Inspection on 16/05/06 for The Trio House

This inspection was carried out on 16th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Trio House 22/06/09

The Trio House 26/06/07

The Trio House 07/11/05

The Trio House 22/06/05

The Trio House 19/02/05

The Trio House 15/09/04

The Trio House 18/03/04

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 Trio House The 15 Abbotsmead Road Belmont Hereford Herefordshire HR2 7SH Lead Inspector Christina Lavelle 16th May 2006: Unannounced Inspection (Additional visits 19th May & 12th June) 9.15 Trio House The DS0000024794.V293987.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 Trio House The DS0000024794.V293987.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. Trio House The DS0000024794.V293987.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Trio House The Address 15 Abbotsmead Road Belmont Hereford Herefordshire HR2 7SH 01432 342416 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) Miss Margaret Clark Stevenson Miss Margaret Clark Stevenson Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Trio House The DS0000024794.V293987.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents may also have a physical disability in addition to a learning disability 7th November 2005 Date of last inspection Brief Description of the Service: The Trio House is home to three adults who need care due to severe learning disabilities. The service users are all men in their thirties and forties and the home was set up just for them in 2001 when the care home they were living in was closing. The provider/manager of The Trio House was the manager of their former care home and so they have all known each other for years. The property is a reasonably sized, detached family house situated on a large, new modern housing estate on the outskirts of Hereford city. There are some local shops and facilities nearby, such as a supermarket with a café and a park. The home also has a suitable vehicle for outings into town and further afield. The home has a fairly small and secure garden, which can be reached through the conservatory. Service users all have single bedrooms upstairs. One of the bedrooms has an en-suite toilet and bath and another has an en-suite toilet and shower. There is also a separate bathroom and ground floor cloakroom. The home has a good-sized lounge and a brick built conservatory with seating and a television etc and so can be used as an extra sitting room. The house also has a kitchen/dining area, a utility room, office and staff sleeping-in room. The current fee for the service is £1076.10 for each service user. Additional charges are made (as specified in the home’s Terms & Conditions of Residence document) for holidays, clothing, individual personal needs, renewing personal goods, funeral expenses and transport. Trio House The DS0000024794.V293987.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit was part of a key inspection of this service and was carried out in six hours during the day time in summer. Two further brief visits were made to the home on the 19th May and 12th June to follow up one specific issue relating to staffing. The main purpose of this inspection was to assess the service provided against key National Minimum Standards. Service users are not able to discuss their lives and whether they like living at The Trio House because of their disabilities and limited communication. Time was spent in their company to observe their activities and interactions with staff. Letters with comment cards were also sent to service users’ families and health and social care professionals involved with their care asking for their views of the home. Feedback received is referred to in this report. Relevant records about service users’ care, the food provided, staffing and showing how the home is kept safe were also checked and the premises looked around. Since the last full inspection two complaints had been made to the Commission about the service. Some concerns being similar to those raised by previous complainants. An unannounced inspection was undertaken on March 6th 2006 to follow up the first complaint. Whilst most concerns were not substantiated it was apparent that some staff had left the home recently and new staff had been working before all necessary checks had been obtained by the home. The most recent complaint indicated possible risks to service users’ safety and so the home was referred under Herefordshire multi-agency procedures for the Protection of Vulnerable Adults. What the service does well: The Trio House provides a secure and very comfortable home for service users. The home offers them the opportunity to live in an “ordinary” house, which has helped them to be part of and so accepted in the local community. The house is furnished, equipped, decorated and maintained to a high standard. Service users’ bedrooms are nice and personal and there is enough space in the home for them to be with others if they wish or be on their own in their bedroom. The atmosphere in the home is homely and relaxed. The three men are clearly at ease with each other and appear to get on well with the provider and staff. Good links are maintained with service users’ families and two relatives who responded to the Commission’s request for their views were positive about the care their relatives receive, the home in general and the provider and staff. Staff make sure that all service users’ personal care needs are met. They also support them to take part in social and leisure activities outside the home to make their lives more active and interesting. Trio House The DS0000024794.V293987.