Inspection on 11/05/06 for Tulips Care Home, The

This inspection was carried out on 11th May 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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tulips Care Home, The 05/10/07

Tulips Care Home, The 09/12/05

Tulips Care Home, The 07/10/05

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Townley Road, 2-3

Chatsworth Care - Tudor Lodge

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

CARE HOME ADULTS 18-65 Tulips Care Home, The 326 Hither Green Lane Hither Green London SE13 6TS Lead Inspector Sean Healy Unannounced Inspection 11th May 2006 09:30 Tulips Care Home, The DS0000058570.V291963.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 Tulips Care Home, The DS0000058570.V291963.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. Tulips Care Home, The DS0000058570.V291963.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Tulips Care Home, The Address 326 Hither Green Lane Hither Green London SE13 6TS 020 8695 1175 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) ammouymcfarlane@btbroadband.com Tulips Care Home (The) Navlette McFarlane Care Home 4 Category(ies) of Learning disability (4), Mental disorder, registration, with number excluding learning disability or dementia (4) of places Tulips Care Home, The DS0000058570.V291963.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th December 2005 Brief Description of the Service: The Tulips Care Home is a large detached two-storey house situated just off the South Circular Road South London, providing care and support for up to four female adults aged 18 to 65 Years. It is registered for providing a service for people with Learning Disability and Mental Health support needs. The home is convenient for public transport to Central and South East London and is a short walk to local shops, and a 10 minute bus ride to Lewisham or Blackheath, offering a range of shops and cafes. The home has space for three cars in the front and has lots of on road parking nearby. All residents each have their own rooms located on the ground and first floors. Bathing facilities are made up of a shower room and toilet on the ground floor, and a bathroom/toilet on the first floor. There is a medium sized garden to the rear of the house, which is in the process of development and is accessible from the hallway. The home is privately run, owned by the registered manager and first opened in March 2005. Current service users are young and the home’s philosophy is to encourage participation in the day-to-day running of the home and in the local community. Staffing is provided by the female manager and currently four female full time staff, with some use of agency staff. The staff team is in the developmental stage. Information about the service provided is made available to current and potential service users in the homes Statement of Purpose and Service Users Guide. The recent CSCI report is currently kept in an inaccessible cabinet. The manager agreed to make this available to service users and explain it’s content to them. At 11th May 2006, the homes fees are set at £600- per week, for all service users, which covers all of the homes charges including food. Residents have to pay for other personal expenses such as hairdressing, transport and personal shopping. The provider’s email address is: ammouymcfarlane@btbroadband.com Tulips Care Home, The DS0000058570.V291963.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and was carried out over one day. The home’s registered manager was present and co-operated during the inspection. The inspector interviewed two staff member and spoke with two service users. Many of the requirements had now been met and there was evidence of increased staffing and improvements in recruitment practices, care planning and in the environment. Advice was sought from social workers connected with the home regarding their views on the suitability of the home and current performance. Comments received were favourable and showed improvements had been made, with a need for further training for staff in areas of mental health support being recommended. The inspection included a tour of the home and examination of records on care plans and building maintenance records, and staff records regarding recruitment and supervision. There were no service user vacancies. What the service does well: The home provides a homely environment, which gives good potential for ordinary living. There have been positive comments from care management regarding the successful support for some service users needing sensitive support with mental health needs. There is a welcoming approach to service users having visitors, and one service user said she had the opportunity to visit the home before moving in and was given the choice about the move. She said that her family visit regularly, and can come at any time, and the staff are friendly and helpful. The service users know the manager well and have regular contact with her. The home is kept clean and well maintained. Food is good and service users are completely involved in preparing their meals and have full access to the kitchen. The management of the home responds well to all suggestions in how to improve the home and service offered. Tulips Care Home, The DS0000058570.V291963.