Inspection on 03/05/07 for The Grove

This inspection was carried out on 3rd May 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Grove 20/04/09

The Grove 22/04/08

The Grove 27/09/06

The Grove 02/08/06

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 The Grove The Grove 74 King Street Dawley Telford Shropshire TF4 2AQ Lead Inspector Rebecca Harrison Key Unannounced Inspection 3rd May 2007 09:40 The Grove DS0000066733.V334673.R01.S.doc Version 5.2 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 Grove DS0000066733.V334673.R01.S.doc Version 5.2 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 Grove DS0000066733.V334673.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Grove Address 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 Grove 74 King Street Dawley Telford Shropshire TF4 2AQ 01952 501 202 www.dimensions-uk.org Dimensions (UK) Ltd vacant post Care Home 5 Category(ies) of Learning disability (5) registration, with number of places The Grove DS0000066733.V334673.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th September 2006 Brief Description of the Service: The Grove is registered with the Commission for Social Care Inspection (CSCI) to provide accommodation and personal care for a maximum of five adults with a learning disability. The Grove is a large detached property situated in the town of Dawley, Telford. The home offers access to local amenities and public transport and is in keeping with the local community. The accommodation is based over two floors providing five single bedrooms, a kitchen, lounge, dining room, conservatory and large enclosed gardens. Dimensions (UK) Ltd is the registered service provider and the responsible individual is Ms Susan O’Loughlin. There is no registered manager currently in place however Ms Vicky Shakespeare is the acting manager of the home. People who use the service and their representatives are able to gain information about this home from the Statement of Purpose and Service User Guide and inspection reports produced by CSCI can be obtained direct from the provider or are available on CSCI’s website at www.csci.org.uk The current fee charged per person is £6216.00 per month. The Grove DS0000066733.V334673.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 3rd May 2007 and was carried out by two inspectors over a period of seven hours. It included talking with service users, the acting manager and area manager, staff on duty, looking in detail at all aspects of care provided for two people, examining a number of records and a tour of the home. CSCI received four surveys from visiting professionals and a relative in preparation for the inspection and comments received have been included in the report. CSCI’s Pharmacist Inspector undertook a full audit of medication during an unannounced inspection on 2nd April 2007 and the findings of the inspection have been included in this report. The purpose of the inspection was to assess all 22 ‘Key’ National Minimum Standards for Younger Adults and to review the requirements made at the last inspection undertaken on 27th September 2006. A quality rating is provided throughout the report based on each outcome area for the people who use the service. These ratings are described as excellent/good/adequate or poor based on findings of the inspection. The people who use the service, managers and staff on duty were very helpful and co-operated fully throughout the inspection. What the service does well: The staff team are committed to the people they support and work positively within the available resources. People are supported to maintain good relationships with family and friends. It was reported that fourteen of the fifteen staff employed hold an NVQ award, which exceeds the National Minimal Standards. Feedback received from surveys in preparation for the inspection includes: ‘The home has some good long standing staff that have great potential’. ‘The home maintains contact with medical and other professionals and treats clients with respect, dignity & genuine care’. ‘The staff team should be commended for attempting to maintain high standards of care under extremely difficult circumstances. The staff are very loyal to the residents in their care’. The Grove DS0000066733.V334673.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The recruitment of permanent staff would reduce over reliance of agency staff. Staffing levels must be kept under constant review and staff deployed in sufficient numbers to meet the individual needs of the people accommodated at all times to ensure service users and staff are not placed at risk of harm or abuse. The people who use the service and the staff team have undergone numerous changes in management over the last three years and now require some stability in order to move the service forward and to provide more positive outcomes for service users. Medication policies and procedures need to be reviewed. The Grove DS0000066733.V334673.R01.S.doc Version 5.2 Page 7 A change of appointee ship needs to be undertaken as soon as possible to ensure people directly receive the financial benefits they are entitled to receive. Feedback received from surveys in preparation for the inspection include: ‘Higher management need to respond more speedily and appropriately when issues are brought to their attention’. ‘With the right level of staffing and skill mix and clear leadership the service will become closer to the goal of supporting individuals to live the life they choose’. ‘There needs to be good staff development and support network in place and staff need to be more adaptable and work towards the need of the service users and not rotas. I would really like to see Dimensions working better to develop and support staff in the right ratios so that residents have a better quality of life’. ‘The home needs to retain four staff per shift during the day and reduce agency workers. They need to maintain and increase activities for all men both inside and outside based on risk assessment as appropriate. Improvements are taking place but it is imperative that such improvements continue and do not slip once attention from the service has been removed’. 