CARE HOME ADULTS 18-65
The Drive 17 The Drive Sidcup Kent DA14 4ER Lead Inspector
Maria Kinson Unannounced Inspection 25th January 2006 10:00 The Drive DS0000006811.V276629.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Drive DS0000006811.V276629.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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. The Drive DS0000006811.V276629.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service The Drive Address 17 The Drive Sidcup Kent DA14 4ER 020 8309 0440 020 8309 1532 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Drive Care Homes Ltd Vacant Care Home 12 Category(ies) of Learning disability (12) registration, with number of places The Drive DS0000006811.V276629.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 12 Male or Female - LD (Learning disability) Date of last inspection 9th June 2005 Brief Description of the Service: The Drive offers a permanent home for up to twelve adults who have a severe or profound learning disability with associated and complex needs. Complex needs include mobility needs, arising from sensory deprivation, communication needs or behaviour that challenges. The home is located in a residential area within walking distance of the local town and public transport. The Home has it’s own transport which is used to provide opportunities outside of the Home. Staff support is provided 24 hours a day. Opportunities for leisure and occupation are provided by the Home and some service users attend a day service provided by their sponsoring authority. This is determined by the assessment of need and in negotiation with the commissioning authority. The Drive DS0000006811.V276629.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on 25th January 2006 between 10.00am and 17.15pm. A partial tour of the home was undertaken and the inspector spent time talking with service users, staff and one visitor. Care, recruitment and health and safety records were examined. Comment cards were distributed to relatives and health care professionals that were in regular contact with the home. Ten comment cards were returned to the commission. At the time of this inspection there were ten service users living in the home. What the service does well:
The arrangements for the recent change of manager were handled well. The new manager was working hard to get to know service users, relatives, staff and other professionals that were in contact with the home. Support plans provided detailed information for staff. Potential hazards were assessed and recorded and strategies to minimise risks were implemented where possible. The home had a comprehensive complaints and adult protection procedure. Complaints and concerns were investigated thoroughly and responded to promptly. The relatives that responded to the questionnaire sent out by the commission were mostly satisfied with the overall care provided in the home. Some relatives commented that “activities had improved” and were confident that the new manager would “do a good job”. Relatives said, “this home provides the care and love that enhances quality of life”, “my family member is very happy”. The manager worked hard to provide consistency for service users by using regular bank staff to cover vacant posts where possible. The home had not used agency staff in the two months prior to this inspection. The home was clean, tidy and odour free. Equipment was serviced at regular intervals and fire safety arrangements were good.
The Drive DS0000006811.V276629.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
Feedback from relatives was mostly good but some concerns were raised about staff interactions, activities and the use of temporary staff. Relatives made the following comments, “staff are adequate in numbers, but do little to engage users or interact in the evenings”, “the quality of day to day care is variable”.