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? The system for drawing up care plans has been very much improved. All service users now have a very detailed care plan which are very individual to each service users needs, and are very clear and understandable. Risk assessments have also much improved, and are regularly reviewed. Risk assessments now also include protection of service users personal finances. Care plans now include specific information about individual service users personal care support needs, and comments from service users show that staff are sensitive to providing support without providing any unnecessary help. Medication is now managed well, with good records being kept, and regular checks being carried out by the manager of the home. The Adult Protection policy has now been revised to follow the local authorities guidelines for how best to protect service users, and the staff understand how to protect service users interests. There is now a plan in place for developing the home, which includes repairs and upgrades of equipment such as shower room improvements. The home has moved the office area to the first floor, allowing a more relaxing environment in the kitchen area where it was originally placed. Service users said they are pleased to be “able to have a chat in peace and quiet” in the kitchen now. All staff employed have now got appropriate references and police checks on file, which show them to be well suited to working in the home. There is now a training and development plan for the home and for individual members of staff, and the homes manager has started the NVQ level 4 course in management. A number of health and safety measures have been introduced to make service users safer, such as a hot water regulator being installed, a window restrictor being fitted on an upstairs bedroom window, and recommendations made by the fire officer being fully implemented. The view of service users and health and social care professionals, is that the management of the home has improved, and that service users are now being well looked after. Tulips Care Home, The DS0000058570.V291963.R01.S.doc Version 5.1 Page 7 What they could do better: All service user reviews with Social Services need to be are carried out, and the provider and all service users need to be provided with a full assessment of care needs. It would be a helpful way of ensuring that service users consistently have the opportunity to take part in activities of their choice if the home introduced a system for recording when activities have happened. The homes recruitment policy should say how the home would check new staff to see if they have a criminal record or a history of abuse before being employed by the home. The home now does carry out these checks but it would help to protect service users if it is written in the homes policy on recruitment. The home would be safer and look more homely if the following work was done: 1. Remove the spare flagstones from the garden patio area 2. Keep keys of the home and money/medication cabinet locked away 3. Secure the wall panel in the laundry room which has come loose 4. Carry out decoration to parts of the hallway and stairway area where paint or wallpaper need repair 5. Repair and decorate the ceiling in the kitchen which was damaged by a water leak 6. Clean or replace the carpet in the ground floor service users bedroom 7. The fire risk assessment must be approved by the fire officer and fully implemented including carrying out regular fire drills 8. Portable appliances tests must be done on all portable electrical equipment The home should ask service users views about whether their cultural needs are being met as the staff cultural backgrounds do not in the main reflect that of service users. The manager should improve the notes kept on staff interviews, and keep a better checklist showing that all the necessary checks have been done on staff, before they start working in the home. There should also be at least two people involved in interviewing new staff to make sure that interviews are seen to be fairly conducted and that the best staff are employed. The home needs to make it clear to all staff, and service users, as to which staff are employed by the home, and ensure that all staff have written contracts showing their responsibilities and benefits. This will help staff to feel clearer about their jobs and their rights. Some service users and staff were not sure which staff were permanent, and which were employed by the agency. Tulips Care Home, The DS0000058570.V291963.R01.S.doc Version 5.1 Page 8 The home manager needs to complete NVQ training and consider whether having an assistant manager would be of benefit to the running of the home. The home must carry out an annual Quality Audit and use the results of this, and other systems such as service users surveys, to put in place a development plan for the home. 