Inspection on 23/10/08 for Stiperstones

This inspection was carried out on 23rd October 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Stiperstones 10/07/09

Stiperstones 15/04/09

Stiperstones 05/01/09

Stiperstones 21/04/08

Stiperstones 22/05/07

Stiperstones 10/01/06

Stiperstones 11/08/04

Stiperstones 26/04/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Stiperstones Stiperstone Clappers Lane Chobham Surrey GU24 8DD     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Suzanne Magnier     Date: 2 3 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 37 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 37 Information about the care home Name of care home: Address: Stiperstones Clappers Lane Stiperstone Chobham Surrey GU24 8DD 01276858440 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Alistair Ian Ogilvy Type of registration: Number of places registered: Welmede Housing Association Ltd care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 8 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD Date of last inspection Brief description of the care home Stiperstones is a care home for eight adults with learning disabilities and provides personal care only. The property is located in Clappers Lane, Chobham, Surrey and accommodation is provided on two floors accessed by stairs. The home has eight single bedrooms and facilities include a kitchen, lounge, dining area, office, laundry, bathrooms and toilets. The property has a private drive and a large garden, which is secure and easily accessible. Private parking is available. Care Homes for Adults (18-65 years) Page 4 of 37 Over 65 0 8 Care Homes for Adults (18-65 years) Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the care home was an unannounced Key Inspection. Following the previous key inspection on the 21st April 2008 the service has not met all the requirements made and enforcement action may be considered. Ms S Magnier Regulation Inspector carried out the inspection and an Area Manager and the deputy manager represented as the registered manager was supporing residents on an annual holiday. Feedback following the inspection was addressed to the area manager. For the purpose of the report the individuals using the service are referred to as Care Homes for Adults (18-65 years) Page 6 of 37 individuals or residents. The inspector arrived at the service at 09.00 and was in the home for eight hours. It was a thorough look at how well the home is doing. It took into account detailed information provided by the home and any information that CSCI has received about the service since the last inspection. The commission had sent comment card requests to residents relatives healthcare professionals and staff. Three written comment cards were returned from relatives although two cards given by the homes staff to relatives were designed to be addressed to healthcare professionals. Written omments received by the commission from relatives stated that the care staff are wonderful, and as far as we are concerned the carers are excellent and our relative appears to be very happy. I have a very high opinion of how my relative is looked after and they alwyas respect my relatives dignity, and give maximum choice where this is possible. There is a family feel to Stiperstones and I cant think of anyway in which the care service could improve. There is total commitment to ensure that my relatives needs are attended to creating a homely environment and I have never known my relative to be so relaxed over the period he has been at Sitperstones. Two written comment cards from staff were received and some comments included that the manager has an open door policy and is always available and that the service does well in providing leisure opportunities to residents but could improve the filing systems, organisation of paperwork and improve recruitment. The inspector spent time being, talking and observing the body language of people living at the home and with staff members in order to gain their views and opinions about the service. The inspector looked at how well the service was meeting standards and has in this report made judgments about the standard the service. Documents sampled prior and during the inspection included the homes Annual Quality Assurance Assessment (AQAA,) Statement of Purpose and Service User Guide, residents care plans, risk assessments, medication procedures, staff files, a variety of training records, and several of the services policies and procedures including complaints and safeguarding vulnerable adults. No complainant has contacted the Commission with information concerning a complaint made to the service since the last inspection and the commission have not beem made aware of any safeguarding vulnerable adult concerns. The home had submitted the Annual Quality Assurance Assessment (AQAA) prior to the inspection, which was brief yet informed the commission about the service. From the evidence seen by the inspector and comments received, the inspector considers that the home continues to be able to provide a service that meets the needs of people who have diverse religious, racial or cultural needs. What the care home does well: What has improved since the last inspection? What they could do better: The Statement of Purpose lacked information to state that the home does not provide nursing and lacked information of how residents are consulted about the running of the home. This was a requirement issued at the last inspection and has not been met. Not all residents care plans are up to date to promote and make proper provision for their care, treatment and supervision and ensure that their changing needs are identified and met. This was a requirement issued at the last inspection and has not been met. Records of food provided by the home are not in sufficient detail to enable any person inspecting the record to determine whether the diet offered to residents is satisfactory in relation to nutrition. This was a requirement issued at the last inspection and has not been met. There are not safe procedures for the administration of medicines in place to ensure