Inspection on 10/10/06 for Thomas House

This inspection was carried out on 10th October 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Thomas House 02/05/07

Thomas House 03/11/05

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

Pennine Camphill

Muston Road (70)

Grayling

The Cornerstone

John Street Nursing Home

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

CARE HOME ADULTS 18-65 Thomas House 70 Grove Park Calder Grove Wakefield WF4 3BZ Lead Inspector Gillian Walsh Key Unannounced Inspection 10th October 2006 09:30 Thomas House DS0000062919.V315274.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 Thomas House DS0000062919.V315274.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. Thomas House DS0000062919.V315274.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Thomas House Address 70 Grove Park Calder Grove Wakefield WF4 3BZ 01924 283445 01924 263312 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) K and M Care Mrs Maureen Preston Ms Katherine Barrick Care Home 2 Category(ies) of Learning disability (2) registration, with number of places Thomas House DS0000062919.V315274.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd November 2005 Brief Description of the Service: Thomas House was registered with CSCI in the summer of 2005. Thomas House is a spacious semi-detached property offering ensuite facilities within the 3 bedrooms, 2 spacious lounges, a large well-equipped kitchen and a garden to the rear of the property. At the moment, only 2 bedrooms are registered with the Commission for Social Care Inspection but the owners are to seek variation to register the third bedroom. This domestic property is situated in a residential area of Wakefield and the location allows for easy access to public transport and to local community facilities. The operators of Thomas House (K&M Care) have experience of working with adults who have a learning disability and/or autism. The manager/proprietor informed the Commission in October 2006 that the current scale of charges for care at the home are £1400 - £2200 per week. Details about the home are made available to prospective service users and their representatives via the Service User Guide and Statement of Purpose, both of which are available on request from the home. Details of the Commission for Social Care Inspection are included in these documents. Thomas House DS0000062919.V315274.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit to the home made as part of a full inspection, which took place on 10th October 2006. The visit lasted from 9.30am to 1.30pm. Time was spent speaking to residents and staff, checking documentation and taking a tour of the communal areas of the premises. As part of this inspection the views of residents, relatives, healthcare professionals including General Practitioners and involved social workers were sought by way of questionnaires with the response, at the time of writing the report, as follows: Of the 4 residents’ and 4 relatives’ questionnaires sent, none were returned. Of the 2 GP questionnaires sent, none were returned. Of the 2 social worker questionnaires sent, one was returned which said that the “proprietors are very experienced in working with people with autism. They offer a high quality, informed service to people in this client group”. In writing this report, information and evidence was not only obtained by way of visiting the home but also from notifications and information sent to CSCI and from previous CSCI inspection reports. In gathering evidence, CSCI undertook case tracking, reviewed documentation, sought feedback from residents and their families, staff, the home’s manager and the service co-ordinater and undertook relevant observations and discussions appropriate to needs of the residents, taking into account their needs and communication needs. The home’s manager was not available on the day of the visit but the service co-ordinator, who is also joint proprietor, was informed of the inspection process and received feedback. The inspector would like to thank residents and staff for their time and assistance during this inspection. What the service does well: Although neither of the service users at the home were able or chose to speak with the inspector at any length, one person did say “yes” when asked if they felt comfortable and well cared for at the home. Both service users appeared well cared for and settled at the home. Care planning for one of the service users was of a very good standard and evidence within daily records showed that the care plan was being followed. The home provides a comfortable and homely environment for service users. Thomas House DS0000062919.V315274.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Thomas House DS0000062919.V315274.R01.S.doc Version 5.2 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 Thomas House DS0000062919.V315274.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Pre admission assessments of prospective service users’ needs and aspirations are not always being carried out or, where relevant, obtained from the social worker. This could result in staff not having necessary information in order to meet service users’ needs. EVIDENCE: Pre admission assessments were in place for one of the two service users currently in residence at the home. The one that was in place was very thorough and gave good detail of the person and their needs. A community care assessment was also in place for this person. No pre admission information was available for the other resident and the service co-ordinator said that none was available in the home for the service user who receives respite care. Thomas House DS0000062919.V315274.R01.S.doc Version 5.2 Page 9 Discussion took place with the service co-ordinator about the importance of pre admission assessments and a requirement has been made in this regard. Thomas House DS0000062919.V315274.