S42317 Starboard House V218914 170505.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first unannounced inspection of Starboard House this year and was held over two days. The newly appointed manager, a senior support worker, three residents and three staff assisted the inspector with the inspection. At the previous announced visit held September 23rd and 24th 2004 the home was issued with forty-seven requirements four of which had to be dealt with immediately and three requirements had been repeated. Progress has been made to meet the forty-seven requirements, however sixteen remain outstanding and one is with the Commission for Social Care Inspection Providers Relationships Manager to coordinate at a national level. Since September 2004 the home has gone through some major disruptions and changes. The previous manager and deputy manager were dismissed, an investigation into an allegation of abuse was undertaken and a subsequent allegation of abuse is still under investigation. A new manager and deputy manager have recently been appointed and with the assistance of the senior support worker are working towards meeting the previously made requirements. The manager is in the process of making application to register. What the service does well: What has improved since the last inspection? The homes cleanliness and sense of order has improved. The newly appointed manager and staff provide a calmer, relaxed environment for the residents to live and staff appear clear of their roles and responsibilities. Some of the residents stated they liked the new manager and said they enjoyed the peace Starboard House H55-H03 S42317 Starboard House V218914 170505.doc Version 1.30 Page 6 and quiet. The home has improved its weekly menu with input from the residents, which provides a well-balanced diet. What they could do better: 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 H55-H03 S42317 Starboard House V218914 170505.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection Starboard House H55-H03 S42317 Starboard House V218914 170505.doc Version 1.30 Page 8 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 standard(s) 1,2.3.4 and 5. The organisation has not provided the residents with an accessible and updated statement of purpose and service user guide and has failed to provide each resident with a contract of their terms and conditions of residency, therefore the residents are not aware of who is responsible for supporting them, their rights and the value of the fee they pay. The home must also ensure prospective residents are appropriately assessed and supported to move into the home, and the home must provide sufficient numbers of skilled and competent staff to meet their needs. EVIDENCE: The requirement issued at the previous inspection to ensure all residents are issued with a contract of their terms and conditions of residency, and ensure they are supported by an advocate, a family representative or their placing authority to understand and sign the contract has not been met. Therefore the residents at Starboard House are not aware of their rights of residency or the fee they pay to live there. A further failure to comply with the requirement may result in further enforcement action being taken. The home’s statement of purpose and service user guide has not been adapted and updated as required Starboard House H55-H03 S42317 Starboard House V218914 170505.doc Version 1.30 Page 9 at the previous visit, therefore the requirement will be carried over and a further failure to comply may result in further legal action being taken. At the previous visit the inspectors established that a new resident had moved in without the appropriate assessments and processes taking place. The visit identified that the home had not taken the appropriate steps to support the new resident, provide sufficient and competent staff to meet the resident’s needs and did not seek the views of other residents who live in the home. The failures to follow the correct processes led to the breakdown of the resident’s placement and placed both residents and staff at risk. The newly appointed manager was advised to ensure that all perspective residents are correctly assessed and the home ensures that the residents needs can be efficiently and effectively met. The manager informed the inspector that he felt under pressure from senior management to fill the homes vacancy and avoid a further overspend by reducing staff hours. The manager stated he felt this undue pressure to fill the homes vacancy. The pressure placed on the manager to fill the vacancy does not demonstrate that the organisation values and respects the needs of the residents and the importance of ensuring residents are assessed and placed appropriately with sufficient confident and skilled staff. Starboard House H55-H03 S42317 Starboard House V218914 170505.doc Version 1.30 Page 10 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 standard(s) 7,8,9 and 10 The home provides each resident with a personal file, ensures residents medical needs are met and residents are supported with their medication, however the home must ensure the residents records provide specific detail, record outcomes of medical interventions, changes to medication and residents records are kept separately. EVIDENCE: The inspector was assisted by a senior member of staff, who demonstrated that the home has taken steps to re organise and produce the resident’s personal plans in a tidier format and provide better detail to assist staff to appropriately support the residents. The personal plans provide important contact details and care plans that provides information on the residents needs, however the plans require further development as they do not identify the residents strengths, or provide specific detail on “how” the resident’s health, welfare and identified risks must be met. In order to ensure the residents are provided with a continuity of care and support, the home must develop the care plans and risk assessments further to clearly identify how the support is to be