The Drive DS0000006811.V276629.R01.S.doc Version 5.1 Page 7 Records of daily events and significant issues were poor. Records did not include adequate information, were difficult to read in parts and were not kept up to date. A significant amount of work had been undertaken to improve the visual appearance of the home but some work was incomplete. The carpet on the stairs was stained and the kitchen cupboards were old and worn. Clinical waste was not always stored appropriately. The manager should continue to work towards achieving a full establishment of permanent staff. This will provide greater continuity of care for service users. Ongoing training for permanent staff was satisfactory but very few staff had attained a care qualification and bank staff did not receive adequate training. The induction-training programme was thorough but did not comply with recognised standards. Staff interactions had improved but further work was required to ensure that all staff used appropriate communication strategies. This will maximise service users ability to understand, be understood, and make choices. There were a number of systems in place for assessing the quality of care and facilities provided in the home but this did not include internal auditing. The manager had not submitted an application for registration. This must be forwarded to the commission by 01/04/06. 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. The Drive DS0000006811.V276629.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Drive DS0000006811.V276629.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed during this inspection. EVIDENCE: Two service users had moved out of the home since the last inspection. The home had two vacant rooms. The Drive DS0000006811.V276629.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 9. Support plans included comprehensive information about service users assessed needs and strategies to reduce risks. Records were not always updated to reflect changing needs. This practice could compromise resident’s safety and well-being. EVIDENCE: Two support plans and assessments were examined. The information provided in plans was detailed and provided helpful guidance for staff about service users individual needs and preferences. Both plans were reviewed at regular intervals. It was not apparent if the plans had changed in recent months as amendments were made on the computer and a new copy was printed out. Staff should consider revising the evaluation sheet to include this information. Both of the files included up to date risk assessments and guidance regarding the management of challenging behaviour. Although care plans were good overall some of the daily care records were not up to date and did not include adequate information. One of the service users had scratch marks on one side of his face. This injury was not recorded in the daily care notes or care plan and none of the staff could clearly explain when
The Drive DS0000006811.V276629.R01.S.doc Version 5.1 Page 11 the marks were first observed or how the service user had sustained the injury. Failure to observe and record significant issues could lead to allegations of abuse and neglect. Another record indicated that staff had witnessed an incident between two service users. Some information was recorded in the daily care notes but this did not include the identity of the other service user or state whether the person was injured in the incident. See comments under standard 42 regarding accident and incident reporting. See requirement 1. The Drive DS0000006811.V276629.R01.S.doc Version 5.1 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 14. The arrangements for providing daily variation and stimulation for service users had improved. EVIDENCE: A structured weekly activity programme had been developed for each service user. Programmes were varied but both of the plans seen included ‘one to one’ and group activities. Daytime activities included local walks, arts and crafts, sensory sessions, swimming, foot spa sessions, aromatherapy and outings to local pubs and cafes. During the evening the programme indicated that some service users would attend local clubs or take part in activities in the home such as bubbles, music and hand care. Some of the service users attend local day centres or colleges. It was not always clear from the records whether all of the activities listed on the programme were taking place. See recommendation 1. On the day of the inspection some of the service users attended a sensory session, others were supported to colour pictures and during the afternoon an aroma-therapist provided hand massage in the dining room. Noise levels were quite high during the aromatherapy sessions as one
The Drive DS0000006811.V276629.R01.S.doc Version 5.1 Page 13 service user was playing the organ and other service users and staff were coming and going. As service users are now familiar with the therapist staff should consider whether this activity might be more relaxing for service users in the comfort of their own room. The Drive DS0000006811.V276629.R01.S.doc Version 5.1 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 20. The arrangements for accessing specialist health care services had improved. This should enhance service users quality of life and provide additional support for staff. The management of medication in the home was good. EVIDENCE: The Registered Person had advised the commission that the home would not accept new admissions without written confirmation from the funding authority, about the arrangements for gaining access to specialist services. This issue was also discussed with the manager. Since the last inspection the local learning disability team had agreed to take referrals for service users that had developed new physical and emotional problems since moving into the home. This should provide significant improvements for service users with complex health needs and support for staff. Three referrals had been forwarded to the community learning disability team but none of the service users had been assessed at the time of this inspection. Written feedback was obtained from three health and social care professionals that were in contact with the home. Two out three respondents said that staff demonstrated a clear understanding of clients needs and were satisfied with