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 poor This judgement has been made using available evidence including a visit to this service. Not all service users have a care plan in place which could result in appropriate care not being delivered. Evidence is available within daily records that service users are supported to make decisions about their lives. Risk assessments are not always in place and, where they are, there is evidence that they are not being complied with. EVIDENCE: Only one of the two current service users had a care plan in place. The plan was very thorough and gave good detail of the service user’s needs, preferences and abilities. It also included a communication diary and a timetable of how the person likes to spend their day. Risk assessments had Thomas House DS0000062919.V315274.R01.S.doc Version 5.2 Page 11 been developed for this person although, despite a risk assessment being in place which specified that, during car journeys, two staff must be in attendance, the service user was observed to leave the home to take a car journey with only one member of staff. Risk assessments had not been developed for the other service user. Daily records for both service users were very detailed and demonstrated how the person had chosen to spend their time, how their mood and behaviours had been and what care interventions they had received. Thomas House DS0000062919.V315274.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): 12,13,15,16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users take part in appropriate educational and leisure activities. Relationships with friends and families, where appropriate, are encouraged and supported. EVIDENCE: The service co-ordinator said, and documentation confirmed, that both service users attend local resource centres. One person is studying English and Maths and another attends for relaxation, horse riding and hydrotherapy. Staff and service users enjoy trips out together, making use of local pubs for meals out and taking longer trips to the country or seaside. Service users have their own leisure activities, which they enjoy and these are facilitated by staff. Thomas House DS0000062919.V315274.R01.S.doc Version 5.2 Page 13 Where appropriate, service users maintain contact with families and friends with home visits and the home’s own visiting policy which allows families and friends to visit as they wish. Observations during the visit were that staff enable and support service users to enjoy freedom of movement within the home and that their independent living skills are supported and encouraged. The service co-ordinator said that meals are organised on a daily basis and are made to meet the needs and preferences of the individual service user, which currently includes a vegetarian diet. Where the service user is unable to express their preferences about food, advice is sought from family. Fresh fruit was seen to be available for service users whenever they wanted it. Thomas House DS0000062919.V315274.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 poor This judgement has been made using available evidence including a visit to this service and is particularly affected by the issues regarding medications. Service users appear to receive personal support in the way they prefer but, in the absence of a care plan for one person, this could not be fully determined. Arrangements are in place for ensuring that service users’ health needs are met. Service users are not protected by the home’s policies and procedures for dealing with medications. EVIDENCE: Neither of the service users were able, or wished to say, whether the support they received at the home met with their needs and preferences although one person did answer “yes” when asked by the inspector if they were happy and if staff helped them as they wished. Daily records confirmed, where a care plan Thomas House DS0000062919.V315274.R01.S.doc Version 5.2 Page 15 was available, that staff work to the care plan. Observations on the day were that service users’ personal needs were met in private and with sensitivity. The service co-ordinator said that both service users are registered with local GPs and that, wherever possible, their own GP is retained. The home uses local services for dentists, opticians etc. Neither of the service users are able to manage their own medications and therefore systems for receipt, storage and administration of medication by staff were checked. Although daily stock balances of medication are recorded on the MAR (Medication Administration Record) sheets, four of the five balances recorded were found to be incorrect when checked against the amounts of medication available in the home. All of the amounts of medication exceeded the amounts recorded on the MAR sheet. For example, records indicated that there should have been 5 Omeprazole tablets left but 13 tablets were in the packet. In addition, the instructions for the administration of Venlafaxine were confusing and did not reflect what was actually being administered. Thomas House DS0000062919.V315274.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. A complaints policy and procedure is in place. None of the staff working at the home have received training in protection of vulnerable adults which has the potential to put service users at risk. EVIDENCE: The service co-ordinator said that no complaints or concerns have yet been made to the home but that systems are in place for when this occurs. The service co-ordinator said that none of the staff had yet had training in adult protection and was herself unaware of Wakefield Metropolitan District Council’s own policies and procedures and how to report suspicions of abuse. The home’s own policy for Adult Protection did not include details of how to make appropriate referrals. Thomas House DS0000062919.V315274.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users live in a comfortable, clean and hygienic environment. EVIDENCE: The communal areas of the home were seen and appear to provide a comfortable and spacious environment for service users in a homely and domestic setting. Standards of hygiene appear to be very good. Concerns were raised with the owners that only two of their bedrooms had been registered with the Commission as, at the time of registration, the third bedroom did not meet National Minimum Standards with regard to en-suite facilities but a person was due to be admitted to the home for a period of respite care. This would mean that three bedrooms were in use when only two Thomas House DS0000062919.V315274.R01.S.doc Version 5.2 Page 18 were registered. The owner/manager said that this was an omission on their part as they had forgotten, when they had completed the necessary work, to apply to the Commission for registration of the third bedroom. The owner/manager was advised to submit immediate application for registration of the room, as it would be an offence under the Care Standards act to provide accommodation to three service users when only registered for two service users. Advice was also given that if registration of the room was not achieved in time the person must not be admitted for respite care. Thomas House DS0000062919.V315274.