carried out. At the previous visit the inspectors found that residents information was mixed with other residents and staff were writing inappropriately in residents notes. The inspector found on this occasion that day-to-day notes on residents’ remain held together in one file and some Starboard House H55-H03 S42317 Starboard House V218914 170505.doc Version 1.30 Page 11 written information about the residents was inappropriate. This demonstrates that the home does not respect the resident’s confidentiality or respect how they may feel if they were to read inappropriate information about them. Therefore the requirements made at the previous visit have not been fully met and will be carried over and monitored at the next visit. The manager is advised that a further failure to comply will result in further action being taken. There is evidence that the home meets the residents’ health care needs very well, the senior gave examples of the health care professionals currently involved with the residents and the positive support they receive from them. There was evidence in residents’ plans that visits had taken place with GP’s psychologists, and specialist health care teams such as community nurses. At the time of the inspection a resident was being visited and assessed by a physiotherapist. The resident appeared aware of the reasons for the visit. Residents with whom the inspector spoke with said that staff were very supportive with assisting them to attend health care appointment and that they regularly receive chiropody, dental and ophthalmic treatment. The manager demonstrated a new form he has developed to record health care visits, in principle the form was very good, however the manager must ensure staff are recording the outcome of visits and any treatment required to ensure staff are following the required regime of care. The inspector found that there has been a great step forward in the processes used in the administration of medication and a new administration system has been implemented, some staff have received medication training and in addition the manager stated he assesses the staffs’ competency and regularly monitors the administration of the medication. This is seen as very good practice, however the manager must record that he is monitoring medication to ensure they are being given correctly, as required at the previous visit. The manager must also be able to demonstrate that the GP has authorised changes to the medications and the use of “as required “ (PRN) medications are supported by clear written care plans as required at the previous visit. A failure to seek written authorisation for changes to medication and not provide written plans for the use of “as required” medications could result in discrepancies in their administration and inappropriate use of medications, potentially resulting in serious harm to health and welfare of the resident. Therefore the requirements made at the previous visit will be repeated and a further failure to comply may result in further action being taken. The inspector met with a newly appointed member of staff who demonstrated a very good understanding of the importance of ensuring the residents are respected, provided with privacy and dignity and their confidentiality upheld. The residents with whom the inspector met with felt the staff and the new manager were very nice and treated them kindly. However as stated above, in order for the residents confidentiality be respected, any information held on them must be held separately. Starboard House H55-H03 S42317 Starboard House V218914 170505.doc Version 1.30 Page 12 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 standard(s) 12,13,14 and 15 The home has taken some steps to provide an environment where residents can exercise choice, individual and social preferences, maintain contact with family and friends and receive wholesome well balanced meals. However the home still falls short of using a person centred approach and empowering residents to exercise their rights and choice. EVIDENCE: The inspector met with three residents at the time of the visit, each gave examples of the hobbies and interests they had and the social activities they regularly engaged in. The residents were complimentary of the support provided by staff and the staff said they enjoyed supporting the residents in their hobbies and interests. One resident said she regularly visited family and friends and had recently been helped by staff to discourage an old acquaintance from bothering her. Residents were observed on the day of the visit making drinks and assisting staff to prepare the evening meal. One resident spoke about her responsibility to clean her room and sort her washing. A member of staff informed the inspector that she felt it was the staff’s responsibility to ensure that the residents are engaged in valued activities and their independence is developed and maintained. This demonstrates that staff are aware of the needs and abilities of the residents. The inspector sampled notes of a meeting held between a resident and Starboard House H55-H03 S42317 Starboard House V218914 170505.doc Version 1.30 Page 13 member of staff (keyworker meeting) the meeting reviewed the activities engaged in by the resident since the last meeting, the residents successes and achievements and if the resident’s needs had changed. In principle this is seen as a very good format for reviewing the residents’ health and welfare needs and meets the needs of the service but not necessarily those of the resident. At the previous visit the home was required to take a person centred approach to empowering the residents to make choices and manage their personal affairs, inpart this has been met by using this format and that the home demonstrates it supports residents to engage in valued activities of their choice, however the inspector noted that the meetings did not regularly take place and the information seen was the first meeting since December 2004. The senior was aware that reviews must take place more frequently. The residents