The Drive DS0000006811.V276629.R01.S.doc Version 5.1 Page 15 the overall standard of care in the home. One respondent was not satisfied and said, “service users social needs were not being fully met”. Two medication charts were examined. Records of administration of medication had improved. No gaps or anomalies were noted. The Drive DS0000006811.V276629.R01.S.doc Version 5.1 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. The home had a comprehensive complaints and adult protection procedure for responding to complaints or allegations of abuse. Prompt action was taken to protect residents. EVIDENCE: The home had received one verbal complaint since the last inspection about an environmental issue. The complaints log indicated that the concern was investigated and addressed promptly. The commission had not received any complaints about this service in the period since the last inspection. The manager reported significant issues and accidents to the commission and Social Services. Two incidents that had occurred in the home since the last inspection were referred to Bexley Social Services for investigation under their adult protection procedure. The commission had not received any feedback about the outcome of the investigations at the time of this inspection. The manager said that both investigations were now closed and none of the allegations were substantiated. The Drive DS0000006811.V276629.R01.S.doc Version 5.1 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. The visual appearance of the home had improved but further work should be undertaken to ensure that all parts of the building are comfortable and welcoming for service users and their family members. Staff did not always follow infection control procedures. This could compromise service users safety. EVIDENCE: A significant amount of work had been undertaken in the home to make the environment more homely for service users and their relatives. Dividing doors now separated the lounge and dining room. This made the rooms appear smaller and less institutional. New carpets had been fitted in the lounge, dining room and ground floor corridor. All of the communal bathrooms and toilets had been tiled and two new dining tables had been purchased. Some of the work was incomplete in parts this included the paintwork in the toilets and bathrooms and the panels at the side of the doors in the lounge. Replacing some of the old looking fixtures in the bathrooms and toilets and fitting blinds or curtains in the lounge would also provide a more finished look. The inspector was told that chairs to match the new dining tables were on order. The carpet on the staircase was stained. This issue was identified during the inspection that took place in March 2005. Some of the kitchen cupboard fronts
The Drive DS0000006811.V276629.R01.S.doc Version 5.1 Page 18 were worn. This issue was also highlighted in the environmental health inspection report. See requirement 2. Thermostatic valves had been fitted to all of the radiators in service users rooms. Access was difficult in some instances. Further work may be required to ensure that adequate space is provided for staff to adjust the temperature to meet service users needs. Three bedrooms were viewed. All of the occupied rooms were clean, comfortable and welcoming. Staff had purchased sensory equipment such as mirrors, lights and tactile objects for one of the service users who had difficulty concentrating and some sensory loss. In one bedroom a used continence pad and pair of vinyl gloves were left on the floor. Staff must disposal of waste appropriately. See requirement 3. The Drive DS0000006811.V276629.R01.S.doc Version 5.1 Page 19 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35. Staffing levels were satisfactory. The homes recruitment procedure provides good protection for service users. Staff training was variable. The home must ensure that staff have adequate qualifications and skills to support service users with complex needs. EVIDENCE: The interactions between staff and service users were mostly good. Some staff had good communication skills but further work was required to ensure that all staff meet this standard. Two care staff had completed NVQ training. One member of staff was undertaking this training. The home had not met the Department of Health’s target for 50 of care staff to achieve a vocational qualification in care by December 2005. See requirement 4. The off duty roster for the week of the inspection was examined. Each daytime shift included a Team Leader and three support workers. On a Monday and Friday there was an additional carer of a morning as some of the service users required support at day centres. There was two waking staff on duty overnight. The registered person also employs a driver and part-time maintenance and domestic staff. The manager works Monday to Friday but is currently undertaking some weekend and evening visits.
