Inspection on 01/11/06 for Tomswood Lodge

This inspection was carried out on 1st November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Tomswood Lodge 26/11/07

Tomswood Lodge 11/05/06

Tomswood Lodge 30/06/05

Tomswood Lodge 01/12/04

Tomswood Lodge 24/06/04

Tomswood Lodge 10/07/03

Tomswood Lodge 29/04/03

Tomswood Lodge 21/05/02

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

CARE HOME ADULTS 18-65 Tomswood Lodge 154 Tomswood Hill Hainault Ilford Essex IG6 2QP Lead Inspector Key Unannounced Inspection 1 -9th November 2006 10:00 st DS0000025932.V318004.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 DS0000025932.V318004.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. DS0000025932.V318004.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tomswood Lodge Address 154 Tomswood Hill Hainault Ilford Essex IG6 2QP 020 8500 7554 020 8262 5295 tomswoodlodge@aol.com 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) Mr Jackdeo Meetaroo Mrs Sushita Meetaroo Mr Jackdeo Meetaroo Care Home 8 Category(ies) of Learning disability (8) registration, with number of places DS0000025932.V318004.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to eight adults with low to moderate learning disabilities, excluding adults exhibiting severe challenging behaviours. May include residents with associated mental health problems and a maximum of two residents who are wheelchair bound. 11th May – 20th June 2006 Date of last inspection Brief Description of the Service: Tomswood Lodge is a care home for eight people aged between 18 and 65 who have low to moderate learning disabilities; they may also have associated mental health problems. The home is privately owned and one of the proprietors is also the registered manager. The house is detached and in keeping with others in the road. It is situated in a residential part of Hainault, on a bus route and within a 20-minute walk of the underground station. Shops and other local community resources are within walking distance. There are three bedrooms on the ground floor, along with two toilets and two showers. Also on the ground floor is a dining/lounge area, domestic style kitchen, conservatory, staff room and office. The upper floor has five bedrooms, two toilets, a shower and a bathroom. There is parking space to the front of the house, a large garden to the rear and a utility room, which is accessed via the garden. Activities are organised both within the home and in the local community, residents are encouraged to attend day centres and local clubs. The Statement of Purpose and the Service User Guide are issued to every prospective service user and these documents can be found on the residents’ notice board, which is situated in the lounge. A copy of the most recent inspection report is also available. The fees for the home are from £750 a week according to residents’ needs. The proprietor/manager made this information available on 1st November2006. DS0000025932.V318004.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 over a day. Five men currently live at the home. The inspector spoke to all five of the residents about their experience of living at the home. Discussion took place with the proprietor/manager and three of the care staff. Staff were spoken to about care practices and their employment at the home. The inspector also observed interaction between the resident and staff, which was friendly but professional. A tour of the home took place and a number of staff and residents’ records were examined. The views of other professionals who visit the home were also sought during the inspection. At the last inspection in May 2006 the home was experiencing problems. Serious allegations that were made by two female residents (they no longer live in the home) have been investigated. The Police have investigated some of the allegations but the Crown Prosecution Service has decided that no further action is to be taken. Other action has been taken in that a member of staff is no longer working at the home and their name has been added to the Protection of Vulnerable Adults (POVA) list, which means that they cannot work with vulnerable people. Risk assessments have been reviewed and action taken to ensure that one of the residents is accompanied at all times when in the community. This resident is also receiving specialist input regarding his behaviour and he also has an advocate who is working alongside him. The Commission has also imposed conditions that the occupancy level of the service is reduced to five people. What the service does well: The home is clean and tidy, and provides a family style environment. All of the residents enjoy living at the home and were keen to tell the inspector what they like to do and where they like to go. They all enjoy going out for meals, some go to play snooker, others ten-pin bowling and three of the residents have recently been on the London Eye whilst two of the residents went to a Care Exhibition with the manager. Two of the residents go home to see their families and other residents have families visiting them. The manager and staff try to ensure that leisure activities are planned to meet individual choices and capabilities. All of the residents take some part in the daily life within the home; keeping their bedrooms tidy, dusting, hoovering, peeling the vegetables, emptying the DS0000025932.V318004.R01.S.doc Version 5.2 Page 6 dishwasher, putting the laundry in the washing machine, shopping and gardening. What has improved since the last inspection? What they could do better: The stair carpet is showing signs of wear and needs replacing. One resident’s care plan now identifies that his delusional thoughts can lead him to accuse people; including those on the television and people whose names the home do not recognise of talking about him and hitting him. This must be transferred to his risk assessment with guidelines for staff; ‘that all accusations of verbal or physical abuse must be recorded in the daily records and that any accusations were there is a possibility that abuse could have taken place, such as, by a member of