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. Tulips Care Home, The DS0000058570.V291963.R01.S.doc Version 5.1 Page 9 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 Tulips Care Home, The DS0000058570.V291963.R01.S.doc Version 5.1 Page 10 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 and 5 Quality in this outcome area is adequate. Service users individual aspirations and needs are not fully assessed which may result in important needs not being met. Each service user has a written contract showing terms and conditions. EVIDENCE: All of the service users have an assessment of care needs on file, which was carried out by the home manager who is an experienced mental health care professional. However none of the service users have been provided with a compete single comprehensive care management assessment of need, and the manager of the home has said that she has asked for these, but as yet has not received one. The homes own assessment is adequate in the short term and includes a range of areas of health and social care support including activities for service users. However the home only opened one year ago and a number of service users are relatively new to the home. It is important that the assessment provided to the service users and the home is holistic and does not exclude information, which would prevent the home from providing important services or activities. This is especially important given the level of mental health support issues for all service users. The information provided to the home about one service user did not include important health care information such as oedema, and severe constipation, and also did not mention important information about behavioural issues. In spite of this the home had themselves identified these issues and included them in the care plan. The home needs to contact all relevant social Tulips Care Home, The DS0000058570.V291963.R01.S.doc Version 5.1 Page 11 workers and ensure that a full assessment of health care and social care needs are provided. (Refer to Requirements YA2) The manager has ensured that service users each have a copy of their contracts, showing terms and conditions for living at the home, and the contracts have been updated to include rooms to be occupied, arrangements for care and support reviews and ensured that all other details required by Standard 5 are included. Two service users confirmed that they had a copy of their contracts and understood them. Tulips Care Home, The DS0000058570.V291963.R01.S.doc Version 5.1 Page 12 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 and 9 Quality in this outcome area is adequate. Service users cannot be completely sure that their assessed and changing needs are reflected in their individual care plans, and may not always be given adequate independent support to be able to make decisions about their lives. The home does a good job in assessing risk with service users to enable them to remain as independent as possible. EVIDENCE: The style and layout of the care plans have been revised and now look very good. This is a marked improvement on the original care plans, and the wording is now very positive and respectful. There is a good level of detail regarding a range of health and social care needs and they are written very clearly. Service users commented that they were able to read them and were spoken to about them by the manager when this system was being reviewed. The care plans are based mainly on the home’s own assessment of need rather than on a single all encompassing social care assessment. The home has done a good job in carrying out their own assessment and in planning how to meet the stated needs, but given the significant mental health support issues involved in providing the care and support, and the consequences to service Tulips Care Home, The DS0000058570.V291963.R01.S.doc Version 5.1 Page 13 users when mental health support increases, it is extremely important that all service users have a full assessment of their needs provided by relevant social care professionals. (See standard 2 of this report) Care plans are reviewed by the manager and staff on a regular basis, with regular visits every few weeks from a mental health professional for some service users. However the care reviews involving significant professionals have not been happening every six months, and some service users did not have formal 6 week or 3 month reviews following admission to the home. The manager said she had asked that these reviews happen, and will now formally request that these reviews take place. (Refer to Requirements YA6) Some service users fully manage their own finances, one service user gets support from family, and one service user needs some support from the home. The local authority has asked the home to facilitate receipt of small weekly benefit payments, as the service user does not have a bank account. The home has agreed to this, and it involves having these payments made directly into the home’s own bank account, as the service user concerned may be vulnerable to financial abuse, should it be paid directly to her. Social services have confirmed this to be the case, and have committed to trying to set up a system, which ensures that the service users money is at least paid into an account which is solely for her own use. This situation has not yet been resolved or agreed with the service user, and the home does not currently provide access to advocacy support. The home must fully inform the service user of the problem and ensure that any decision taken includes the service user’s consent involving support from independent advocacy if appropriate. (Refer to Repeated Requirement YA7) The system for assessing and reviewing risk has been significantly improved and each service user has an individual body of risk assessments all of which were reviewed in March 2006. This demonstrates a good commitment by the home to protecting service users while maintaining good levels of independence. The risk for some service users is significant, and comments from other professionals involved show the home to be very competent in involving them, and the service users, in developing good strategies and approaches for managing risk situations. Tulips Care Home, The DS0000058570.V291963.