that residents are protected from harm or abuse with regard to medication practices in the home. This was a requirement issued at the last inspection and has not been met. There are not suitable arrangements in place to ensure staff have received training or by other measures to prevent residents being harmed or suffering abuse or being placed at risk of harm or abuse. This was a requirement issued at the last inspection and has not been met. Care Homes for Adults (18-65 years) Page 8 of 37 People employed at the home do not receive a formal induction and training appropriate to the work they are to perform in order to ensure the safety and well being of residents in their care. This was a requirement issued at the last inspection and has not been met. Unannounced Regulation 26 visits and protocols have not been strengthened in order to promote improved management of the home and promote the best interests of the residents. This was a requirement issued at the last inspection and has not been met. Not all cleaning fluids/materials are stored and kept securely in compliance with the control of substances hazardous to health (COSHH) guidance in order to ensure the health and safety of residents. This was a requirement issued at the last inspection and has not been met. The skills and abilities identified within an individuals care plan are not reflected in the care and support provided by the homes staff in order to promote the individuals right to maintain and develop existing skills and residents are not always supported in a way which takes into account their wishes, feelings, respect and dignity which must be upheld at all times. Planned, consistent and predictable meaningful activities are not offered to all residents especially to those who require more than one or two staff support. Forms of restriction of movement for residents in their home for example the locking of doors must be avoided and only used in exceptional circumstances and agreed within a multi agency team decision. The procedures for ensuring the health and safety of residents must be improved so that residents are protected from harm for example with regard to control of infection, safe food handling, and fire safety and advice and services from other health care professionals for example dieticians are sought and nutritional risk assessments completed and for each resident. People employed at the home must be suitably vetted, in order to ensure the safety and well being of residents in their care. The home must have a gas and electrical safety certificate and a current insurance indemnity certificate available for inspection at the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 37 Care Homes for Adults (18-65 years) Page 10 of 37 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents and their representatives do not have accurate information about the home in order that they can make an informed choice about moving to the home. The homes admission and assessment procedures ensure that individuals needs are appropriately identified and met and people can visit the home prior to residency. The home does not provide intermediate care. Evidence: The homes Statement of Purpose and Service user Guide have been updated since the previous inspection and there was an improvement in the documents which were designed in large print and contained up to date photographs of the home and the local community. Both documents detailed the facilities and services offered by the home yet the Statement of Purpose lacked information to state that the home does not provide nursing and lacked information of how residents are consulted about the running of the home. It was concluded therefore that the previous requirement had not been met. Failure to comply with this regulation is an offence and enforcement action will be considered. Care Homes for Adults (18-65 years) Page 12 of 37 Evidence: There have been no admissions to the home since the previous inspection. All the residents have been residing at the home for some years and their care needs assessments were developed whilst in the care of the previous care service provider. The inspector sampled one resident file, which contained the initial assessment details for the resident moving into the home. Welmede have an admission and assessment policy and procedure which was sampled by the inspector to ensure that all prospective residents have a care needs assessment prior to admission to the home and to ensure that the homes staff would be able to meet the individuals needs. The policy includes encouraging prospective residents to visit the home, meet with the other residents and have an overnight stay if they choose to prior to moving to Stiperstones if that was their choice. The home does not offer intermediate care. Care Homes for Adults (18-65 years) Page 13 of 37 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The support, personal care needs, goals and aspirations of individuals needs must be kept up to date and evidenced as regularly reviewed and monitored to ensure that the changing needs of residents are identified and met. Residents are not always fully consulted about matters which affect their daily lives. The management of risk assessments has improved yet need to be more robust to ensure the safety and wellbeing of residents at all times. Evidence: The inspector requested the care plan documents for one resident who was at the home for most of the day. The care plan documented the individuals relevant personal details, their likes and dislikes, agreed working guidelines for staff to follow when supporting the individual, a variety of risk assessments related to the individuals lifestyle and evaluation forms which documented the individuals skills and goals. Care Homes for Adults (18-65 years) Page 14 of 37 Evidence: The individuals documented daily needs/support guidelines within the care plan for example personal hygiene, dressing and eating and drinking were dated August 2007. Within the care plan were documents called evaluation forms which detailed how the individual was supported in daily living tasks and a care plan action