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 summary of this inspection report can be made available in other formats on request. The Grove DS0000066733.V334673.R01.S.doc Version 5.2 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 Grove DS0000066733.V334673.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective people and their representatives have the information needed to choose a home and are provided with a contract, which tells them about the service they will receive. EVIDENCE: The home has a Statement of Purpose in place and the people who use the service have been issued with a pictorial handbook, which also includes a copy of the terms and conditions of residency. These have been produced in a format appropriate to the needs of the individuals living at the home and have been approved by an independent advocate. There have been no new admissions to the service since the last inspection therefore it was not possible to assess key standard 2 on this occasion. Assessment procedures were considered satisfactory at the time of the last inspection. The Grove DS0000066733.V334673.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are provided with detailed information to ensure the individual assessed needs of people receiving a service are met. People are appropriately supported to make decisions and are enabled to take responsible risks within a risk-assessed framework, which is regularly reviewed. EVIDENCE: Care documentation held on behalf of two people was examined during the inspection. Both support plans were person centred and detailed. There was evidence that one person had recently been reviewed in conjunction with the Joint Community Learning Disability Team. It was reported the review for the other person is currently on hold at the request of family, but would be held as soon as possible. The home have yet to introduce Dimensions own support plan documentation which was fully acknowledged by the acting manager who stated that she intends to address this as soon as possible. Three agency staff The Grove DS0000066733.V334673.R01.S.doc Version 5.2 Page 11 spoken with during the inspection confirmed that their induction included reading all care documentation and risk assessments prior to supporting people at the home. People who use the service have designated key workers and the acting manager stated that monthly key worker reports are to be introduced shortly based on current needs and goals. One of the key workers spoken with had an explicit understanding of the person he key works and observation of work practice made evidenced that he has developed a positive relationship with the person concerned. Since the last inspection staff have started to develop ‘My Life’ books with people they support. Behaviour care plans examined were detailed and cross-referenced to risk assessments and staff spoken with considered they are provided with Sufficient information to positively manage any behaviours that challenge. One Individual reactive management plan examined was in need of review. There was evidence of advocacy support for existing service users prior to the most recent admission and in the development of terms and conditions of residency. The same independent advocate is currently representing the best interests of four people following a referral under adult protection procedures. Throughout the inspection staff were observed to engage with service users in a positive manner and people were offered choices and were actively involved in decision-making processes in relation to their daily routines and activities. Records examined on two peoples files evidenced that individuals are enabled to take responsible risks based on assessment. Since the last inspection some new risk assessments have been developed for in-house and community based activities however other risk assessments remain on NHS PCT documentation and had not been reviewed since January 2006. Staff are in the process of signing risk assessments. The Grove DS0000066733.V334673.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Opportunities for people to partake in social and recreational activities have improved based on staffing availability. People are helped and encouraged to keep in contact with family and friends and are involved in menu planning however there are concerns relating to how and if the dietary and nutritional needs of some people are being met. EVIDENCE: Due to increased staffing levels following a referral under adult protection procedures people are now being provided with greater opportunities to have a community presence and partake in structured activities. It was reported that people have recently been supported to attend an open day at the local college to pursue appropriate courses as recommended by the previous inspection. Activity plans have been developed and all activities undertaken are recorded following each shift. During the inspection people were supported to access the The Grove DS0000066733.V334673.R01.S.doc Version 5.2 Page 13 community and it was reported that one person was due to attend a regional forum for the organisation on the evening of the inspection. Staff reported that activities are much improved as evidenced in records examined for two people. Observations made throughout the inspection suggest that in-house activities require further development, which was acknowledged by the acting manager. Communication guidance was available on the files examined and documentation has been produced in a user-friendly format for example, service user handbooks, contracts and pictorial menu planner to assist people with choosing meals. A new pictorial communication book has been developed for another person, which contained numerous photographs and symbols relevant to family, his activities and his home. Records seen on the files examined evidence that people have the