the family, staff or resident then this must be reported to the Commission and the local authority. This matter has been fully discussed with the manager and the funding authority. The home is jointly owned, with one owner being the registered manager, and the other working as a member of the care staff. Both are very ‘hands on’. This type of arrangement can often disadvantage a home, in that there is no one taking a more objective view. This has been discussed with the manager at previous visits and at a meeting with the commission. The proprietors should consider how the home could be best managed so that all standards and regulations are met. The home needs to undertake an annual audit, which would reflect the aims and outcomes for residents and an annual questionnaire to obtain the views of relatives, health professionals and stakeholders. DS0000025932.V318004.R01.S.doc Version 5.2 Page 7 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. DS0000025932.V318004.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 DS0000025932.V318004.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): 1,2, and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their relatives have the information they need to be able to make an informed choice about moving into the home. The assessment of needs and other information and reports received from health and social care professionals means that staff have detailed information to enable them to determine whether or not they can meet the needs of prospective residents. Prospective residents know that the home can meet their needs. EVIDENCE: Tomswood Lodge has a Service User guide, which is also used as the Statement of Purpose; parts of the guide are in pictorial form. This document gives prospective residents and their relatives information regarding the home and what services the home can offer. There have been no new admissions to the home since the last inspection. The home currently has five male residents. The file of the most recent resident was examined and it was found to contain an assessment that had been undertaken by the manager prior to the resident’s admission to the home. The DS0000025932.V318004.R01.S.doc Version 5.2 Page 10 registered persons had also received an assessment and care plan from the funding local authority and information from health professionals. The registered person’s care planning system would identify the needs of the prospective residents, and set out how these were to be met. Both the resident and his relative have been involved with the decision in him moving into the home. The resident told the inspector “I was happy to move into the home as they made me feel very welcome. DS0000025932.V318004.R01.S.doc Version 5.2 Page 11 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): 6,7,8 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Most of the residents’ identified needs are reflected in up to date care plans and risk assessments, which safeguards themselves and others. The residents, with assistance, are able to participate in all aspects of life in the home and to make decisions about their lives. EVIDENCE: There is a care planning system in place that is clear and concise. Each resident has an individual care plan and the care plans of all five residents were examined and discussed with the registered person. The care plans cover in sufficient detail all aspects of health and personal care needs, as well as social, religious and recreational needs. Residents’ preferences and choices are also taken into account. One of the residents now has an advocate from DS0000025932.V318004.R01.S.doc Version 5.2 Page 12 Mencap and she has introduced a Person Centred Planning Co-ordinator from the funding authority to commence a person centred care plan for this resident, this will identify more person centred activities, and perhaps assisted employment opportunities. Care plans were examined alongside the daily records and compared with the support being given. One of the residents’ files shows a photograph that is more than two years old that is not a good likeness and should be updated. This is Recommendation 1. The daily records reflects the care that is being given on a day-to-day basis and how residents are involved in the life of the home assisting with tasks such as, shopping, peeling the vegetables, assisting with putting the laundry in the washing machine and then hanging it out on the line and tidying their bedrooms. One resident said “I keep my bedroom tidy most of the time and I like to help round the home because one day I would like to have my own flat”. The daily logs are recorded at the end of the three shifts and relate to each resident’s care plan. Professionals that visit the home felt that there had been an improvement in some of the home’s paperwork. Other records seen, showed resident’s choice of meals, whether or not they participated in activities within the home and the community and their likes and dislikes. Residents’ meetings take place every two months and topics are discussed and recorded. Recent topics have been their Christmas meal and going to London sightseeing. Two of the residents have an advocate and the local advocacy service has been to the home to talk to the residents about what is abuse and the different forms of abuse. Some of the residents are able to handle small amounts of money and are encouraged to pay for their newspapers and beverages when visiting the café. Staff were observed interacting with the residents, their relationship was easy going and friendly but in a professional manner. Staff were aware of residents that required close supervision, when one of the residents was in the garden having a cigarette a member of staff was observing at all times but from a distance that was not intrusive to the resident. All of the residents’ care plans have been reviewed at least three monthly. Two of the residents’ care plans have been reviewed more frequently; one resident was discharged from hospital and his care plan was reviewed and changed because of his health needs and dependency and the care plan was again