plan. Both documents were dated January 2008. Following the previous inspection a requirement was made that the homes staff must ensure that the care plans for each resident are up to date to promote and make proper provision for the care, treatment and supervision of residents and ensure that their changing needs are identified and met. It was concluded that the previous requirement had not been met. Failure to comply with this regulation is an offence and enforcement action will be considered. It is acknowledged that residents living at the home are unable to sign their care plans due to their individual limited ability and this detail was recorded on the care plan sampled on behalf of the individual. Following the previous inspection the home have reconsidered the use of photographs in documents that may leave the service in order to protect the residents rights to privacy and confidentiality. Consideration has also been given to residents choice regarding gender specfic care in order to promote individuals choice and diversity. Following the previous requirement that the home must request a formal local authority review regarding the care plan/placement by the funding authority be undertaken the home evidenced that they had written to the local authorities yet no formal reviews had taken place within the last six months. This matter has been raised with the commissions senior management. There was evidence to support that residents views had been sought in group meetings about some of the decisions in their lives and these included choices of meals, colour of the individuals bedroom and some activiies. The information stated that views had been obtained by offering individuals photographs, pictures and colour charts. A variety of risk assessments were available within the care plan sampled and had been last updated, according to the documents seen, in January 2008. There was evidence that the documented agreed working guidelines had links to the risk assessments which was viewed as good practice and an improvement in ensuring the safety and welfare of the resident. It is recommended, to promote good practice, that each staff member signs to state they have read and agreed risk assessments in order to promote consistent support and protection for the individual. During the inspection the registered manager contacted the service regarding a Care Homes for Adults (18-65 years) Page 15 of 37 Evidence: situation which had occurred on the planned residents holiday and during a telephone discussion it was identified that although a risk assessment had been completed regarding the residents holiday this had not been robust in detailing a contingency plan regarding staffing and a requirement made theat the risk management process is strenghenned. Care Homes for Adults (18-65 years) Page 16 of 37 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are able to exercise some choice in the daily lives yet this needs to be better managed to support residents in taking part in consistent and planned social and recreational activities. Individuals are supported to maintain bonds with family and friends. Residents freedom of movement in theri home must not be resricted. Records regarding the homes menus and kitchen facilities must be improved in order that residents receive a healthy and balanced diet. Evidence: The evaluation forms found within the individuals care plan sampled documented some of the skills and abilities that the individual could take part in for example with personal hygiene, dressing and choosing clothes. There was no written documentation found which supported that the homes staff worked with the individual to maintain and promote their existing skills and abilities. This shortfall was evidenced during the Care Homes for Adults (18-65 years) Page 17 of 37 Evidence: previous inspection and recorded within the report. It is required that the skills and abilities identified within an individuals care plan are reflected in the care and support provided by the homes staff in order to promote the individuals right to maintain and develop existing skills. One activity sheet within an individuals care plan was sampled and discussed with the deputy manager. The information seen stated that the resident attended two activities regularly yet on further investigation, and sampling the individuals daily diary, the deputy manager told the inspector and the area mannager that the resident did not attend the activities as they needed additional support which had only recently been organised by Welmede. The individual daily record books detailed that the resident had been out for a drive, enjoyed time in their garden, and had been at home. No general activities chart was made available for inspection or on display within the home and despite the deputy manager telling the inspector that three of the residents were visiting the local farm on the morning of the inspection there was no evidence by use of objects of reference or otherwise seen to assist residents in knowing what they may be doing that morning. Additionally during the afternoon of the inspection, following the difficulties raised with the planned holiday, several residents were escorted to the homes vehicle to have a ride to Shropshire. From the evidence gathered during the inspection it was apparent that some activities are planned whilst others are spontaneous. It was evident through sampling daily record books that staff have made efforts to offer residents opportunities for social engagement and that all residents require a varying degree of staff support. Due to the evidence gathered it was concluded that although there has been an improvement in the consulatation with residents about their social interests and activities there remains a shortfall in offering planned, consistent and predictable meaningful activities to all residents especially to those who require more staff and a requiremnet has been made that this be addressed. There was evidence in the residents bedrooms that leisure activities such as TV, listening to music and having objects of interest were available. Residents have been