informed the inspector that they take turns in assisting staff to plan the weekly menu and if they do not like what’s on the menu they can have an alternative choice. The menus appeared wholesome and well balanced. The residents informed the inspector that they are assisted by staff to make snacks and can help prepare the evening meal if they wish. The members of staff with whom the inspector spoke with were not aware of the concept of person centred planning, however they demonstrated through the course of the visit that they respected the residents. Although it is recognised that the home is supporting residents to be involved in making decisions and choices the home must skill staff in the knowledge and concept of person centred planning and the various approaches that can be used and in doing so empower the residents more, by making it real and tangible. In addition the home must ensure personal information is accessible, and the organisation must ensure those residents who can manage their financial affairs are placed in a position to do so. Starboard House H55-H03 S42317 Starboard House V218914 170505.doc Version 1.30 Page 14 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 standard(s) 16 and 18 The home has made little progress in providing information for residents on how to complain and protect residents from abuse. The failure to undertake specific required recruitment checks on staff will be evidenced in section 6: Staffing EVIDENCE: The inspector met with three residents who all stated they were very happy living at Starboard House and did not have any complaints, however not one of the residents could remember receiving any information on how to complain. However they did say they would tell someone they liked if they were unhappy. The residents were not aware that they could contact the Commission for Social Care Inspection if they did not feel their complaint had been dealt with. Staff with whom the inspector spoke with said they were aware that there was a complaints procedure and a book for reporting complaints but could not confirm if the residents had received any information on how to complain. The inspector did observe a large printed complaints procedure on the back of a residents door, however it referred to the previous manager and the senior member of staff could not confirm if it had any meaning for the resident. The home could not demonstrate that they have provided each resident with a complaints procedure that met the residents cognitive and communication ability. Therefore the requirement made at the previous visit to produce an accessible complaints procedure will be repeated. The home is in the process of providing training for staff in detecting and reporting abuse, making them aware of what constitutes abuse and how to Starboard House H55-H03 S42317 Starboard House V218914 170505.doc Version 1.30 Page 15 report concerns or allegations. The inspector spoke with two staff one who confirmed he had received in house training on abuse and physical interventions using the organisation’s policies and procedures, the other staff member had not yet received training despite being in post since January 2005. The member of staff who had not received training was able to inform the inspector what they would do if they witnessed or suspected abuse and showed very good values in the importance of protecting vulnerable people. A recent allegation of abuse demonstrated that the home took seriously the allegation and followed the correct procedures. However the requirement made at the previous visit to ensure all staff are trained in abuse awareness and physical interventions will be repeated as five months to train a new member of staff in these areas is an unacceptable timescale and places residents and staff at potential risk. The home was also required to obtain the local authorities policy on “Protecting Vulnerable Adults”, there was no evidence of the policy being obtained, and therefore the requirement will be repeated. Starboard House H55-H03 S42317 Starboard House V218914 170505.doc Version 1.30 Page 16 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 standard(s) 19, 21 The home has taken steps to improve the cleanliness, and safety of the physical environment. However not all requirements made at the previous visit have been met and therefore will be carried over. EVIDENCE: Starboard House is a unique interesting home with an additional one-bedroom bungalow shared by two residents set in its grounds. Starboard House provides a homely environment fitted and equipped with high quality furniture and furnishings. Since the previous visit the home has improved its level of cleanliness and has made space by de cluttering the home. The kitchen was especially cleaner and tidier and there was evidence that the toilets are cleaned regularly. The residents with whom the inspector met with stated they liked their home and found it comfortable, three residents proudly showed the inspector their rooms, which are equipped with personal furnishings and belongings, such as TV, stereos, evidence of hobbies and soft furnishings. Although residents appeared happy with their rooms there is evidence that some residents have frequently moved rooms to accommodate other residents physical and emotional needs, however there is no evidence to suggest that Starboard House H55-H03 S42317 Starboard House V218914 170505.doc Version 1.30 Page 17 the residents had been supported to make the decision or agreed to move. This further demonstrates that the residents live within a home that is service and organisation driven and not based on what the resident wants. Residents have a wash hand basin in their room. However some residents are restricted to wash as the taps to the basin were not working correctly and plugs were missing. One resident said she had only been able to get a cold wash in her room, but recently could not get a wash at all as member of staff had taken her plug to use in the bathroom and not returned it. The manager was advised that this practice was totally unacceptable