opportunity to develop and maintain personal and family relationships. The records of the person most recently admitted identified that a friend from his previous placement had visited him and he was supported to send a close relative a card following an operation. The other person case tracked had recently been supported to visit his family in Wales. Family contact details were available on the files examined and the acting manager reported that the team are currently liaising with families to establish important events and anniversaries. Throughout the inspection people were treated with respect and it was evident that permanent staff have developed positive working relationships with the people they support. Staff spoken with had an understanding of service user rights however people had not been registered to vote at the local elections, which was confirmed by a staff member. Since the last inspection individual mailboxes have been fitted in the reception area and people are supported to open their mail. A member of staff was observed to knock on bedroom doors during a tour of the home. People have unrestrictive access to the home and can choose when to be alone or in the company of others as observed throughout the inspection. Bedrooms are lockable however a member of staff on duty stated that none of the service users currently have a key to their room but considered three people could possibly use this facility. It was reported that no one currently undertakes any religious observance. Pictorial menu planners have recently been introduced and the new menu system was discussed with a member of staff. One care plan examined stated that the person is overweight however the pictorial planners do not provide a range of healthy options. Some gaps were found in food records and there was poor evidence of the person being provided with healthy meals as per his care plan. A weight chart has not been maintained for the other person case tracked despite it being stated that he has previously had an eating disorder and the care plan stating that his weight needs monitoring as it fluctuates. The Grove DS0000066733.V334673.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. Poorly managed systems and poor records for some medication meant that some people could receive the wrong medication or may not receive any medication at all, potentially placing people at risk of harm. EVIDENCE: Preferences in relation to personal support needs were documented on the two files examined. Staff spoken with had a good understanding of the needs of the people they support. A Health Action Plan was available on the one file examined and the manager stated that these have been developed for four people. Health appointments were documented on the files examined and evidenced that people are supported to access NHS healthcare facilities, are appropriately referred for specialist services and outcomes of all appointments were recorded. Records evidence that much work has been undertaken by the team to familiarise an individual with his new dental practice. The Grove DS0000066733.V334673.R01.S.doc Version 5.2 Page 15 An unannounced pharmacy inspection was undertaken on 2nd April over a period of six hours. The reason for the inspection was to assess the effectiveness of the home’s arrangements for the receipt, recording, handling, storage, safekeeping, safe administration, and disposal of all medicines received. The inspection comprised of examining the home’s policies and procedures, the medication storage areas, the records kept and talking to the staff. Medication Policy: The policy and procedures for the safe handling of medicines within the home was found to be lacking in detail and did not provide the staff with a detailed account of how medicines should be handled within the home. Record Keeping: The home was recording the receipt of medicines into the home but on closer examination not all the medicines had been recorded. It was also learned that any medication carried over from the previous month was not being consolidated with the new quantities. This meant that the home did not have an accurate audit trail to assure that each service user had received their medication as prescribed. The recording of the administration of some medication was poor. There were a number of gaps, which meant that there was no conformation of whether the medication had been given. An audit of some medication suggested that sometimes the records were being signed when the medication had not been given. Where generic abbreviations were being used these were not being defined and therefore the reason for the non-administration of the medication was not evident. This practice and the lack of adequate recording have the potential to put service users at risk. Administration: One of the service users had recently been discharged from hospital with some Co-codamol 30/500 tablets and it was seen that the home had failed to administer these and had administered the lower strength of co-codamol 8/500 tablets, which had been prescribed in July 2004, instead. The home had failed to identify the differences between the two strengths and had handwritten the MAR chart as Co-codamol 8/500 tablets. The result of this would have meant that the person might have experienced more pain than he needed to. On closer examination it was discovered that the Co-codamol 8/500 tablets being administered had expired in October 2006, which would have meant that the tablets would have been even less effective resulting in the person having to experience even more pain. The Grove DS0000066733.V334673.R01.S.doc Version 5.2 Page 16 The home also appeared to be administering some medication differently than what the label attached to the medication was showing and the home had no written evidence from the prescriber to confirm the difference. The home also did not appear to be carrying out an assessment before the administration of when required medication and in some cases appeared to be administering it on a regular