helped by staff to maintain their relationships with family and friends. The staff confirmed that individuals continue to show no interest in participating in attending places of worship however the home have continue to have contact with the local vicar and staff would promote peoples spiritual and religious beliefs by providing support should an interest be shown. On arrival at the home it was observed that the four residents at home were in the lounge with the door locked with the only access for residents to get into the main house was via the kitchen. The deputy manager advised that the door had been locked as staff had seen the inspector arriving and also that one resident kept going into the Care Homes for Adults (18-65 years) Page 18 of 37 Evidence: main house whilst the decorators were there. The deputy manager assured the inspector that doors were not generally locked in areas of the home and that this was an isolated incident however the inspector was in the lounge when a staff member asked the deputy manager if they should lock the door as they were leaving the room despite the inspector and deputy manager being in the room. A requirement has been made that no resident is restricted within their own home and that rights to residents freedom of movement or restrictions are agreed in the individual plan and contract. During the course of the inspection the inspector did not observe meal times. Following the previous inspection the homes staff have improved the documented menu which details a varied and nutritious diet. A document titled variations to menu was sampled which indicated that the planned menu was not generally referred to and that items on the menu for the day were not available in the home or were in the freezer. The staff stated that they were going to get items of shopping on the way back from the activity and this was observed by the inspector. Whilst sampling the menus it was observed that the homes staff prepared chicken meals or takeaways regularly. Ingredients for spicy and curried food including fresh garlic, beetroot, peppers and corriander were found in the fridge which did not relate to any meals on the planned menu and this was brought to the area managers attention. The deputy manager showed the inspector a pack of see read menu planning documents which she stated were going to be used by the home yet these had not yet been implemented. The requirement made at the previous inspection that that records of food provided by the home must be in sufficient detail to enable any person inspecting the record to determine whether the diet offered to residents is satisfactory in relation to nutrition had not been met. Failure to comply with this regulation is an offence and enforcement action will be considered. The homes cupboards,fridges and freezers contained some fresh fruit, vegetables, and dairy products yet during discussions with staff about the shopping for food for the home it was concluded that there was no clear set shopping day and shopping was undertaken on an ad hoc basis. It is recommended that the purchase of food stocks is better managed to ensure residents have a well stocked supply of food. Care Homes for Adults (18-65 years) Page 19 of 37 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents physical, emotional and health care needs are not fully met monitored and met. Individuals choice and dignity is not consistently promoted. Medication procedures do not ensure that medication is administered to all individuals in a safe and appropriate way. Evidence: During the inspection it was identified that the registered manager had developed a decoration plan which included written arrangements that a resident would be accomodated in another residents room while they were on hoilday. It was also discovered that a resident had slept in another persons room the night before the inspection as the decorators had decorated the wrong room by mistake. There was no evidence available to indicate that these arrangements had been agreed with the residents or their representatives and did not reflect the occupancy rights, respect and courtesy to residents. During the inspection it was overheard one staff member saying to a resident theres a good boy which did not reflect dignity and respect for the individual who was a middle aged man. A requirement has been made that residents are supported in a way which takes into account their wishes, feelings, respect and Care Homes for Adults (18-65 years) Page 20 of 37 Evidence: dignity which must be upheld at all times. Records of health care appointments indicated that residents had attended medical appointments both inside and outside of the homes environment. Appointments included specialised health care professionals, general practitioners (GP), and access to chiropodists, opticians, speech and language therapists, district nurses, dentists, and other hospital specialists. One care plan sampled indicated that monthly weights were recorded yet the last entry was seven months ago, another two care plans indicated that the individuals were weighed on a monthly basis. As highlighted in the previous inspection there were no records found to indicate that residents had received support from the dietician or the reason for the resident body weight being measured. Due to the concerns raised at the time of the inspection regarding the nutritional standards of the home a requirement has been made that arrangements must be made to ensure that treatment, advise and services from other health care professionals are sought and nutritional risk assessments completed and for each resident. The inspector sampled the orderly secured medication cupboard in the home. Several charts on the inside of the medication cabinet were out of date and included personal details of a resident who had not resided at the home since 2005. The residents on holiday had taken their medication with them and it was noted that no medication was stored using the monitored dosage system. The local Pharmacist supplies the homes medication and the inspector was advised that the home is not currently supporting any residents