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13 15 16 and 17 Quality in this outcome area is good. Service users are able and supported to take part in age, peer and culturally appropriate activities, and are part of the local community. Service users have appropriate personal, family and sexual relationships, their rights are respected, and responsibilities recognised in their daily lives. A healthy diet is provided and meals are provided at times which suit service users. EVIDENCE: The home has improved care plans, which include activities with the home and in the community. Most service users said that they go out independently and regularly to a range of activities such as shopping, the pub, and local theatre, and have regular contact with family friends. One service user described a range of activities which she is supported to attend such as embroidery classes, cookery classes, attending shows at the Lewisham Theatre on a regular basis, as well as helping out in the home in the kitchen and keeping her room clean and tidy. She said that she would like to be asked a bit more about what should go onto the shopping list, and would like to do art/painting classes. She said she had settled in well to the home and felt she could now ask the manager and staff for these things to be included in her activities. Each service user has now got Tulips Care Home, The DS0000058570.V291963.R01.S.doc Version 5.1 Page 15 a written weekly plans for activities, to act as a reminder for them, and for staff. Social and health care professionals said the home have done very well in maintaining a range of activities which have greatly benefited service users. Information about activities done with service users is recorded on handover notes for each service user. After discussion it was agreed that it would be useful to develop a more easily monitor-able system for recording that activities have or have not successfully happened. This is a useful means of quickly identifying when problems are arising and for quickly intervening. (Refer to Recommendations YA12) The home has a policy of encouraging and supporting service users to maintain contact with family and friends and in supporting personal relationships. All service users interviewed described the staff and manager as being helpful in welcoming family and friends into the home, and a number of service users are pursuing personal relationships. Attention is paid by the manager of the home to ensure that any potential abuse is highlighted to service users, and help and advice is offered where necessary. There are good working relationships developing between staff and service users, and service users said that staff are good to talk to and are always available to offer help. There are no barriers in the home separating staff and service users, and all service users said they have their own keys to their home and rooms and staff are respectful of their right to privacy. It is expected that service users will engage in all domestic activities and this is specified in the home’s service user guide. The specific tasks that individual service users will take part in are starting to be reflected in their individual plans. Service users said that the food in the home is good and there are a variety of things they like to eat available. The menus are dated and planned on a rolling menu system showing weeks 1 to 4. They also said they were involved in shopping and were offered a choice in what they ate, and two service users confirmed they were involved and that the food is good. Service users have full access to kitchen facilities and can make snacks as they wish to, and are involved in cooking activities. Two service users were regularly seen to sit eating and chatting in the kitchen. One said it was good that the office area had moved away from the kitchen. Tulips Care Home, The DS0000058570.V291963.R01.S.doc Version 5.1 Page 16 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 and 20 Quality in this outcome area is good. Service users’ plans now reflect the way they prefer to receive personal care/support, and their physical and emotional needs are met. Service users now retain control of their own medication, where appropriate, but are not fully protected by the home’s procedures and practices, which may result in mistakes in administration going undetected. EVIDENCE: The home has now very much improved care plans for all service users, and included better guidance to ensure that their independence is protected and respected. All personal care support provided is same-gender, and is only provided when necessary with full consent from the service user requiring it. Support is minimised to prompting when possible and this is generally applied. All health care needs are being properly assessed and met. Some medication management issues were identified as a problem at last inspection and the home has done some good work to ensure medication is locked securely and that there is an adequate system for recording incoming medication and checking that administration recording is being properly done. Service users consent for staff to manage and administer medication is recorded in their individual care plans. A range of health care professionals are involved and all service users are registered with a local GP. Tulips