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Trio House The DS0000024794.V293987.R01.S.doc Version 5.1 Page 7 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 Trio House The DS0000024794.V293987.R01.S.doc Version 5.1 Page 8 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): 2 Quality in this outcome area cannot be assessed as this home was set up and continues to provide a service only for the current three residents. Therefore there has not been, and is very unlikely to be, any prospective service users. EVIDENCE: These Standards are either not relevant to the home or are not fully assessed during this visit. However it was previously confirmed that a statement of purpose, service users’ guide and a terms & conditions of residence documents have been produced for the home, as is required. A contract is also in place and has been agreed between the service provider and service users’ funding authority (Herefordshire Council) for the provision of the service. In view that the current resident group is stable there has not been a need for prospective service users to be given information about the home. Therefore key Standard 2 and other Standards relating to an assessment of prospective service users’ needs and aspirations and the arrangement of visits and trial stays at the home as part of an admission process, are not applicable. Trio House The DS0000024794.V293987.R01.S.doc Version 5.1 Page 9 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, 7 & 9 Quality in these outcome areas is adequate. This judgement has been made using available evidence including a visit to the home. Care planning and risk assessment systems are in place to inform staff about service users’ care needs and any possible risks to their safety. However it would help to ensure service users’ wishes and goals are known and they are enabled to make choices in their lives if a more “person centred” approach to care planning and delivery is implemented. It would also ensure service users behaviour is being managed appropriately by staff if and when their plans are reviewed and updated with the involvement of relevant professionals. EVIDENCE: Service users’ care records were looked at. They include some personal and background information, a weekly activities plan, daily reports and a record of significant events. Each person also has a care plan with information about their health, communication, relationships, daily living and self care skills, and when they are out in the community. Any action staff need to take to meet and/or manage some of these areas of need and service users’ basic likes and dislikes are also indicated. Staff are expected to review and update the plans monthly, so they should reflect their current needs, and any changes. Trio House The DS0000024794.V293987.R01.S.doc Version 5.1 Page 10 However the plans do not really focus on service users’ individual wishes and goals and would benefit from being more “person centred”. Whilst some service users’ families had signed plans on their behalf there was no evidence they, or service users’ advocates and relevant other people, had been directly involved in care reviews to ensure that the choices they would make in their daily lives and routines are considered and direct the service they receive. It is positive therefore that one staff member had recently attended a training session on person centred planning (PCP) from the local authority co-ordinator. It was intended in due course for another of the staff team to attend and in the meantime the information would be cascaded to all other staff. Consideration should also be given to the home introducing a more person centred care plan format and seeking the support of the PCP co-coordinator to facilitate reviews. It is also planned for staff to attend a training session on total communication taken by a Speech therapist. This should help staff to encourage service users’ to make their views and wishes known better, to the extent they are capable. Risk assessments had been carried out for each service user, some relating to general environmental hazards, such as guarding radiators. Others are specific to individuals, such as food being cut up and behaviours that could pose a risk to their safety. Some ways for staff to manage these behaviours to protect service users from self-harm were noted, such as reassurance and distraction. However some plans still referred to Restraint Procedures rather than positive interventions. This term is inappropriate, as restraint should only ever be used as a last resort and then in consultation with appropriate professionals and by suitably trained staff. Some issues referred to in daily reports, such as spitting and excessive demands for drinks had either nor been reviewed recently or did have a care management plan in place. Trio House The DS0000024794.V293987.R01.S.doc Version 5.1 Page 11 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, 13, 14, 15, & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to the home. Staff enable service users to participate in various leisure and other activities within the wider community. It would help to make sure these activities are in line with individuals’ interests and needs if a more “person centred” approach was implemented. Service users maintain close contact with their families. It should ensure service users’ receive fresh and wholesome food when meals are prepared just before being served. Particular issues relating to service users’ eating and drinking should be assessed and reviewed regularly to ensure any nutritional difficulties and risk factors are being dealt with appropriately. EVIDENCE: Service users have severe learning disabilities and so are not able to develop work related skills or take up work placements. They all attend a day service for people with learning disabilities one day a week. They are also enrolled on a small breeds course another morning a week at a local college. However one social care professional commented that service users had not attended at Trio House The DS0000024794.V293987.R01.S.doc Version 5.1 Page 12 least nine sessions since September. This was mostly without explanation from the home, although lack of staff or staff not able to drive the vehicle had been cited. However service