basis. The home did not appear to have any written guidance to assist in the administration of the ‘when required’ medication and could result in some medication being administered when there was not a need. The home had also failed to seek written instructions for those medicines that had been prescribed with “as directed” directions. Administering with ‘as directed’ directions breach the Medicines Act 1968 and may result in service users receiving the wrong dose which could affect their health and welfare. Training: The new management team were finding it was very difficult to establish which members of staff had completed training on safe handling of medication, however during the key inspection on 3rd May 2007, the acting manager stated that nine of the permanent staff have undertaken distance learning medication training and that Boots Chemist were visiting the service on 18th May 2007 to provide staff training in the monitored dosage system. The company have decided to retrain all members of staff using the train the trainer concept. In January 2007 Managers were trained on safe medication handling and how to effectively train their members of staff. The pharmacy inspector was not able to comment on the quality of the training because sections of the training pack were missing. The main concern with this training was that the Managers could introduce their own bad practices but the pharmacist inspector was assured that the training concept had quality assurances built into it. There was very little evidence that the home had been carrying out any assessments of competency on the staff to handle and administer medication correctly. The home’s policy was for these assessments to be carried out on a six monthly period. The home was informed that they must, with some urgency, introduce this programme to ensure that the service users are receiving their medication in correct manner. The acting manager stated at the inspection of 3rd May 2007 that she had started to undertake competency tests with some staff however these were not examined on this occasion. It appeared that training was carried out in December 2006 on how to administer Midazolam solution during a seizure but again the evidence of who had done the training was not evident. The Grove DS0000066733.V334673.R01.S.doc Version 5.2 Page 17 Controlled Drugs: On a previous visit it was agreed that the Controlled Drugs cabinet could be removed from the office and relocated in the sleep in room, which was next to the office. On this visit it was seen that the Controlled Drugs cabinet had been removed to make way for the staffs’ lockers. The Controlled Drugs cabinet was found being loosely stored in one of these lockers, which contravenes standard 20 of the National Minimum Standards for Adults 18 – 65. The home was advised to relocate the cabinet on a solid wall using rag bolts. The Controlled Drugs register could not be found and therefore the home was not in a position to appropriately record the receipt, administration and disposal of a Controlled Drug if one was prescribed for one of the residents. Storage: As with the Controlled Drugs cabinet the metal medication cabinet had been removed and had been placed into storage in the outhouse. With the service users having individual medication cabinets in their rooms the excess stock was now being stored in a filing cabinet, which was located in the office. Examination of the filing cabinet found the contents to be disorganised and external medication being stored with the internal medication, which is unhygienic and could lead to cross-contamination of medication. Four out of the five service users had small medication cupboards located in their rooms. It appeared that these cupboards had been appropriately located in each of the rooms. On examination of the cabinets the inspector kept finding small dispensing boxes with one or two tablets in. It was assumed that in some way some of the medication had been spoiled and the home had ordered a small quantity to complete the monthly cycle. The question therefore was why was this medication still present in the cupboards when there were no obvious gaps or abbreviations on the MAR charts. This could be related back to an earlier suggestion that the MAR charts are being signed when medication is not being administered. The home was unable to suggest any other reason for this medication still being present within the cupboards. The Grove DS0000066733.V334673.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users and their representatives have access to a complaints procedure that enables their views to be listened to and acted upon. Procedures to safeguard service users from potential abuse are in place however financial procedures require review. EVIDENCE: People who use the service and their representatives have access to a complaints procedure in an appropriate format. The procedure is held in the key documentation file held in the office and available on the intranet. All service users are provided with a copy of the procedure as seen during the inspection. The homes complaints and compliments log was examined and seven compliments were recorded since the last inspection. Comments include ‘I would just like to thank you for the support and help you showed me during my time at The Grove. The home is run well and the staff and service users are very happy and it shows’. ‘The transfer of services seems to have gone smooth as far as we can tell and thanks to the staff our son continues to be happy at The Grove. ‘Being my first time here, I really felt as though I have always been around. Great reception from staff and team working. Enjoyed every minute of my The Grove DS0000066733.V334673.R01.S.doc Version 5.2 Page 19 shift, helpful & supportive staff. Homely to service users – Nice home The Grove’ One complaint was recorded however the acting manager was unaware of the outcome of this at the time of the inspection. Since January 2007 CSCI have received concerns from seven people regarding the placement