Care Home, The DS0000058570.V291963.R01.S.doc Version 5.1 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. Service users feel that their views are listened to and are acted on, and the home’s written policy now ensures that service users will be protected from abuse, neglect or self-harm. EVIDENCE: The manager is a trained general and mental health nurse, and maintains a high level of presence within the home which reduces risk of likelihood of abuse and allows staff to regularly have access to her experience and advice. The service users and social workers spoken to confirmed that this is the case. The home has an adequate written complaints policy, which is understood by service users. There are no recorded complaints since last inspection, and service users interviewed said they have not made any complaints and feel that they can discuss any concerns with the manager, whom they see on a daily basis. The manager and staff have training in adult protection, and the staff interviewed demonstrated understanding of this policy. The homes policy on Adult Protection has now been revised to reflect the local authorities current policy. It does not however make reference to the homes procedure for carrying out POVA and CRB checks on staff prior to recruitment, or regarding best practice in reporting staff to POVA should the need arise. (Refer to Recommendations YA23) Risk assessments regarding service users managing their own finances have been updated. Tulips Care Home, The DS0000058570.V291963.R01.S.doc Version 5.1 Page 18 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, 29 and 30 Quality in this outcome area is adequate. Service users live in an environment that is generally homely, comfortable and safe, but there are a number improvements to be made to ensure that the home is in a good state of repair. Specialist equipment is provided if needed, and the home is maintained to a good level of cleanliness. EVIDENCE: The home is generally well maintained and kept clean and safe. There is sufficient light and ventilation and furnishings are adequate. The manager is now doing weekly health and safety checks and is using a comprehensive written system for recording findings and action required. Repairs to the home are now being properly recorded and included in a development plan when difficult to immediately address. There is a bathroom and toilet on the first floor and a ground floor shower room and toilet, which meet minimum requirements for toilet and washroom facilities. None of these facilities are wheelchair accessible but current service users are fully mobile. The home’s management is now giving consideration to making adjustments to the design of the shower-room to improve service users comfort. Tulips Care Home, The DS0000058570.V291963.R01.S.doc Version 5.1 Page 19 At the last inspection the home’s office space was located in a small annexe to the kitchen, which made it difficult for service users to have privacy while eating and cooking, without being overseen and overheard by staff seated in the office. Similarly it was difficult to protect service user information adequately as the main phone, fax, computer and filing system is also located in this office. The office area has now been moved upstairs to a more private area, and service users commented that they are pleased that this has happened. The home would be safer and look more homely if the following work was done: 1. 2. 3. 4. Remove the spare flagstones from the garden patio area Keep keys of the home and money/medication cabinet locked away Secure the wall panel in the laundry room which has come loose Carry out decoration to parts of the hallway and stairway area where paint or wallpaper need repair 5. Repair and decorate the ceiling in the kitchen which was damaged by a water leak 6. Clean or replace the carpet in the ground floor service users bedroom (Refer to Requirements YA24) Service users do not have any special need to have any special adaptations or equipment installed in the home. The home is kept clean and hygienic, and checks are now carried out regularly to meet health and safety requirements. Tulips Care Home, The DS0000058570.V291963.R01.S.doc Version 5.1 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34 and 35 Quality in this outcome area is adequate. Service users are currently supported by competent and qualified staff, who have begun working as an effective team having recently formed. Service users are now adequately protected by the home’s recruitment policy and practices. The home’s staff training programme does now ensure service users’ needs are met. EVIDENCE: The home employs staff experienced in providing care for this service user group. Three out of the four care staff are trained to NVQ level 2/3 in care. The service users cultural backgrounds are not reflected in the teams make up, but the homes manager has taken some measures to address this issue by scheduling all staff for Management of Diversity training, and by being sensitive to this issue when employing new staff. It was recommended at last inspection that the home explore service users views on how this staffing arrangement is working for them with a view to ensuring the service users cultural needs are being catered for. This has not happened as yet and this recommendation is now repeated. (Refer to Repeated Recommendations YA32) The home has now contracted the service of an advocacy group to provide support for service