and immediate steps must be taken to ensure all sinks are fitted with plugs unless the resident has been deemed at risk, (therefore risk assessments must be put in place) and action taken to rectify the poor water source to the basins. This problem was identified at the previous visit, therefore the requirement will be repeated and a further failure to comply will result in further action being taken. The requirement made at the previous visit to make safe the stairs has been met in terms of securing the handrail. The top staircase is very steep and not conducive to elderly residents where there is a potential risk of falling, it was agreed at previous visit that the organisation would look into reconfiguring the staircase. The inspector has since been made aware that changes to the upstairs environment may take place which will include some alteration to the stair case, this will be monitored through discussion with the homes area manager and future visits. The home has a small-enclosed garden with various areas for residents to sit. The requirements made at the previous inspection to make safe the garden shed and the uneven ground where the pond had been has been met, however the manager informed the inspector that a quote had been obtained to make further improvements to levelling the ground and landscaping the garden, therefore until such time the work takes place to the garden the residents are to be risked assessed accessing the garden. Starboard House H55-H03 S42317 Starboard House V218914 170505.doc Version 1.30 Page 18 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 The home has little improvement to provide a skill mix of staff and protect residents through their recruitment procedures. Some improvement has been made in training staff. EVIDENCE: There is evidence to suggest that the home has not taken into account the needs and gender of the residents when recruiting staff. The home has predominantly female residents living in the home, however the ratio of male staff to female staff is very high. The inspector was informed that the majority of the residents can manage their personal care with minimal support however through discussion it was established that a female resident with high needs was sent to day services without her personal care being appropriately tended to as only male staff were on duty. The area manager has recently recruited a manager and deputy manager, both of which are male, the deficit of female staff should have been taken into consideration at this time. The manager relies heavily on female part time staff and bank staff to cover the deficit, however a recent letter from a senior manager has indicated that the manager must reduce hours to cover the homes overspend, this will mean potentially cutting female bank staff hours. This is unacceptable practice and the manager and organisation must ensure the home is fully established with an equal staff gender and skills mix to meet the needs of the residents. Therefore the requirement issued at the previous inspection will be carried over and a further failure to comply will result in further action being taken. At the previous visit the inspectors established very poor practices in the homes recruitment procedures and two immediate requirements were made in Starboard House H55-H03 S42317 Starboard House V218914 170505.doc Version 1.30 Page 19 respect of this, the immediate requirements were later followed up and had not been complied with. At the time of this visit the inspector again thoroughly inspected the homes recruitment practices and staff records. Although there had been some improvements the inspector found serious flaws in the procedures, which has potentially placed residents at risk. The newly appointed manager and deputy manager did not have any information held on them in terms of references, Criminal Record Checks (CRB) and Protection Of Vulnerable Adult (POVA) check. The manager could not confirm if the checks had taken place prior to starting, although stated he had provided references at the time of his interview. It was established through the organisation that these vital checks had not been taken up prior to starting the manager and deputy manager. Further checks established that a member of staff working in the home for a considerable amount of time, working in a senior position and in isolation did not have a CRB or POVA check. The failure to further comply with the previous requirements has been taken very seriously by the Commission for Social Care Inspection and further legal action has been taken. (Enforcement). In terms of the home ensuring that staff are skilled to undertake their roles, responsibilities and meet the needs of the residents some improvements have been made and the staff confirmed that they had received various mandatory training such as fire, first aid and food hygiene and some service specific training such as abuse and physical interventions. However not all staff have been trained in these areas and the previous requirement to provide training in dementia and elder care has not been met. Therefore these requirements will be carried over and a further failure to comply may result in further action being taken. The home has an induction pack that is in line with the accredited body TOPSS, however there is evidence to suggest that the induction process is not correctly implemented. A member of staff with whom the inspector met with stated she had received an induction into the home on her first day, but could not recall meeting with a senior member of staff to complete the induction process. The deputy manager had been in post for approximately four weeks and there was no written evidence that he had been appropriately inducted into the home. The home was required at the previous inspection to introduce a service specific induction that met the needs of the residents such as the Learning Disability Award Framework (LDAF) this has not been complied with and therefore will be carried over, a further failure to comply will result in further action being