of one person whose behaviours were having a significant impact on fellow peers and staff resulting in injury to service users and two staff. Concerns were also expressed in relation to poor staffing levels, high levels of staff sickness resulting in the increased use of agency staff, deterioration in service users wellbeing and increased behaviours due to staff shortages, lack of support from the manager and senior managers, poor staff morale and a lack of structured activities for the people using the service. A referral was made under adult protection procedures in relation to four people living at the home and Joint Review meetings have been held and are ongoing. As a result staffing levels have increased to four per shift throughout the day and waking night staffing levels were initially increased. Following a decrease in incidents and the installation of a new Assistive Technology System, night staffing levels have decreased based on a risk assessment. Following the inspection CSCI received a concern on 17th May 2007 stating that a service user was recently accompanied to the hospital in the early hours of the morning by a permanent staff member leaving an agency member of staff alone in the home alone with four service users. This concern was immediately shared with the acting area manager who confirmed that this incident arose and fully acknowledged that this practice potentially placed service users and the agency staff member at risk. A full report is to be undertaken by the provider and forwarded to CSCI. The concern was also shared with the Senior Practitioner of Adult Protection given that four people currently remain under adult protection procedures. The home has a copy of the local safeguarding adult policy and procedures and the training matrix identified that eight staff have received training in adult protection and a further four staff are due to undertake this training in July 2007. It was reported that the majority of the team have received training in physical intervention and agency staff spoken with confirmed that they had received training in physical intervention. Managers stated that they are meeting shortly with the agency to review training requirements. The Management of Actual and Potential Aggression (MAPA) Co-ordinator has met with the team to offer advice in relation to supporting one person. An incident identified by Telford and Wrekin’s Quality Monitoring Officer during a visit to the home concerning an agency member of staff is currently being investigated by the agency. A referral has since been made under adult protection procedures. The incident was reported to CSCI under Regulation 37. The Grove DS0000066733.V334673.R01.S.doc Version 5.2 Page 20 Service users have their own bank accounts however personal allowances are not currently being paid into these accounts due to problems with the appointee ship since the change of provider. It was reported that this issue is being addressed with the benefits officer and will be resolved as a matter of urgency. The acting manager stated that the Financial Manager for Dimensions has recently visited the home and is due to return shortly to undertake a full financial audit. New financial recording books have recently been introduced and two staff sign all transactions. A staff member spoken was confident that procedures safeguard people. The Grove DS0000066733.V334673.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service are provided with a comfortable place to live. The lack of maintenance and effective infection control procedures potentially places people at risk. EVIDENCE: A full tour of the home was undertaken accompanied by the acting manager. It was reported that quotes had been obtained for the replacement of the flooring in the reception as this area continues to appear clinical and does not present a homely environment. Other planned improvements were discussed at inspection and the acting manager was advised to develop a planned maintenance and renewal programme as soon as possible taking into consideration refurbishment of bathrooms to include replacement of broken tiles around the bath and repair of the radiator in the ground floor bathrooms. Bedrooms were personalised and reflect individuality. The provider has experienced problems with outstanding repairs and maintenance however it The Grove DS0000066733.V334673.R01.S.doc Version 5.2 Page 22 was reported that this is currently being addressed with the Contracts Department. It was reported that the Environmental Health Officer has not visited the home since the last inspection and a report received from the Fire Service indicates compliance. Since the last inspection the provider has installed an Assistive Technology System to provide staff with back up assistance if required and reduce waking night staffing levels based on risk assessment. Call systems have been introduced to three bedrooms and bathrooms, a door sensor on one-bedroom and epilepsy and continence systems in place. Staff are provided with a pager for back up assistance if required. Staff spoken with welcomed this new system. They reported that they have been provided with operational guidelines however considered additional training is required for the system to be fully effective. The garden was found very overgrown however it was reported this is currently being addressed. The home was generally found clean during this unannounced inspection and a cleaning schedule is maintained. The lounge carpet required cleaning in addition to a ground floor bath and landing carpet. An odour was detected in one bedroom although the floor covering is due to be replaced shortly. Bathmats were found unlabeled and inappropriately stored which was fully acknowledged by the acting manager. Substances hazardous to health were appropriately stored and it was reported that the system is being revamped and new data sheets and assessments obtained as evidenced in the minutes of a staff meeting. The Grove DS0000066733.V334673.