users’ funding authority recently agreed to additional funding for community based activities and a staff member is allocated specific time on week days for activities and so this situation should not arise again. Staff accompany service users out for walks to the local supermarket and park and occasionally drive to a nearby pub. Although there is little contact with the home’s immediate neighbours, local people have apparently accepted the service users and the extent to which they could integrate is limited anyway. Service users’ care records include a weekly activity plan including outings and activities e.g. swimming, walks, shopping at Tescos, picnics, garden centres, bowling, bingo and watching television. They do not belong to any social clubs for people with learning disabilities because the provider said two service users could not take part in an acceptable way. Service users do not often go out in the evenings but were soon to go on their annual holiday to Spain. Other holidays are arranged, usually over weekends in a caravan, as a group. Daily reports are kept showing the activities each person has actually taken part in. During this visit a service user was taken into town for a snack and another went out later, also with the allocated activities staff member. One service user was sat outside in the sun all morning and was given drinks at regular intervals. Another wandered around trying to obtain drinks and the television was on continually, although no one appeared to be watching it. Whilst these activity plans are helpful they do not show that service users’ individual interests and wishes have been identified and how they are being met. Two recent complainants have also alleged that activities are often short and outings are based on what staff rather than service users want to do. Whilst this is difficult to substantiate, service users’ plans could indicate any goals and/or benefits for each service user and their duration of activities. In relation to food provision the home’s menus were checked and indicated a range of wholesome meals, with plenty of fresh vegetables, fresh fruit, pasta, rice and few less healthy snacks. Several complainants alleged however that service users were described as being “on a strict diet”. Also that their meals were not varied and of poor quality (convenience foods or pre-cooked). Although this was not substantiated in inspections it is good that staff are now expected to prepare fresh meals on a daily basis and had been given recipes to ensure they could produce them properly and as service users could manage (e.g. the meat tender). Some service users also have issues in relation to diet, such as obsessive drinking, which was said to have got worse due to their weight. These difficulties should be reviewed in consultation with relevant professionals to help staff to manage them appropriately. Trio House The DS0000024794.V293987.R01.S.doc Version 5.1 Page 13 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): 18, 19 & 20 Quality in this outcome area is adequate. This judgement is made using available evidence, including a visit to the home. Arrangements are in place to ensure the personal and health care needs of service users are met properly. It would better ensure that some service users’ specific health related issues are being managed appropriately if staff had received training and/or relevant professionals were consulted. Medication is managed safely by the home. EVIDENCE: Service users were seen to be clean and appropriately dressed for their needs, age and the weather. Support needed from staff to meet their personal care needs is described as “all care needed” although a checklist is kept of required personal care tasks showing when and which staff member had provided help. Relevant physical checks and incidents are recorded, such as toileting, weight and seizures. The provider also discussed support obtained from a Psychiatrist, Continence Advisor and Speech Therapist and records showed regular dental and annual “well man” checks are arranged. Daily reports made by staff include health care problems, although one service user’s skin condition that Trio House The DS0000024794.V293987.R01.S.doc Version 5.1 Page 14 was being monitored was described inappropriately as “nappy rash”. A GP had been consulted and a prescription for cream dispensed. It was seen that two service users had recently lost around half a stone and the provider said their weight fluctuates and so was closely monitored. One person was currently having extra snacks and the other was overweight at one time and their family were anxious he did not put excess weight on again as it had affected his mobility. As already discussed this should be reassessed and reviewed regularly in consultation with relevant health care professionals. In respect of seizures they are currently reported in service users’ daily records. It is advised that more detail of the type of seizure and observations made at the time of each incident is necessary to ensure there is information for the Psychiatrist who monitors their epilepsy, including use of medication. Staff training in respect of epilepsy awareness is strongly recommended. Staff had received training in relation to the safe handling of medicines and the home provides policies and procedures. Storage of medication in the home is suitable and administration records were being maintained appropriately. Trio House The DS0000024794.V293987.R01.S.doc Version 5.1 Page 15 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 & 23 Quality in this outcome area is adequate. This judgement has been made using available evidence, including visits to this service. Service users would be better protected if the manager was more open to the views of staff and if all concerns raised were fully investigated, recorded and reported to appropriate other agencies. It would ensure staff are clear about their responsibility, and how and where