The Drive DS0000006811.V276629.R01.S.doc Version 5.1 Page 20 Bank staff were used regularly to cover staff sickness, annual leave, maternity leave and vacant posts. Most of the bank staff undertook regular shifts in the home and were familiar with the layout of the home and service users needs. The home had not used agency staff during the eight weeks prior to this inspection. The manager was working hard to fill the two remaining support worker posts. A full establishment of permanent staff should provide greater consistency for service users and more committed staff. One new support worker was due to commence work in the home in February 2006. Two staff recruitment files were examined. Recruitment procedures were good and the arrangements for supervising new staff that were awaiting an enhanced criminal record bureau disclosure were recorded on the duty roster. One staff member had a POVA first check but did not have a full criminal record bureau disclosure. Records indicated that staff had attempted to resolve this issue by telephoning and writing to the criminal records bureau on several occasions. The manager and head of care were developing an annual training programme for staff. Records indicated that some staff had attended moving and handling, health and safety, medication, abuse and first aid training sessions during the past year. Recent induction training records could not be examined as the staff members held them. The manager must ensure that all records are available for inspection. Records indicated that new staff worked two supernumerary shifts during the induction period. The induction-training programme was quite thorough but did not comply with nationally recognised standards. See recommendation 3. The manager said that bank staff were invited to attend training sessions. The bank staff members spoken with during the inspection had worked in the home for at least six months but had received little training. See recommendation 2. The Drive DS0000006811.V276629.R01.S.doc Version 5.1 Page 21 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40 and 42. The handover period provided a smooth changeover of management and minimal disruption for service users and staff. The home had a number of quality assurance systems in place but did not have a formal system for monitoring care practices on a regular basis. EVIDENCE: A new manager commenced work in the home on 12.12.05. Prior to this there was a formal handover of duties between the existing and new manager. The new manager was working hard to get to know staff, service users and relatives. The new manager had worked with adults and children with learning disabilities for many years but does not have a formal care or management qualification. The manager is currently undertaking the registered managers award. The manager must submit an application for registration to the commission by 01/04/06. See requirement 5. An external auditor had recently assessed the home to ensure that it met the requirements for ISO accreditation. The home had passed the assessment, subject to some further work being undertaken. No internal audits were
The Drive DS0000006811.V276629.R01.S.doc Version 5.1 Page 22 undertaken but the manager does monitor and carry out regular checks on medication, service users personal money and care records. See recommendation 4. Local councillors visit the home each year to meet staff and service users. Regular unannounced visits were undertaken to comply with regulations. Boots carried out an annual audit of medication. The last satisfaction survey was sent to relatives in August 2005. Seven responses were received. Feedback was very positive with a number of the relatives stating that the care and facilities provided in the home had improved. The Manager agreed to discuss the previous recommendation about accident reporting with the Head of Care. All of the homes procedures will be reviewed at this meeting. The manager said she had advised staff to record all accidents and incidents. See standard 6 and recommendation 5. No health and safety issues were identified during this inspection. The Drive DS0000006811.V276629.R01.S.doc Version 5.1 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 X X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 2 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 X 3 2 X 2 2 X 3 X The Drive DS0000006811.V276629.R01.S.doc Version 5.1 Page 24 Are there any outstanding requirements from the last inspection? No 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 YA6 Regulation 17 Requirement The Registered Person must ensure that staff maintain accurate and up to date records about significant issues that occur in the care home. The Registered Person must provide the Commission with an action plan outlining the timescale for replacing the carpet on the staircase and the units in the main kitchen. The Registered Person must ensure that staff follow standard procedures for the disposal of clinical waste. The Registered Person must advise the commission in writing about how the home intends to comply with the target for 50 of care staff to achieve a vocational qualification in care. The plan must include the timescale for meeting this target. The Registered Person must ensure that an application to register a manager for the service is submitted to the commission by 01/04/06. Timescale for action 14/03/06 2. YA24 23 01/04/06 3. YA30 13 14/03/06 4. YA32 18 01/04/06 5. YA37 9 01/04/06 The Drive DS0000006811.V276629.R01.S.doc Version 5.1 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard YA12 YA35 YA35 YA39 Good Practice Recommendations The Registered Person should maintain up to date records about activities and outings. The Registered Person should ensure that bank staff receive appropriate training. This should include record keeping training. The Registered Person should ensure that care staff receive structured induction training to Sector Skills Council specification. The Registered Person should implement a continuous system of self- auditing. The Registered Person should review the homes accident reporting procedure to include all accidents and incidents, regardless of whether the service user sustains an injury. The Drive DS0000006811.V276629.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 The Drive DS0000006811.V276629.R01.S.doc Version 5.1 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