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service are safeguarded by the organisations recruitment procedures and are supported by a staff team who are committed and work positively with the people they support within the resources available. EVIDENCE: Six staff were spoken with during the inspection to include three agency staff. The permanent staff on duty all had a clear understanding of the individual needs of the people they support. Discussions held clearly indicated that the team have clearly experienced problems particularly with high levels of staff sickness and use of agency staff. At the time of the inspection three full-time staff were on long-term sick and one part-time staff member on short-term sick leave. Staffing levels have increased to four staff per shift throughout the day following Joint Review Meetings held under adult protection procedures. On occasions it was reported that only one permanent staff member is on duty with three agency staff, which can have an impact on the provision of activities and community presence and participation for people using the service. The Grove DS0000066733.V334673.R01.S.doc Version 5.2 Page 24 Staff spoken with reported that staff morale is low but improving. One person stated ‘We have been let down by the organisation and service users have suffered but they are trying to put things right now’. Another person stated ‘Things are better here since the Adult Protection meetings and more things are being done with the increase in staffing levels, it’s more positive and new things are being introduced and we are getting more regular agency staff who are familiar with service users needs, however there is still room for improvement overall’. One person stated ‘Things are improving for people however the activity rota in place is not always realistic due to the high use of agency and nobody really knows whose managing the home at the moment’. An agency staff member stated ‘Lovely helpful staff team’. Another person stated ‘ The permanent staff are very good and try to meet peoples individual needs’. A new staff rota has recently been developed and implemented and was an accurate reflection of the staff on duty. The acting manger stated that she is planning to hold a meeting with staff shortly for their suggestions and input to fully cover the service given the high levels of sickness. The home currently has a 45-hour support worker vacancy and interviews are scheduled. Personnel files are currently held at the organisations area office. No new staff staff have been recruited since the last inspection. However recruitment procedures and personnel files for the organisations other homes in Shropshire were examined during the morning of 23rd April 2007. No shortfalls in documentation required by Regulations were identified. Dimensions have requested to centralise their Human Resources records, which CSCI policy now allows following approval. This allows the provider to keep the originals of their records centrally and keep a proforma in the care service, which the acting area manager committed to undertake. Individual training records examined and discussions held evidence that staff have received little training under the current provider. It was stated that ‘Training was available but staff were not referred’. A staff-training matrix has been developed and it was reported that all staff would have completed all outstanding mandatory training courses by September 2007. The training file examined was well presented and the acting manager stated that she is the training representative for Shropshire and has sourced specialist training and this has been discussed as seen in the team minutes. A team-training plan has yet to be developed however it was reported that a Team Away Day would be arranged shortly. The home employs fifteen staff and it was reported that fourteen staff hold an NVQ award and that the one outstanding person will be registered shortly. Staff spoken with stated they are in need of training in autism, which has recently been sourced. A staff appraisal & supervision tracker form has recently been developed and dates were seen which indicate that six staff have recently received formal The Grove DS0000066733.V334673.R01.S.doc Version 5.2 Page 25 supervision and records were available on three staff files examined. The acting manager committed to ensure that outstanding staff receive supervision and stated that appraisals would be undertaken within three months. Staff meetings are held monthly and comprehensive minutes available. It was reported that staff still have clinical supervision provided through the psychology department. The Grove DS0000066733.V334673.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,41 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management team have a clear understanding of the current shortfalls and the improvements required to improve outcomes for service users. Aspects of performance are reviewed and the team are making progress towards raising the standard of record keeping and ensuring the health, safety and welfare of service users is promoted. EVIDENCE: Ms Vicky Shakespeare is currently the acting manager of the home in the absence of the manager. She is being supported by the acting area manager and has obtained and NVQ level 3 award and is working towards NVQ level 4 Care Award. Discussions held indicate that she has attended training appropriate to her role. She reported that she has introduced a number of The Grove DS0000066733.V334673.R01.S.doc Version 5.2 Page 27 changes to the service since her appointment and stated that ‘people are supported by a good strong team who work well together, hold service user interests at heart and are trying to make a difference’. Since the last inspection a number of groups have been developed across the organisation to include a Regional Advisory forum and Joint Consultancy Group to assist with quality assurance and future planning. It was reported that quality assurance surveys have yet to be distributed to service