users who may need it, and they have had introductory meetings with one service user to date. Tulips Care Home, The DS0000058570.V291963.R01.S.doc Version 5.1 Page 21 The staff team consists of more than five staff including the manager, and the manager is considering appointing a full time assistant manager to assist with the management of the home. The manager has discussed staffing levels with commissioning agents who have given their verbal agreement that they are adequate. These staffing levels require that there are always two members of staff on shift during daytime hours and one sleeping over at night. The home has done risk assessments regarding support for each service user, which the manager has now formally agreed with the commissioning agents. Staff meetings now take place on a regular basis. The following concerns were raised at the last inspection regarding the homes recruitment practices and requirements and recommendations were made. Points 1 and 4 have now been fully addressed, and points 2 and 3 continue to need to be addressed. 1. One staff file showed only one reference. Although this member of staff was originally employed by a care agency, there must be two references on file. 2. The homes manager carries out recruitment by herself and is the only person involved in interviewing prospective staff. There should be at least one other experienced person involved in the recruitment procedure to adhere to the homes equal opportunities policy and ensure the best staff are employed. 3. There are currently no recruitment checklists being used to demonstrate that all recruitment information is collected prior to appointment. 4. Although all of the staff had provided proof of their CRB checks, the home had not yet acquired it’s own CRB checks for the staff it employed. The same staff had started work at the home while being employed by an agency but were now employed by the home. The manager had applied for CRB checks for all it’s staff and provided proof of this, however this process needs to be completed and any issues addressed if concerns are raised. (Refer to Repeated Requirement and recommendation YA34) At last inspection staff records did not reflect good adherence to methodically inducting staff in line with recommended good practice such as Skills for Care or LDAF induction frameworks, and individual staff records were inconsistent. Also there were no staff training plans in place for staff. These issues have now been addressed fully and there is a training plan in place for the home and for each member of staff. Concerns were expressed by some staff and service users that they were not clear as to whether some staff are employed by the home or by the agency. This has implications for the team regarding good teamwork, roles and Tulips Care Home, The DS0000058570.V291963.R01.S.doc Version 5.1 Page 22 responsibilities, and for service user confidence in the staff who provide the service. It is also the case that none of the staff employed are in possession of an employment contract from the registered provider, or any other written form of terms and conditions of employment. (Refer to Requirements YA34) Tulips Care Home, The DS0000058570.V291963.R01.S.doc Version 5.1 Page 23 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): Quality in this outcome area is adequate. The home’s management is not yet functioning to the degree of effectiveness required to enable the home to run well, which may place service users at risk. Service users cannot yet be confident that their views underpin all selfmonitoring, review and development by the home, denying them opportunities for inclusion. Service users’ health, safety and welfare are not always promoted and protected by the home, which may place them at risk in their home and local community. EVIDENCE: The registered manager is an experienced registered general nurse with mental health nurse training, but does not have a depth of experience in management and does not currently hold an NVQ level four qualification. She has now started studies on an NVQ level 4 course in Care and Management, which commenced in January 2006. Feedback from two social workers described the manager as hard working and as having been successful in Tulips Care Home, The DS0000058570.V291963.R01.S.doc Version 5.1 Page 24 providing a service for their service users referred. The manager now needs to complete the NVQ level 4 course. (Refer to Repeated Requirements YA37) The manager is considering appointing a full time assistant manager to assist with the management of the home. This was recommended at last inspection but due to a busy developmental period in the home this has not yet been fully decided on. This recommendation is now repeated. (Refer to Repeated Recommendation YA37) The home has now operated for almost 12 months and does not have any adequate systems yet for Quality Assurance or consultation with service users in place. The manager has developed visitors and service user questionnaires, and has carried out some service user surveys, but the results have not been fed back to service users or included in the homes development plan. A development plan for the home has been put in place since last inspection which needs more information from areas which would be drawn from service user surveys, annual Quality Audits and staff development needs identified through appraisal. However these systems are as yet not effectively up and