reviewed two weeks later because his health had improved and his dependency level had decreased. Another resident’s care plan now identifies that his delusional thoughts can lead him to accuse people; including those on the television and people whose names the home do not recognise of talking about him and hitting him. This must be transferred to his risk assessment with guidelines for staff that all accusations of verbal or physical abuse must be recorded in the daily records and that any accusations were there is a possibility that abuse could have taken place, such as, by a member of the family, staff or resident then this must be reported to the Commission and the DS0000025932.V318004.R01.S.doc Version 5.2 Page 13 local authority’. This matter has been fully discussed with the manager and the funding authority. This is Requirement 1. All of the residents have an annual review of their placement, which is undertaken by the manager. Other professionals who were contacted as part of this inspection thought it would be beneficial if they were invited to the annual review. A recommendation that other significent people such as, advocates and health and social care professionals should also be invited to attend. This is Recommendation 2. Risk assessments that were examined showed areas identified such as, behavioural, tasks and activities within the home and in the community, health risks and medication and what action is to be taken. These risks have been forwarded to the resident’s care plan, identifying the needs and how these needs should be met. A new separate risk assessment has been implemented for one resident around leaving the home unsupervised; this assessment needs to be incorporated in the overall risk assessment, as a member of staff could miss this separate assessment. This is Recommendation 3. DS0000025932.V318004.R01.S.doc Version 5.2 Page 14 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 good. This judgement has been made using available evidence including a visit to this service. Residents are able to take part in activities within the local community that are appropriate to their age and cultural. Residents have appropriate personal and family relationships. Their rights are respected and are supported to take responsibility for their actions. EVIDENCE: Residents’ care plans identify lifestyle choices, such as going to church, clubs, local leisure activities and visiting families and friends. The daily logs record whether these activities have taken place and who has participated. All of the residents have opportunities for personal development and a varied activity programme, which takes into account their preferences and interests. Only one of the residents attends a day centre and a club two evenings a week. All of DS0000025932.V318004.R01.S.doc Version 5.2 Page 15 the residents participate in activities within the home and the local community. Some of the residents enjoy delivering a local newspaper with the assistance of a member of staff and then visit a local café for a cup of tea and cake. Some of the residents play bingo at the local bingo hall; others play snooker at Fairlop Waters and ten pin bowling at the local bowling alley. One of the residents with a member of staff now attends a gym two days a week; both undertake activities such as the treadmill and the ‘ski walker’. The resident told the inspector “I enjoy going and I’m hoping to loose some weight”. Recently three of the residents have been on the London Eye and two of the residents went to a Care Exhibition at Earls Court with the manager. Another resident accompanied by a member of staff goes to buy his daily newspaper from the local supermarket and they have a cup of tea and a cake in the cafeteria. All of the residents enjoy going out for meals and most Sundays after attending different church services according to their faith, they go to a local restaurant for lunch. All of the residents have birthday parties at the home, to which family and friends are invited. Recently the residents with the assistance of the manager and staff organised a surprise birthday party for a member of staff. A resident said, “we didn’t tell her, we kept it a secret and she was very surprised”. One of the residents visits his mother weekly; he goes on his own by public transport, two of the residents are taken by the manager to visit their families, one of the resident’s friends visits him at the home and the residents also receive regular visits from families. One of the resident’s behaviour to women is not always appropriate and it is clearly logged that he can be a risk to females. The manager is now taking this matter more seriously and is dealing with his behaviour in a more pro-active way. The resident is closely monitored within the home, which currently only has male residents. When in the community staff always escorts him, and when visiting his family the manager takes him in his car. The resident told the inspector “First of all I didn’t like being taken out by staff but I know it is for my own good”. There has been one incident where he left the home unsupervised and immediate action was taken by notifying the appropriate authorities and contact with his relatives was also undertaken. He returned four hours later saying he had to go out to clear his head. Appropriate risk assessments have been put in place with guidelines for staff on what action has to be taken if there are any further incidents of the resident leaving the home unsupervised. The resident is being seen fortnightly by a psychologist and has been referred for sexual counselling. This previous requirement is now met. The menu is set weekly taking into consideration the residents’ like and dislikes, as well as dietary and cultural requirements. On the day of the inspection the evening meal corresponded with the meals being served. Most of the residents had steak pie, mashed potatoes, cabbage, carrots and peas and for desert jam sponge and custard. One of the residents is diabetic and Asian, he had rice, sag aloo and okra for his dinner and yoghurt for his sweet, another resident is Afro-Caribbean and he told the inspector “Jack buys food DS0000025932.V318004.R01.S.doc Version 5.2 Page 16 from a Caribbean shop, he buys yams, plantain and anything else I want”. The home grows most of their own vegetables including, marrow, cabbage, corn on the cob, beetroot, pumpkin, tomatoes, runner beans, courgettes, carrots and spinach. Residents were complimentary about the food and one said, “I really like my dinners and I can have something different if I want”. Food store cupboards, the refrigerator and freezer were inspected and all foods were appropriately stored. There was also a bowl of fresh fruit, cakes, biscuits and crisps, if residents wanted a snack. DS0000025932.V318004.R01.