users/ their representatives, families and stakeholders however a Family event was held in Telford on 5.12.06. The home has a quality audit file in place and reports of visits required under Regulation 26 are readily available. It was reported that the team would develop a service ‘PATH’ for the forthcoming year at the Team Away Day to inform planning and review. Comments in surveys received by CSCI in preparation for this inspection include: ‘Staff have the right skills and experience but are not empowered by management to make decisions or act in ways which would encourage/ promote out of the box thinking. More creative & resourceful management needs to be in place to make The Grove a place people live the life they choose’. ‘Some good long standing staff that have great potential’. ‘It is unfortunate that that Commission for Social Care Inspection had to be contacted and a referral made under adult protection initiated before Dimensions were pressured into addressing some of these longstanding problems’ ‘I would really like to see Dimensions working better to develop & support staff in the right ratios so that residents have a better quality of life’. ‘The ‘Grove is a warm and homely place. Our son is mostly happy there’. ‘To my knowledge staff are very proactive in seeking medical/ dental treatment for the service users…Limited resources has affected staffs ability to respond to the differing needs of individuals’. This inspection evidenced that the homes record keeping systems are much improved and information is now readily available. The acting manager reported that the home is in the process of transferring records onto Dimensions paperwork. The Grove DS0000066733.V334673.R01.S.doc Version 5.2 Page 28 Records examined evidence that health and safety checks are carried out at the required frequency and all equipment serviced within required timescales. Staff are booked to attend training in safe working practices and risk assessments were last reviewed in April 2007. As previously reported Environmental Health have not visited the home since the last inspection. The Fire Officer has recently visited the home and the report seen demonstrates compliance. Records evidence that staff test water temperatures prior to individuals taking a bath however recorded temperatures average 36°C therefore the manager was advised to address these low temperatures. A health and safety inspection was undertaken by the organisation in February 2007 and managers are working towards meeting the recommendations made. A gas certificate dated 2.4.07 states the gas pipe work is undersized and not to the current standards therefore this needs addressing. Outstanding maintenance and repairs are currently being addressed with the local authority’s Contracts Department. A quality maintenance report, dated 27.3.07 identified many items in need of improvement. The acting manager was advised to review the arrangements for storing knives in the kitchen as a service user was seen unsupervised in the kitchen with access to sharp knives. The home has the Safer Food, Better Business – Food Standards Agency documentation in place and staff are maintaining this. The Grove DS0000066733.V334673.R01.S.doc Version 5.2 Page 29 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 3 2 x 3 x 4 x 5 3 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 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 3 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 x 3 x 3 2 x The Grove DS0000066733.V334673.R01.S.doc Version 5.2 Page 30 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 YA20 Regulation 13(2) Requirement The medication records for the people who use the service must be robust and accurate to make sure that medication is administered as prescribed. The prescribing information must be detailed, accurate and specific to the individual in order to make sure that the people who use this service receive medication at the appropriate time. A comprehensive policy and procedures document must be developed for the handling of medication within the home, which depicts all of the procedures that are, and need to be, carried out by the care staff to ensure people are safeguarded. Staffing levels must be kept under review to ensure service users and staff are not placed at risk of harm or abuse. DS0000066733.V334673.R01.S.doc Timescale for action 14/06/07 2. YA20 13(2) 14/06/07 3. YA20 13(2) 30/06/07 4. YA33 18(1)(a) 31/05/07 The Grove Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA17 YA20 Good Practice Recommendations It is strongly recommended that the dietary and nutritional needs of the service users identified at inspection be assessed and kept under review. It is recommended that the staff competency to handle and administer medication to people who use this service is checked on a regular basis so that medication is given correctly at all times. It is recommended that the medication and Controlled Drug cabinets be reinstalled to make sure that all medicines are safely and hygienically stored. It is strongly recommended that a change of appointee ship be undertaken as soon as possible to ensure people directly receive they the financial benefits they are entitled to receive. It is strongly recommended that a planned programme of maintenance and renewal for the fabric and redecoration of the premises be developed and records kept and all outstanding works actioned as a matter of urgency to ensure the safety of service users. It is strongly recommended that permanent staff be recruited to fill vacant posts as soon as possible to provide consistency and stability for people who use the service. 3. 4. YA20 YA23 5. YA24 6. YA33 The Grove DS0000066733.V334673.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: 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 © 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 Grove DS0000066733.V334673.R01.S.doc Version 5.2 Page 33 - 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. 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