to refer any incidence or suspicion of abuse or neglect of service users, if they had received relevant instruction. EVIDENCE: In view of service users’ disabilities they are not able to express their views or raise concerns directly themselves and so it is essential their families or other people would do so on their behalf. Feedback from service users’ relatives from this and previous inspections confirmed they had never had to make a complaint, and so had not needed to use the home’s complaints procedures. The Commission had recently received two complaints about the service. Their allegations related mostly to staff caring for service users without having CRB disclosures and staff being made to leave when they questioned care practice or their conditions of employment. Other concerns were that service users’ activities are limited and staff oriented, food provided is of poor quality and that staff had been told not to record incidents in the home. Another issue was an incident where a staff member was seen to deal inappropriately with a service user and although the provider was informed no action had been taken. Trio House The DS0000024794.V293987.R01.S.doc Version 5.1 Page 16 The complaints were clearly made by current or former staff and some of the allegations could have an adverse affect on service users’ care and protection. Whilst most concerns were not substantiated in the unannounced inspection carried out on March 6th 2006, it was confirmed staff had been working without CRB disclosures obtained by the home. Some staff had also left following alleged misconduct and disciplinary action had been taken, however this had not been reported to relevant other agencies by the home, as required. Further although complainants alleged they had raised some concerns with the provider there were no records of any complaints or any incidents having been reported and/or investigated. The provider should therefore consider any affect the culture of the home and/or management approach may be having on whistle blowing and staff feeling able to express their views. The home had information available relating to abuse, and staff are expected to go through this as part of their induction. However staff should attend a training session taken by the local co-ordinator for the Protection of Vulnerable Adults to ensure they understand their responsibility to protect service users. Also so they know in what circumstances and how and where to report any suspicion or incidence of abuse or neglect of service users through the local multi-agency procedures for the Protection of Vulnerable Adults. Trio House The DS0000024794.V293987.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, 25, 26, 27, 28, 29 & 30 Quality in this outcome area is good. This judgement is made using available evidence, including this visit to the service. The Trio House provides accommodation for service users that suitably meets their needs and offers them a safe, very homely and comfortable home. Appropriate arrangements are in place to help staff to maintain good hygiene and cleanliness in the home. EVIDENCE: The Trio House comprises of a detached, domestic house that is located in a quiet residential housing estate on the outskirts of Hereford. It therefore fits in well with the local community and has some amenities e.g. a park and large supermarket with a cafe, within walking distance. The facilities and services of the city are not too far away and the home provides a suitable “people carrier” vehicle for staff to enable service users to go out into the wider community. The home provides a very homely and comfortable environment. The house was also observed to be clean and tidy and have a good standard of repair, furnishings and décor. The home is suitable for the service users, who are all mobile and so do not need any specialist equipment, aids or adaptations. Trio House The DS0000024794.V293987.R01.S.doc Version 5.1 Page 18 Service users have single bedrooms that are well personalised and two have en-suite facilities. There is also a communal bathroom on the first floor, which together provides suitable and sufficient facilities to help staff ensure service users receive the individual support they need for their personal care privately. Whilst service users’ ability to develop independence is limited staff confirmed that service users do use their bedrooms when they wish to spend time alone. There is a large lounge and a brick built conservatory, used as a second sitting room, which has patio doors out to the reasonably sized and secure garden. The kitchen/diner also has doors out to a patio where there is garden furniture and is a private and pleasant place for service users to sit in the good weather. There is a utility room with laundry facilities downstairs and an office and staff sleep-in room upstairs. Theses communal rooms provide sufficient space and are well equipped with suitable domestic appliances. It was confirmed in previous inspections that policies & procedures are in place relating to infection control. Disposable gloves, aprons, clinical waste bags and antibacterial wash are provided for staff who said they are using them, and are a means of promoting good hygiene which is an essential for infection control. Trio House The DS0000024794.V293987.