with the administration of controlled medicines and no resident self medicates. The Welmede medication policy and procedure found in the medication file was dated 2004 and the area manager confirmed that a more current document was available dated 2007 which was replaced during the inspection. Records evidenced that systems were in place for the ordering and returns of medication. The stock taking of medicines was not robust as the homes policy stated that two staff must record medicines recieved into the home and only one staff signature was evidenced. During the sampling of the medication administration charts it was observed that there were fourteen gaps in the stock taking of medication which was viewed as unsafe practice regarding the administrative procedures of medication which had the potential of placing residents at risk. The medication folder had a documented list dated 2004 of staff signatures that were deemed competent to administer medicines. Some staff were no longer employed at the home. The medication file contained a section of information, which included the residents photograph, their general description, their GP, next of kin and known allergies. Within Care Homes for Adults (18-65 years) Page 21 of 37 Evidence: the medication file were documented forms regarding the use of homely remedies that had been signed by the GP. Evidence was available to confirm that staff had undertaken medication training and the medication procedures of the home were under review however it was concluded that the previous requirement that the home must ensure that arrangements are in place for the safe administration of medicines to ensure that residents are protected from harm or abuse with regard to medication practices in the home had not been met. Failure to comply with this regulation is an offence and enforcement action will be considered. Care Homes for Adults (18-65 years) Page 22 of 37 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints process has been strengthenned to ensure peoples views and concrens about the home are listenned to and acted upon. Residents rights to protection from abuse and harm are not robust and require improvement. Evidence: During the inspection the Welmede complaints procedure was sampled which gave the reader information to people associated with the home how to make a complaint or raise a concern if they were dissatisfied. A pictorial complaints procedure was also sampled. Following the previous inspection the home have developed a complaints book which details the chronology of events for example the dates of the complaint, actions taken by the home, copies of correspondence with the complainant and the outcomes regarding complaints in order to ensure that there is appropriate evidence to support that peoples views, opinions and complaints are recognised and acted upon. It was evident that the majority of residents would not be able to tell of any dissatisfaction with the service provided, and would be reliant on staff recognising that they were unhappy. The deputy manager advised that staff and residents families would be aware of the residents ways of communicating and would understand any changes which may indicate the resident was not happy, such as changes in mood, Care Homes for Adults (18-65 years) Page 23 of 37 Evidence: behaviours and body language. The local authority multi agency procedures for safeguarding adults dated 2008 was available and the deputy manager advised that no safeguarding referrals had been received by the home. The inspector sampled that the home has a policy statement regarding reporting abuse which was noted to be in accordance with the local authorities multi agency procedures in order to safeguard people in their care. Records were available to evidence that some staff had undertaken safeguarding vulnerable adults training. During the previous inspection it was identified that two staff last received training in November 2005 one of whom was a senior care worker whos records indicated that despite a requirement made during the previous inspection they had not yet received safeguarding training. Records indicated that another staff member who had been employed by the home for six months had also not received safeguarding vulnerable adults training. It was concluded that the previous requirement had not been met that the home must make suitable arrangements, by training staff or by other measures to prevent residents being harmed or suffering abuse or being placed at risk of harm or abuse. Failure to comply with this regulation is an offence and enforcement action will be considered. Care Homes for Adults (18-65 years) Page 24 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home continues to meet the need of the current residents. Infection control arrangements in the home need to be improved. Evidence: During the tour of premises it was acknowledged that areas of the home, including some residents bedrooms were being decorated. The home was noted to be clean and tidy. It was acknowledged that efforts had been made to support some residents to make their rooms more homely with the use of personal ornaments and new furnishings. The homes bathrooms and toilets were clean, and staff advised that as residents are not aware of the importance of flushing the toilets after use the staff have continued to make time to go around the home to ensure that toilets have been flushed after use. One bathroom contained specialist equipment and specific aids to support people in their daily lives and records of safe bathing practices for example water temperature checks were documented. The inspector observed that there was not consistent practice regarding hand washing Care Homes for Adults (18-65 years) Page 25 of 37 Evidence: facilities in the home and some toilets did not have paper hand towels and one toilet had a cloth hand towel. The disposal of clinical waste in the downstairs bathroom consisted of soiled pads being placed in the large swing bin which was also used for disposal of paper hand towels. During the inspection it was observed that a staff member on various occassions did