taken. Starboard House H55-H03 S42317 Starboard House V218914 170505.doc Version 1.30 Page 20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,35 and 38 The home has made some improvement in providing the residents with an open, safer environment and better organised home, however the home fails to seek the views of residents and safeguard the residents from potential financial abuse. EVIDENCE: The home appears to be more relaxed and ordered than the previous visits. The previous manager was dismissed at the beginning of the year and the organisation has recently recruited another manager with a recognised qualification and a deputy manager. There was evidence to suggest with the aid of the senior support worker and commitment from staff that some order in the management of the home was taking place. The residents and some members of staff with whom the inspector spoke with said they liked the new manager and deputy manager. There was evidence to suggest that in the absence of the manager the senior member of staff and a deputising manager Starboard House H55-H03 S42317 Starboard House V218914 170505.doc Version 1.30 Page 21 from another home had made efforts to comply with the forty-seven requirements made at the previous visit. The manager stated he was aware of his role to ensure all the requirements were met, however the inspector findings at the time of the visit established that the home is still not meeting the required standard. Despite only being in post for approximately six weeks the manager stated he felt he was under pressure from the organisation to meet the requirements and fill the vacancy in the home. The area manager undertakes regular visits to the home and produces a monthly quality audit, however this does not meet the requirement made at the previous visit to produce a quality audit to seek the views of the residents, relatives, purchasers and professionals. The home cannot demonstrate that the home is run in the best interest of the residents, therefore the requirement made at the previous visit will be carried over and a further failure to comply will result in further action being taken. There was evidence that the home supports residents to manage their weekly personal allowance and there is a clear audit trail of expenditure, however evidence found at the time of the visit indicated that the residents pay for staff meals and drinks when accessing the local community. The manager could not confirm the organisation’s policy on staff’ expenditure. At the previous visit the inspectors established that the residents no longer attend their local bank or building society to draw out their rent, denying those that can manage their finances the autonomy to do so. The manager now has the responsibility of visiting the bank to draw out a large lump sum of money, which is then divided as per the residents allowance to each resident. This is another demonstration of a service needs led home and not a resident led home. The issues concerning the systems used to hold residents monies has been forward to the Commission for Social Care Inspection Providers Relationship Manager who is currently investigating the systems the organisation uses. The home has made improvements to the environment, which provides a safer place for the residents to live. All, but one of eight health and safety requirements made at the previous visit have been met. However immediate action was taken to meet the eighth requirement, and a problem established with a fire door closure at the time of the visit was also immediately dealt with indicating the home now takes seriously the environmental health and safety needs of the residents. There was written evidence to indicate that staff had recently received training in fire management, and residents were aware of what to do in case of a fire. All chemicals harmful to the health of the resident were safely stored away and there was evidence that regular checks were being made on fridges and freezers to check they were working correctly. Starboard House H55-H03 S42317 Starboard House V218914 170505.doc Version 1.30 Page 22 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 1 1 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 3 COMPLAINTS AND PROTECTION 2 x 1 x x x x x STAFFING Standard No Score 27 1 28 x 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 1 x 1 1 2 1 x 1 x 2 3 Starboard House H55-H03 S42317 Starboard House V218914 170505.doc Version 1.30 Page 23 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 Requirement Timescale for action 15/08/05 2. OP1 OP22 5 & 22 3. OP2 5(1)(b) 17(2) The home must ensure the Statement of Purpose details: The registered manager and their skills and qualifications. Numbers, skills and qualifications of staff. This requirement has been repeated. A further failure to comply will result in further action being taken. A copy must be sent to the Commission for Social Care Inspection by the stated date. The home must include in the 15/08/05 Service User Guide how Service users can complain and gain access to the latest inspection report. This requirement has been repeated. A further failure to comply will result in further action being taken. A copy must be sent to the Commission for Social Care Inspection by the stated date. The organisation must issue 15/08/05 each service user with a statement of terms and conditions. Advocates and service users’ representatives must be Version 1.30 Starboard House H55-H03 S42317 Starboard House V218914 170505.doc Page 24 4. OP2 OP37 5(b)(c), 17(1)(a) 5. OP7 15((1) 6. OP7 OP10 OP37 17(a)(b) 15(2)(a) 7. OP7 OP30 18(a)(c) (i) 10(3) 8. OP9 13(2) 9. OP9 13(2) consulted where required. Service users must be issued with a contract at the point of moving in. This requirement has been repeated, a further failure to comply will result in further action being taken. The organisation must ensure a copy of the residents contract is held within the home at all times. This requirement has been repeated, a further failure to comply will result in further action being taken. The home must ensure residents care plans and risk assessments provide specific detail on how residents must be supported. The home must keep all information pertaining to the residents and confidential. This requirement has been repeated. A further failure to comply will result in further action being taken. The home must ensure all staff receive training in writing care plans and recording information appropriately. This requirement has been repeated. A further failure to comply will result in further action being taken. The home must review residents PRN medications and produce protocols for their use. This requirement has been repeated. A further failure to comply will result in further action being taken. The home must implement a recorded procedure for making routine checks on the administration and recording procedures for medication. This requirement has been repeated. 