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence including a visit to this service. Residents receive personal support in a way they prefer and their physical and emotional needs are met. Due to their level of disability, residents are unable to administer their own medication. There are policies and procedures in place to ensure that this is carried out safely. EVIDENCE: Care plans and daily records were examined and discussed with the manager. The care plans clearly identify health and personal care needs and how these should be met. The daily records are written to show how each of these needs have been met during the day. Most of the residents require encouragement and prompting rather than physical assistance. Some residents prefer to bath and others prefer to shower. Residents were seen to be dressed in clothes that were appropriate for the time of year and which suited their personalities; one resident was in a shirt and tie, another resident was wearing tracksuit bottoms DS0000025932.V318004.R01.S.doc Version 5.2 Page 18 and a tee shirt. Most of the residents buy their own clothes with assistance from the staff, one resident said, “I want to buy a suit, so that I look smart when we go out”. Health care needs are being recorded with information easily retrievable. Residents have been seen by the optician, dentist and chiropodist and all have undergone annual physical health checks. Other health professionals have also been involved such as, physiotherapist, psychiatrist, psychologist and audiologist. One resident has had a hospital admission, during which he lost a considerable amount of weight. Since his discharge his weight has been monitored and records that were examined showed that his weight is gradually increasing. The inspector saw this resident the day before his hospital admission and was pleased to see that he is making a good recovery. All of the residents had visited him whilst he was in hospital and said they were pleased to have him home. As stated earlier in the report one of the residents is trying to loose some weight, he is being encouraged to take more exercise and to look at a more healthy eating diet. None of the residents are able to self medicate; therefore all medication they require is administered by staff. There are policies and procedures for the handling and recording of medication within the home and staff have received medication training as part of their induction programme. Medication Administration Records (MAR) charts and the medication cupboard were checked and found to be correct and all medication was stored appropriately. Two of the residents’ medication was audited and the amount give and the amount remaining reconciled with the MAR charts. DS0000025932.V318004.R01.S.doc Version 5.2 Page 19 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. Most of the time the residents can be sure that their views are listened to and acted upon and that they are protected from abuse. EVIDENCE: The home has a clear complaints procedure, which is available in written and pictorial format. A copy of the policy is available on the notice board in the lounge. There have been no complaints recorded since the last inspection. Residents were asked individually what they would do if they were unhappy with anything at the home, responses included “I would tell my mum or Jack (manager)”, “I would tell J (keyworker)”, “I would tell Jack or my sister”. All of the residents told the inspector that they were happy at the home and didn’t want to live anywhere else. The home has a comprehensive Adult Abuse and Protection policy and procedures and the procedure to inform the Commission of any untoward incidents under regulation 37 of the Care Homes Regulations 2001, these have been signed and read by all the staff. Three staff members that were spoken to were very clear on what constituted abuse and their responsibilities to report any potential abuse. Staff files indicated that all members of staff have attended Abuse awareness/Adult Protection training. One resident experiences delusional thoughts that can lead him to accuse people; including those on the television and people whose names the home do not recognise of talking about him and hitting him. However, there was no evidence of how these allegations DS0000025932.V318004.R01.S.doc Version 5.2 Page 20 were to be addressed. This resident is always accompanied when in the community, and it is therefore most unlikely that there would be substance to the allegations. However, it is important that all those responsible for supporting this resident are clear as to how the allegations are to be addressed. The manager and staff must ensure that all accusations of verbal or physical abuse must be recorded in the daily records and that any accusations were there is a possibility that abuse could have taken place, such as, by a member of staff, a resident or a member of the family then this must be reported to the Commission and the local authority. The proprietor/manager must ensure that the correct procedures in relation to potential or actual adult protection issues are followed, as opposed to relying on their own judgement. This is Requirement 2. DS0000025932.V318004.