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Service users could be put at risk due to poor recruitment policies and procedures and a lack of staff induction and training. EVIDENCE: The registered manager has NVQ level 4 in Care and holds the registered managers award. None of the other staff, including the service co-ordinator, hold the NVQ award but are hoping to enrol on the course early next year. Both staff files were seen but did not include all of the information required by regulation to ensure that service users are protected by the home’s recruitment policies. Neither of the care staff had CRB (Criminal Record Bureau) clearances and one file contained only one reference. The service coordinator explained that the home is not yet registered with the CRB or with an umbrella body and therefore clearances cannot be requested. As care staff Thomas House DS0000062919.V315274.R01.S.doc Version 5.2 Page 20 were observed to be working unsupervised, serious concerns were expressed about this both verbally during the visit and in writing following the visit. Neither of the staff files contained evidence of any induction or training and the service co-ordinator said that no staff training had yet taken place at the home. Thomas House DS0000062919.V315274.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is poor. The home’s manager needs to make several improvements to ensure that service users are protected. Systems for quality monitoring are not yet in place. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s manager jointly owns the home with the service co-ordinator. She has several years’ experience of working with people with learning disabilities and has gained NVQ level 4 in care and the registered managers award. Evidence contained throughout this report suggests that the manager needs to Thomas House DS0000062919.V315274.R01.S.doc Version 5.2 Page 22 make several improvements in ensuring that Care Home Regulations are met and that processes are in place to ensure the safety of service users. No formal quality monitoring is in place as the home has only been caring for service users for approximately four months. The service co-ordinator said that they were looking into setting up a system of evaluation and improvement. Issues regarding recruitment of staff, lack of care planning, poor risk assessment processes and a lack of staff training, all have the potential to put service users at risk. The home has also failed to notify the Commission under regulation 37 of a serious injury to a service user. Thomas House DS0000062919.V315274.R01.S.doc Version 5.2 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 1 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 3 25 1 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 1 33 X 34 1 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 1 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 1 x 1 X 2 X X 1 X Thomas House DS0000062919.V315274.R01.S.doc Version 5.2 Page 24 No 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 YA2 Regulation 14(1)(ad) Requirement Timescale for action 31/10/06 2 YA6 YA18 15(1) 3 YA9 13 (4) (c) 4 YA20 13(2) The registered person must not provide accommodation to a service user at the care home unless a full assessment of their needs has taken place and confirmation has been given to the service user or their representative that their needs can be met at the home. Unless it is impracticable to carry 16/10/06 out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan (“the service user’s plan”) as to how the service user’s need in respect of his health and welfare are to be met. The registered person shall 13/10/06 ensure that unnecessary risks to the health or safety of service users are identified and so far as is possible eliminated. All written risk assessments must be complied with. The registered person shall make 13/10/06 arrangements for the recording, handling, safekeeping, safe administration and disposal of DS0000062919.V315274.R01.S.doc Version 5.2 Thomas House Page 25 5 YA23 6 YA25 7 YA32 YA35 YA42 8 YA34 9 YA37 10 YA42 medicines received into the care home 13(6) The registered manager must make arrangements by training staff or by other measures, to prevent service users being placed at risk. Section 24 Accommodation must only be Care supplied to two service users (as Standards stated on the certificate of Act. registration) until the third bedroom is registered. 18(1) The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of the service users - (a) ensure that at all times, suitable qualified, competent and experienced workers are working at the care home in such numbers as appropriate for the health and welfare of service users (c) ensure that persons employed at the care home receive (i) training appropriate to the work they are to perform. 19 (1)(b) The registered person shall not employ a person to work at the care home unless he has obtained in respect of that person the information and documents specified in paragraphs 1 to 7 of schedule 2. 10(1) The registered provider and the registered manager shall, having regard to the size of the care home, the statement of purpose, and the number and needs of the service users, carry on or manage the care home with sufficient competence and skill. 37(1)(c) The registered person must inform the Commission without delay of any serious injury to a service user. 31/10/06 31/10/06 31/10/06 10/10/06 31/10/06 11/10/06 Thomas House DS0000062919.V315274.R01.S.doc Version 5.2 Page 26 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 YA39 YA32 Good Practice Recommendations The registered manager should set up a system for quality monitoring and review within the home. 50 of care staff should hold the NVQ level two in care award. Thomas House DS0000062919.V315274.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Brighouse Area Office Park View House Woodvale Office Park Woodvale Road Brighouse HD6 4AB 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 Thomas House DS0000062919.V315274.R01.S.doc Version 5.2 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!