15/08/05 31/07/05 31/07/05 15/08/05 15/08/05 31/07/05 Starboard House H55-H03 S42317 Starboard House V218914 170505.doc Version 1.30 Page 25 10. OP8 17(1)(a) 11. OP12 12(2)(3) 16(2) (m)(n) 12. OP16 22 (2)(3)(5) (6) 17(2) 13. OP18 OP35 13((6) 20(1)(a) (b) 17(2) 14. OP18 OP35 13((6) 20(1)(a) (b) 17(2) A further failure to comply will result in further action being taken. The manager must ensure a record is kept of the outcomes and treatment required following a visits to and from helath care professionals. The home must ensure a person centred approach is adopted in meeting the residents needs, wishes and desires. The organisation must evidence that staff training related person centred trainig and approaches, documentation and information available to residents and staff. The requirment to adopt a person centred approach has been repeated therefore this requirement has been repeated a further failure to comply will result in further action being taken. The home must ensure residents have access to the complaints procedure. This must be produced in accessible formats to meet the residents cognative and communication abilities. This requirement has been repeated. A further failure to comply will result in further action being taken. The home must ensure it obtains the Local Authority Policy “Protecting Vulnerable Adults” This requirement has been repeated. A further failure to comply will result in further action being taken. The home must ensure all staff receive training in Abuse awareness and Physical Intervention. This requirement has been repeated. A further failure to comply will result in further 31/07/05 30/09/05 31/08/05 15/07/05 31/07/05 Starboard House H55-H03 S42317 Starboard House V218914 170505.doc Version 1.30 Page 26 action being taken. 15. OP12 OP19 12(1)(2) (3) The organisation must provide evidence that the residents recently moved to alternative rooms have fully agreed with the move. An advocate, family representative or Social Worker must be involved if the resident has difficulty understanding. The home must risk assess the each resident accessing the garden until such time the uneven ground has been leveled to an acceptable standard. The home must ensure all wash hand basins in residents bedrooms are working correctly. Baths and wash hand basins must be fitted with plugs unless residents are individually assessed as at risks. This requirement has been repeated. A further failure to comply will result in further action being taken. The home must ensure appropriate numbers of skilled, and mixed staff are employed and on duty at all times to meet the level and specific needs of the residents. This requirement has been repeated. A further failure to comply may result in further action being taken. The organisation must operate a thorough recruitment procedure and ensure all staff have the appropriate checks undertaken on them prior to employment. The home must ensure all staff recieve training specific to the needs of the residents such as Dementia and Elder Care. Please forward a training plan by given date. The home must ensure that staff 31/08/05 16. OP19 13(4)(a) (b)23(2) (o) 13(4) (a)(b)(c) 23(2)(c) 31/07/05 17. OP21 31/07/05 18. OP27 18(1)(a) 31/07/05 19. OP29 19 In line with the enforceme nt notice 31/08/05 20. OP30 OP4 18(1)(a) (c)(i) 21. OP31 18(1)(a) 31/08/05 Page 27 Starboard House H55-H03 S42317 Starboard House V218914 170505.doc Version 1.30 (c) 18(2) 22. OP33 12(2) 12(5)(a) (b) 24(1)(a) (b) 24(2)(3) 23. OP35 16(2)(1) 24. OP35 OP14 OP17 16(2)(l) 5 (1)(b) fully complete their induction in a timely fashion as per TOPSS guidelines and adopt an induction process such as the Learninig Disabilities Award Framework which is resident specific. This requirement has in part been repeated. A further failure to comply will result in further action being taken. The home must produce a quality audit that includes the views of the residents, commissioners, relatives and professionals by the given date. The quality audit must then be forward to the Commission for Social Care Inspection. This requirement has been repeated a further failure to comply will result infurther action being taken. The home must ensure residents do not subsidise staff expenditure when accessing the community. i.e Pub Lunches. The organisation must establish a robust system to support residents who can manage their own financial affairs including rent. This issue is currently with the Commission for Social Care Inspection,s Providers Relationship Manager. 31/08/05 31/07/05 25. 26. 27. 28. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Starboard House H55-H03 S42317 Starboard House V218914 170505.doc Version 1.30 Page 28 No. 1. Refer to Standard OP12 Good Practice Recommendations The oprganisation is advised to sign up to the Local Authorities Charter for Person Centred Approaches. Starboard House H55-H03 S42317 Starboard House V218914 170505.doc Version 1.30 Page 29 Commission for Social Care Inspection 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 H55-H03 S42317 Starboard House V218914 170505.doc Version 1.30 Page 30 - 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. 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