not wear protective clothing when preparing meals. This was brought to the staff members attention who questioned what type of apron they should be wearing. It has been required that more robust arrangements are made for the disposal of clinical waste and spread of infection in the home through more robust infection control measures. Care Homes for Adults (18-65 years) Page 26 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home were sufficient numbers to support the residents at all times. The home did not provide evidence of a robust system for the recruitment, induction and training and development of staff in order to ensure the safety and protection of residents in the home. Evidence: The inspector was advised that the home is currently supporting 8 residents. The staff team is stable with the majority of the staff having worked at the home for several years. The inspector sampled the staff rotas and observed that there are usually four staff on duty at each shift with two waking night staff. Three staff were on duty during the inspection and their duties included providing residents with personal care, shopping, cooking, housekeeping and laundry, as well as assisting residents with social activities and transporting them to these using the homes vehicle. One staff file was sampled of a person who had been employed by the home for six months. The recruitment file contained an application form that was scantily completed, the file included references obtained from the current registered manager Care Homes for Adults (18-65 years) Page 27 of 37 Evidence: of the home, and two staff members where the person had worked previously and contained a current CRB disclosure. The staff members training records indicated that they had not received any statutory training including safeguarding vulnerable adults and there was no evidence that they had received a formal induction to the home. A requirement regarding the lack of staff training was highlighted at the previous inspection and it was concluded that the requirement had not been met to ensure that people employed at the home are suitably vetted, receive a formal induction and training appropriate to the work they are to perform in order to ensure the safety and well being of residents in their care. Failure to comply with this regulation is an offence and enforcement action will be considered. Care Homes for Adults (18-65 years) Page 28 of 37 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is not robust. The home is run in the best interests of the residents and their views and opinions and those of other associated with the home are sought. Residents general safety and welfare is not promoted and improvements need to be made regarding some health and safety concerns in the home. Evidence: It was noted that the system within the home of the order of the files had improved and the office space within the home where care plans and other resident documents were stored had been made more manageable following the previous inspection. The registered manager did not represent the service as they were supporting residents on their annual holiday. An area manager represented the service at the inspectors request and was supported by the deputy manager. Evidence was seen to support that the views and opinions of residents and other stakeholders are actively sought through resident meetings, contact with residents Care Homes for Adults (18-65 years) Page 29 of 37 Evidence: relatives and friends and visitors to the home. The inspector sampled some Regulation 26 notification reports, which were held in the service. The reports were varied in content and it was apparent whilst sampling the reports that areas within the home for example shortfalls in medication practices, fire safety equipment and menus had not been consistently inspected and the shortfalls identified. The inspector was informed that the Regulation 26 visits are unannounced and the area manager was reminded that it is the expectation that any shortfalls in the quality of the service would be noted by the organisation during the Regulation 26 visits, so that appropriate action could have been taken to rectify the shortfalls. The shortfalls were raised during the previous inspection and it was concluded that the previous requirement had not been met that the Regulation 26 visits and protocols must be strengthened in order to promote improved management of the home and promote the best interests of the residents. Failure to comply with this regulation is an offence and enforcement action will be considered. It was noted that a cupboard in the kitchen, which contained cleaning fluids was locked yet the key was sited in the lock. The deputy manager failed to initially understand that the chemicals in the cupboard were chemicals that could be potentially dangerous to residents. The storage of chemicals was raised during the previous inspection and it was concluded that the requirement made that all cleaning fluids/materials must be stored and kept securely in compliance with the control of substances hazardous to health (COSHH) guidance in order to ensure the health and safety of residents had not been met. Failure to comply with this regulation is an offence and enforcement action will be considered. During the tour of the premises it was noted that several fire doors within the home, including residents bedroom doors were not closing. An immediate requirement was made that all doors in the home must comply with fire regulations and defective doors are repaired without delay and the home contact the local fire authorities to seek advice in order to safeguard the resident and others in the home in the event of a fire. This shortfall was highlighted during the previous inspection and a requirement made which had not been met. Failure to comply with this regulation is an offence and enforcement action will be considered. It was clear that although the staff undertake health and safety checks within the home and the defective doors had been reported to the Welmede maintenance departments there was no recognition by the homes manager and staff of the