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 & 35 Quality in this outcome area is poor. This judgement has been made using available evidence, including these visits to the home. Suitable staffing levels are being maintained and staff had undertaken some relevant training to help them meet service users’ needs and keep the home safe. However there has been ongoing staffing issues which can have an adverse affect on the consistency of support service users receive and on their protection. Service users would benefit from a more stable staff team and further staff training in some areas. Service users’ safety would also be better ensured if there were more robust recruitment procedures. EVIDENCE: The provider and one staff member were on duty when the inspector arrived on the first visit, with another coming on duty at 10.00am to enable individual service users to take part in activities. Staff rotas confirm two staff are always deployed during the daytime with three some weekdays to facilitate activities. During the night one staff sleeps in on call. Taking into account that staff are also responsible for the household and laundry tasks and preparing meals this level appears sufficient to meet service users’ personal and social care needs. The home has had an ongoing staff turnover that is high for such a small staff team. An unstable staff team does not promote consistency of care and allow the whole staff team to get to know service users and their needs well. It was Trio House The DS0000024794.V293987.R01.S.doc Version 5.1 Page 20 previously recommended the provider should consider introducing a system to monitor staff turnover, which could include reviewing the home’s recruitment procedures and conducting exit interviews (with records kept) with a view to finding out why staff are leaving and reducing staff turnover in future. One fairly new staff member was spoken with privately about her recruitment, induction, training and experience of working at the home. It was confirmed she had appropriately completed an application form, attended an interview (including meeting the service users). Following a satisfactory probationary period she would then agree a contract of employment with the provider. Staff records were checked for all recently appointed staff. It was seen that two written references and an enhanced CRB/POVA check had been obtained for all except one person who did not yet have a CRB disclosure. The provider explained this had been sought some months ago and a second application had since been submitted. However because of staff shortages and as the provider has confidence in this person they had been working at the home alone with service users on sleep-in shifts without even a POVA First Check being sought. Although it was found in the second visit that the staff member had meanwhile only worked with other staff the provider was reminded that staff must not be employed in a care service at all without an enhanced CRB disclosure. Only in exceptional circumstances may a POVA First Check be obtained but then a suitable supervisor must be nominated to work with them. This is in breach of The Care Homes Regulations and a statutory requirement notice was subsequently issued. The provider had previously been notified in writing on 31st March 2006 that to employ staff without a CRB could result in prosecution. In the most recent follow up visit to the home it was evident this matter had still not been addressed and a decision will be made about any action to be taken against the provider when legal advice has been sought. The home has now introduced LDAF induction training for new staff, which is accredited especially for those caring for people who have learning disabilities. This should commence as soon as possible after newly appointed staff start work at the home. In the interim period an induction checklist and shadow shifts are used to familiarise them with service users’ needs, daily routines and the home’s policies and procedures. LDAF training should be followed by NVQ and only two staff had currently achieved this qualification. Another person is about to enrol and the programme of NVQ should continue to ensure at least half the staff team achieve this qualification as the Standards specify. Most of the staff team have prior experience in care and had undertaken all the mandatory health & safety training topics. It was confirmed however that training in first aid and food hygiene was arranged for the following week for one new staff member and to “refresh” other staff. In respect of service users’ special needs it is recommended staff attend an epilepsy training session. Trio House The DS0000024794.V293987.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 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to the service. Lack of compliance with relevant legislation reflects on the registered person’s competence to run the home well. The management approach must ensure that suitable staff work together to create an open and positive atmosphere. A system to review the quality of care needs to be fully implemented to ensure that the service continually develops for the benefit of service users. EVIDENCE: As detailed in the Staffing outcome section staff had been working at the home without all required checks being undertaken. This has been raised with the provider previously and a statutory requirement notice was issued. This notice was not complied with and so legal advice is being sought and may result in prosecution. It was also found again in the most recent visit to the home that staff records could not be accessed. A statutory requirement notice was issued and the provider’s response with action taken has still not been submitted. Trio House The DS0000024794.V293987.R01.S.doc Version 5.1 Page 22 Several ex-staff have complained to the Commission that the provider makes staff leave if they question care practice in the home and/or their conditions of employment. Whilst the provider refutes this she confirmed that several staff had been dismissed, or asked to leave before their probationary period was over, due to their poor care practice and neglect of service users. This also reflects on staff not being able to express their views and concerns openly. Clearly it is appropriate for staff work performance to be monitored to ensure their practice is in the best interests of service users. However it is concerning that disciplinary action had been taken against some staff and yet this was not notified as required to the Commission and/or referred under the Herefordshire Protection of Vulnerable