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): 24,25,26,27,28 and30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents live in a homely and comfortable environment. However the stair carpet is showing signs of wear which could put service users at risk. Bedrooms, communal living areas, toilets and bathrooms meet the residents’ needs. EVIDENCE: The house is in keeping with other properties in the road. A tour of the home was undertaken including the residents’ bedrooms. The home is decorated and furnished in a homely fashion and all parts of the home were clean and tidy. All of the bedrooms were personalised with football memorabilia, CDs, videos, DVDs, posters and family photographs. At the last inspection a requirement was set regarding the replacement of some of the residents’ bedroom furniture. The residents have received new bedroom furniture; including wardrobes, bedside cabinets and chests of drawers and some of the residents DS0000025932.V318004.R01.S.doc Version 5.2 Page 22 told the inspector that they assisted in putting the furniture together. This Requirement is now met. The ground floor consists of three bedrooms, a conservatory that leads from the lounge/dining room; a family sized kitchen, a shower room and separate toilet. On the first floor there are further bathing and toilet facilities as well as the remaining bedrooms. The stair carpet is showing signs of wear and needs to be replaced as this could put the safety of residents at risk. This is Requirement 3. A utility room at the back of the garage is accessed via the large well-kept garden. The garden contains a large vegetable patch were the manager with the assistance of a few of the residents, has grown marrow, cabbage, corn on the cob, beetroot, pumpkin, tomatoes, runner beans, courgettes, carrots and spinach. At the last inspection a Requirement was set regarding the front garden, which required attention, as it was full of weeds. The garden has now been cleared and this Requirement is now met. DS0000025932.V318004.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 good. This judgement has been made using available evidence including a visit to this service. Competent staff that are qualified supports residents. Staffing levels are satisfactory and there are sufficient staff on duty and have the appropriate skills and training to meet the individual needs of the residents. The procedures for the recruitment of staff are robust and provide safeguards for residents living in the home. Staff receive regular supervision and annual appraisals take place. EVIDENCE: Duty rotas were inspected and they correlated with the staff on duty, there were sufficient staff on duty to meet the needs of the residents. There are two DS0000025932.V318004.R01.S.doc Version 5.2 Page 24 staff on duty on each shift and one waking night staff, as well as the manager who normally works Monday-Friday. The manager covers staff absences with the permanent staff, which ensures continuity of care. The registered persons have a clear recruitment policy and procedures. All of the staff files were inspected and showed that appropriate recruitment procedures are now being followed; all of the staff have an up to date Criminal Records Bureau (CRB) check, the most recent member of staff had a completed application form and two written references and her POVA first were taken up prior to her commencement, her CRB check was also applied for prior to her commencing work and this was returned four weeks later. This member of staff, who has worked in the home for a year, confirmed that she had an interview and that she has undertaken an induction programme. She has also attended other training – Food & Hygiene, Health & Safety, COSSH, Adult Protection/Abuse Awareness and has completed her NVQ2. Six of the staff have completed their NVQ2 and two have completed the NVQ3. Other courses that staff have attended in the past year are – understanding learning disability, administration of medication, risk assessment and care management. Six members of staff hold their first aid certificate and one of the senior carers has recently completed a key skills course in Maths and English and the Learning Disability Framework in Care. Staff files indicated that they are receiving supervision every two months and annual appraisals have taken place, staff also confirmed this. Two of the seniors are currently undertaking a supervisor’s course and the manager has almost completed the NVQ assessors course. Staff meetings take place every two months. DS0000025932.V318004.R01.S.doc Version 5.2 Page 25 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 approach to running the home has improved in most areas, since the last inspection, but some Regulations are still not fully complied with. This means that residents’ health, safety and welfare are not always protected. Residents cannot be confident that their views underpin all self-monitoring, review and development of the home. The home’s record keeping, policies and procedures do not always safeguard the residents’ rights and best interests at all times. DS0000025932.V318004.R01.S.doc Version 5.2 Page 26 EVIDENCE: The Commission have discussed with the registered provider/manager that he needs to demonstrate a clear sense of leadership and as to what is required of him. Since the last key inspection (11/05/06) he has taken steps to ensure that residents are safer, that their well-being is clearly recorded and that the Commission is notified of any event in the care home which adversely the wellbeing or safety of any service user. The Commission have received Regulation 37 notices regarding incidents within the home and hospital admissions. As stated in the last inspection report the proprietor had been served with two Statutory Requirement Notices, the first (23rd March 2006) being the failure to notify the Commission of an event. The Commission are now being notified of events within the home. The second (24th April 2006) to reduce the number of service users that the home is registered to accommodate to a maximum of five. The proprietor appealed against the second notice. However, following the process of the appeal, the Statutory Requirement Notice was upheld. The home is jointly owned, with one owner being the registered manager, and the