potential hazards to residents in the event of fire. The home have maintained records relating to water and food temperature checks to ensure residents safety and well being. Care Homes for Adults (18-65 years) Page 30 of 37 Evidence: The homes gas safety, electrical certificates and a current insurance indemnity certificate were unable to be located in the home during the inspection. Records indicated that the home completes an accident and incident book which was sampled by the inspector. The inspector confirmed the procedures that the home must report any incidences to the CSCI under Regulation 37 notifications of any event that affect the well being and welfare of residents in the home. As recorded throughout the report a large number of aspects of the homes management are potentially putting the health, safety and welfare of residents and staff at risk. This includes the lack of accurate evidence available to potential residents and their representatives regarding the services offered by the home, the lack of arrangements to promote residents skills and abilities, lack of adequate resources regarding residents rights to access planned and consistent activities, lack of staff induction, mandatory and safeguarding adults training, shortfalls regarding medication procedures, lack of evidence to support residents receive a nutritious and varied diet, concerns regarding the use of restraint in the home, and lack of robust health and safety procedures. It has been required that the home must forward to the CSCI an improvement plan detailing how the home intends to improve the services provided in the home to ensure the safety and well being of residents in their home. The requirements made during the inspection and detailed within the report have a bearing on the safety of, and outcomes for, the residents who live at the home and the failure to comply with the regulations is an offence and will lead to enforcement action. Care Homes for Adults (18-65 years) Page 31 of 37 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 1 Schedule 1118 5 (1) (a-f) (2)(2A)(ab)(3)(4) The Statement of Purpose 21/06/2008 and service user Guide must detail the information in respect of the Care Homes Regulations 2001 (as amended September 2006). Both documents must be kept under review and the commission and service users notified of any revision within 28 days. Records of food provided by 21/06/2008 the home must be in suffienct detail to enable any person inspectiong the record to determine whether the diet offered to residents is satisfactoey in relation to nutrition. The home must ensure that 21/07/2008 arrangements, including training, are in place for the safe administration of medicines and ensure that residents are protected from harm or abuse with regard to medication practices in the home. The home must make suitable arrangements, by training staff or by other measures to prevent 21/07/2008 2 17 Schedule 4 13. 3 20 13.213.(4c) 4 23 13.(6) Care Homes for Adults (18-65 years) Page 32 of 37 residents being harmed or suffering abuse or being placed at risk of harm or abuse. 5 42 Schedule 4 .14 The defective bedroom doors 26/04/2008 must be repaired without delay in order to safeguard the resident and others in the home in the event of a fire. An improvement plan must be provided to the CSCI detailing how the home intends to improve the services provided in the home. The Regulation 26 visits and protocols must be strengthened in order to promote improved management of the home and promote the best interests of the residents. 21/05/2008 6 42 24 (A) 7 42 26 21/05/2008 8 42 13.(4)(a) All cleaning fluids/materials 21/05/2008 must be stored and kept securely in compliance with the control of substances hazardous to health (COSHH) guidance in order to ensure the health and safety of residents. Care Homes for Adults (18-65 years) Page 33 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Arrangements must be made that risk assessments are further strenghtenned. To ensure the saftey and well being of residents as far as reasonably practicable. 21/11/2008 2 11 15 The skills and abilities identified within an individuals care plan are reflected in the care and support provided by the homes staff. In order to promote the individuals right to maintain and develop existing skills. Arrangements must be made to offer planned, consistent and predictable meaningful activities to all residents especially to those who require more staff. To ensure that residents have access to and choose from a range of planned and appropriate activities. 27/11/2008 3 14 16 27/11/2008 Care Homes for Adults (18-65 years) Page 34 of 37 4 16 13 Arrangements must be made that no resident is restricted in their home. Residents must be granted the freedom of movement within their home in order that their rights to freedom of movement or restrictions are agreed in the individual plan and contract. 27/11/2008 5 18 12 Arrangements must be 27/11/2008 made that residents are supported in a way which takes into account their wishes, feelings, respect and dignity which must be upheld at all times. In order to promote residents rights to respect and dignity. 6 19 13 Arrangements must be made to ensure that treatment, advise and services from other health care professionals are sought and nutritional risk assessments completed and for each resident. In order to ensure residents health regarding nutition is promoted. 27/11/2008 7 30 13 Arrangements must be made for improved practice for the disposal of clinical waste and spread of infection in the home. To ensure residents and staff are protected from the spread of infection. 27/11/2008 Care Homes for Adults (18-65 years) Page 35 of 37 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 That each staff member signs to state they have read and agreed risk assessments in order to promote consistent support and protection for the individual. It is recommended that the purchase of food stocks is better managed to ensure residents have a well stocked supply of food. 2 17 Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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