Adults procedures. A decision would then have been made by a multi-agency team as to which agency should best investigate any alleged poor practice and/or neglect of service users and what action should be taken. This also helps to make sure that unsuitable people are prevented from moving to another care service setting to work with other vulnerable adults. In addition there were no records kept of the disciplinary process the provider had carried out and of any investigation of the alleged poor care practice and neglect, other than some written statements made by other staff. Although some aspects of the service, in particular relating to the environment and health & safety are audited there should be an effective quality assurance and monitoring system in place that reflects aims and outcomes for service users. This should result in an annual development plan for the continual improvement of the service, based on service users, their families and other stakeholders’ views and how the home is achieving goals for service users. In relation to the promotion of staff and service users’ safety the following aspects were looked at: • The fire log showed that the required weekly fire test and other monthly fire safety checks were recorded as having been carried out at the specified intervals. • Fridge temperatures are monitored. • Regular checks are carried out relating to the environment, vehicle, and electrical appliances. • COSHH risk assessments are in place. There were no safety hazards noted in the premises which indicates that due attention is paid to maintain and promote safety in the physical environment. Trio House The DS0000024794.V293987.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 N/A 3 N/A 4 N/A 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 4 25 3 26 3 27 3 28 3 29 N/A 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 2 15 3 16 X 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 N/A 2 X 2 X X 2 X Trio House The DS0000024794.V293987.R01.S.doc Version 5.1 Page 24 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA22 Regulation 21 Requirement The registered person must listen to and act on the views and concerns of staff. This applies to any matter relating to the home that may affect the health or welfare of service users. All allegations of abuse and/or complaints must be fully investigated and recorded. A protocol must be put in place to ensure people are not employed at the home until a satisfactory enhanced criminal record check has been obtained for them. This protocol must be available for inspection. In addition staff may only work at the home if a POVA first check has been obtained and that if so they are appropriately supervised. A statutory requirement notice was issued on 22nd May 2006 requiring a written response with details of action taken to comply with this notice. It was confirmed in the follow up visit that action had not been taken and legal advice is now being sought. This may result in prosecution. The provider must make notifications to the Commission without delay in respect of any allegations of misconduct by any person who works at the home. DS0000024794.V293987.R01.S.doc Timescale for action 10/07/07 2 3 YA23 YA34 13 & 22 19 10/07/07 01/06/06 4 YA37 37 10/07/07 Trio House The Version 5.1 Page 25 5 YA37 17 A procedure must be put in place to ensure that records required by The Care Home Regulations are available for inspection by the Commission of Social Care Inspection staff at all times. A protocol must also be prepared to ensure that staff are aware of the action taken in respect of records being available for inspection. A statutory requirement notice was issued on 22nd May 2006 requiring a written response and details of action taken to comply with this notice. A response was not submitted within the given timescale and legal advice is now being sought. 01/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA6 Good Practice Recommendations Consideration should be given to introducing a more “person centred” approach to care planning and seeking input from the local PCP co-coordinator to facilitate service users’ care reviews with their relatives and advocates. Risk assessments relating to service users’ behaviour (which could be challenging or self harming) should be reviewed and suitable management plans put in place in consultation with relevant professionals if necessary. Service users’ plans should reflect the extent to which each person can make decisions and choices in their lives. If they are not able to do so other relevant people should be involved in making decisions on their behalf and this input should be recorded and in what circumstances. Issues that could affect service users’ health (e.g. drinking and weight) should be reassessed and reviewed in consultation with relevant health care professionals. The staff team must receive instruction in respect of abuse and neglect of service users and the multi-agency DS0000024794.V293987.R01.S.doc Version 5.1 Page 26 2 YA6 3 YA7 4 5 YA19 YA23 Trio House The 6 7 8 YA32 YA32 YA33 procedures for Protection of Vulnerable Adults (POVA) from the local POVA co-ordinator, employed by the Housing & Social Services Directorate. The programme of NVQ training for staff should continue to ensure that sufficient staff achieve this qualification. Staff should attend a training session on epilepsy. A system should be introduced to monitor staff turnover, at the home, which could include reviewing the home’s recruitment procedures and conducting exit interviews. Trio House The DS0000024794.V293987.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection Worcester Office The Coach House, John Comyn Drive Perdiswell Park Droitwich Road Worcester WR3 7NW 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 Trio House The DS0000024794.V293987.R01.S.doc Version 5.1 Page 28 - 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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