other working as a member of the care staff. Both are very ‘hands on’. Both the manager and his wife are well regarded by residents and there have been significent improvements in the management of the service, since the last inspection. However, this type of arrangement can often disadvantage a home, in that there is no one taking a more objective view of how the home operates. This has been discussed with the manager at previous visits and at a meeting with the Commission. It is recommended that the registered persons develop a system of support from an independent source, e.g. a consultant or mentor, to ensure that the service to residents fully complies with all national minimum standards and regulations and provides good outcomes for residents. This is Recommendation 4. There is no evidence that the home has an undertaken an annual audit, which would reflect the aims and outcomes for residents or an annual questionnaire to obtain the views of relatives, health professionals and stakeholders. This was a previous Requirement that has not reached the timescale for action (31/12/06). This is Requirement 4. Residents’ care plans and risk assessments have been reviewed and updated, with clear actions and guidance for staff. As stated earlier in the report one resident’s care plan was reviewed and changed on his discharge from hospital and then reviewed and changed as his health and mobility improved. One resident experiences delusional thoughts that can lead him to accuse people; including those on the television and people whose names the home do not recognise of talking about him and hitting him. He told the inspector on the day of the inspection of an incident, which could not have happened in the way DS0000025932.V318004.R01.S.doc Version 5.2 Page 27 he described it. This resident is always accompanied when in the community. The manager must ensure that his risk assessment clearly states what action staff are to take and that all accusations of verbal or physical abuse must be recorded in the daily records and that any accusations were there is a possibility that abuse could have taken place, such as, by a member of staff, a resident or a member of the family then this must be reported to the Commission and the local authority. The manager must ensure that ‘the homes record keeping procedures safeguards residents’ rights and best interests. This is Requirement 5. The serious allegations that were made by the female residents (they no longer live in the home) have been investigated. The Police have investigated some of the allegations but no criminal proceedings are to take place. Other action that has been taken is that a member of staff is no longer working at the home and their name has been added to the Protection of Vulnerable Adults (POVA) list, which means that they cannot work with vulnerable people. Risk assessments have been reviewed and action taken to ensure that one of the residents is accompanied at all times when in the community. This resident is receiving psychiatric and psychology input regarding his behaviour and he also has an advocate who is working alongside him. All health and safety records were inspected and all were found to be in order. DS0000025932.V318004.R01.S.doc Version 5.2 Page 28 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 3 3 3 4 X 5 X CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 25 26 27 28 29 30 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 2 X 2 3 3 3 3 X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000025932.V318004.R01.S.doc 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X 2 3 X Version 5.2 Page 29 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 YA9 Regulation 13(4) (a) Requirement The registered persons must ensure that all risk assessments clearly identify the risks and what action to be taken by staffs when a resident makes an allegation to ensure the safety of the resident and others. Previous timescale of 15/07/06 not met Timescale for action 31/12/06 2 YA23 13 (4)(c) 31/12/06 The registered persons must ensure that all accusations of verbal and physical abuse must be recorded in the daily records and that any accusations where there is any possibility that abuse could have taken place, such as, by a member of staff, a resident or a member of the family, must be reported to the Commission and the local authority. The registered persons must ensure that the correct procedures in relation to potential or actual adult protection issues are followed, as opposed to relying on their own judgement. The registered persons must ensure that the stair carpet is DS0000025932.V318004.R01.S.doc 3 YA24 16(2) 31/01/07 Version 5.2 Page 30 replaced so that it does not pose a risk to safety. 4 YA39 24 The registered person shall establish a system for reviewing the quality of the care provided at the home, that takes into account the views of the residents and significent others. The registered person must ensure that records are up to date and accurate for the protection of residents. 31/03/07 5 YA41 17(1) 31/12/06 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 2 3 Refer to Standard YA6 YA6 YA9 Good Practice Recommendations It is recommended that a resident’s file has a photograph that should be more recent and a better likeness of the resident. It is recommended that health and social care professionals are invited to resident’s annual reviews It is recommended that the risk assessment that identifies what action to take when a resident leaves the unaccompanied are incorporated into his overall risk assessment. It is a recommendation that the registered persons develop a system of support from an independent source, e.g. a consultant or mentor, to ensure that the service to residents fully complies with all national minimum standards and regulations and provides good outcomes for residents. 4 YA38 DS0000025932.V318004.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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 DS0000025932.V318004.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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