running, and need further work from the homes management. (Refer to repeated Requirements YA39) A number of health and safety requirements were identified at last inspection, all of which have been addressed by the home. However a number of other health and safety requirements have been identified now as follows; 1. The fire risk assessment must be approved by the fire officer and fully implemented including carrying out regular fire drills 2. Portable appliances tests must be done on all portable electrical equipment (Refer to Requirement YA42) Tulips Care Home, The DS0000058570.V291963.R01.S.doc Version 5.1 Page 25 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 2 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 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 3 3 3 X 2 X 2 X X 2 X Tulips Care Home, The DS0000058570.V291963.R01.S.doc Version 5.1 Page 26 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 YA2 Regulation 14.1 a, b, c, d Requirement Timescale for action 31/07/06 2 YA6 15.1 and 2 The registered provider must ensure that all service users are admitted only on the basis of a full assessment undertaken by people competent to do so, involving the prospective service user, using an appropriate communication method and with an independent advocate as appropriate. The provider must evidence that a request has been made to relevant social services for all current service users to be provided with a complete care needs assessment. The registered manager must 31/07/06 ensure that all service users placements are reviewed by the placing authority, and provide evidence that the home has requested these reviews. This is a repeat of a previous requirement, Timescale 31/01/06 partially met. Timescale now revised. The registered manager must ensure that all service users are involved in decision making with regard to all of their financial DS0000058570.V291963.R01.S.doc 3 YA7 12 31/07/06 Tulips Care Home, The Version 5.1 Page 27 4 YA24 5 YA34 6 YA34 support arrangements, especially in relation to the receipt and management of benefits. This is a repeat of a previous requirement, Timescale 28/02/06 partially met. Timescale now revised. 23.2 The registered provider must 31/07/06 ensure that the home’s premises are suitable for its stated purpose and are accessible, safe and well maintained. In doing so the outstanding repairs listed under standard 24 of this report must be addressed. 19.1(a,b,c) The registered manager must 31/07/06 operate a thorough recruitment procedure involving at least two experienced persons conducting interviews, and ensure that there is a clear record of all recruitment information being taken up for each employee including dates. This applies also to current staff employed. This is a repeat of a previous requirement, Timescale 28/02/06 not met. Timescale now revised. Failure to meet this requirement may result in enforcement action 18.1 ( a b The registered provider must 31/07/06 c) ensure that there is a consistent and stable staff team employed by the home, and that all staff are in possession of a written statement of their terms and conditions as required by this standard 9.2 (b, I) The registered manager must complete an NVQ level 4 course in management and care. This is a repeat of a previous requirement, Timescale still in date, 31/10/06, partially DS0000058570.V291963.R01.S.doc 7 YA37 31/10/06 Tulips Care Home, The Version 5.1 Page 28 met. 8 YA39 24 The registered manager must ensure that the home develops a system of Quality Assurance to include an annual development plan for the home, survey and publication of service users views, and an Annual Audit system. This is a repeat of a previous requirement, Timescale 31/01/06, and 31/03/06, now partially met. Timescale has now been revised. The registered manager must ensure that safe working practices are employed in the home and that all parts the home are free from hazards to service users and staff, paying special attention to addressing the issues identified in this report under this standard. 31/07/06 9 YA42 13.4 30/06/06 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 YA12 Good Practice Recommendations In order to assist in maintaining the quality of care the registered manager should consider introducing a structured means of monitoring service users activity levels. The registered manager should include reference to POVA and CRB checks in the homes recruitment policy when it is next reviewed. The registered manager should seek service users views on the staffing arrangements for the home to ensure their cultural needs are being fully considered. This is a repeat of a previous recommendation. DS0000058570.V291963.R01.S.doc Version 5.1 Page 29 2 3 YA23 YA32 Tulips Care Home, The 4 YA32 5 YA37 The registered manager should consider improving the current system for recording that appropriate preemployment checks have been carried on staff by the introduction of a recruitment checklist. The registered provider and manager should consider the appointment of a permanent assistant team manager. This is a repeat of a previous recommendation from last inspection. Tulips Care Home, The DS0000058570.V291963.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH 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 Tulips Care Home, The DS0000058570.V291963.R01.S.doc Version 5.1 Page 31 - 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. 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