Inspection on 09/12/05 for Tulips Care Home, The

This inspection was carried out on 9th December 2005.

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 16 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 11/05/06

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 9th December 2005 9:20 Tulips Care Home, The DS0000058570.V271475.R01.S.doc Version 5.0 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.V271475.R01.S.doc Version 5.0 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.V271475.R01.S.doc Version 5.0 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.V271475.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th October 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. Currently there are three service users in residence. 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. Tulips Care Home, The DS0000058570.V271475.R01.S.doc Version 5.0 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 one staff member and spoke with two service users. There were a number of issues of serious concern identified regarding staffing at the last inspection in early October 2005, which merited an early second inspection. 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. The home was authorised to take referrals since last inspection due to these improvements. 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. 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 good description of what the home offers for service users in the Service Users’ Guide showing terms and conditions and how charges are made. There is a good policy on introducing service users to the home and having the opportunity to stay over and meet other service users and find out how things are managed. 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. There is a good complaints policy in place, and because the home is small the service users know the manager well and have regular contact with her. Bathing facilities are adequate and the home is kept to an adequate level of cleanliness. Food is good and service users are completely involved in preparing their meals and have full access to the kitchen. Tulips Care Home, The DS0000058570.V271475.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? All service users have a full assessment of care and support needs and mental health support needs assessments have been obtained where needed. The home has tried to ensure that all service users have regular reviews with social services although there have been problems making these happen on time. All service users now have written and costed contracts, showing their rights and responsibilities, which have been signed by them. Care and support plans have improved, and there is a more methodical system for planning, which allows for more detailed information, but further improvements are necessary. Some work has been done to improve risk assessments to protect service users and staff, but again more work needs to be done. Records of food provided have improved and good records are now being kept. Service users confirmed that they are given choices of food and are involved in shopping and cooking. Medication is now locked securely and good records are being maintained about medication given, but improvements are needed on management monitoring and recording of incoming medication. Service users consent to allow staff to manage and give medication is on file on each service users file. All staff including the manager have attended Adult Protection training. Work has begun in developing a system for planning for development and maintenance, and consideration is being given to moving the office space to a more suitable place in the home away from the kitchen area. Two out of four staff have the required NVQ qualification and the manager has registered on an NVQ level 4 course in care and management, commencing in January 2006. Sleepovers are now shared amongst staff instead of one person doing them, which had previously been the case. There are now always at least two staff available to provide support during daytime hours, and the manager has discussed these staffing levels with individual social workers, who agreed that they are adequate. Recruitment procedures have improved. The manager ensured that all staff who were not in possession of acceptable police checks were not allowed to work at the home. All current staff have been recruited through a recruitment agency and had been police checked by the agency. The manager is in the process of taking up more current police checks for all staff. The manager has employed an assistant manager through the agency and is considering making this post a permanent one to improve management support in the home. Tulips Care Home, The DS0000058570.V271475.R01.S.doc Version 5.0 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Tulips Care Home, The DS0000058570.V271475.R01.S.doc Version 5.0 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 Tulips Care Home, The DS0000058570.V271475.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 5 Prospective service users individual aspirations and needs are being assessed by the home, and service users are in possession of contracts of terms and conditions informing them of their rights and responsibilities. EVIDENCE: Two requirements from last inspection were met regarding ensuring that the home has copies of all service users current assessments and that these are dated. There is now evidence of all service users having Social Services assessments and relevant CPA assessments on file, and the manager agreed that though the information is adequate it needs to be improved in detail. The manager had carried out assessments of her own confirmed that she is continuing work on improving the homes own assessment system. (Refer to Recommendations YA2) There was no good written evidence that six-week/three-month/six-month reviews had taken place. Three out of four service users have moved in over the past month and six-week reviews have not been yet scheduled. It was described by the manager that it is the home’s policy to carry out these reviews and this is also expected as good practice to ensure an informed choice is being made regarding the homes suitability. The manager needs to write to social services to prompt these reviews to happen for all service users. (Refer to Requirements YA 6) Tulips Care Home, The DS0000058570.V271475.R01.S.doc Version 5.0 Page 10 At the time of last inspection the manager said that service users’ contracts were in place but were not kept at the home, and service users did not have a copy of their contracts. The manager has now ensured that service users each have a copy of their contracts, 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, understood them. Tulips Care Home, The DS0000058570.V271475.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Service users cannot be sure that all of their assessed needs and personal goals are reflected in their individual plan, which may result in important needs not being addressed. Service users make decisions about their own lives but need more information about their rights and advocacy support to ensure that their rights are fully protected. Service users are supported to take risks but action to minimise hazards needs to be improved otherwise risk to service users and staff may remain high. EVIDENCE: All service users files now contained Care Assessments and Care Programme Approach risk assessments. The manager had carried out her own assessments and produced care plans, which had some good detail. It was noted that service users’ individual plans were originally based only on information compiled by the manager and now include information from social services assessments and CPA assessments. The wording of the care plans has been improved and originally referred to the service users’ support needs as a “problem” but now refers to “support needed” or “goal”. Action for achieving goals is now more specific stating who will take responsibility. However, there are no agreed dates yet for care management reviews for any service users, and one service user who moved to the home in March 2005 has not yet had a Tulips Care Home, The DS0000058570.V271475.R01.S.doc Version 5.0 Page 12 review. The manager must prompt social services to carry out these reviews. (Refer to Requirements YA6) Care plans also need more detail and guidance in relation to Personal Care support needs (stating when no support is required as appropriate) and challenging behaviour management where appropriate. (Refer to Requirements YA6) Some service users fully manage their own finances and at least 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 not yet agreed to this, as it would involve having these payments made directly into the home’s own bank account. This situation has not yet been resolved or agreed with the home or 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 Requirements YA7) Risk assessments are now in place for each service user based on social services’ and CPA assessments. Some service users were or had been subject to the Care Programme Approach and had CPN involvement and these issues have been considered in carrying out risk assessments. The home has introduced an improved system for assessment and management of risk and three out of four service users are supported by fairly comprehensive risk assessments. However, not all service user’s files contained a full list of risk assessments showing the risk identified, a risk assessment for each area of risk and guidance for staff and service users in the management of the risk. This was a requirement from the last inspection and is partially met but is restated. (Refer to Repeated Requirement YA9) Tulips Care Home, The DS0000058570.V271475.R01.S.doc Version 5.0 Page 13 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): 12,13,16 and 17 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’ rights are respected and responsibilities recognised in their daily lives. A healthy diet is provided for, and meals are provided at times which suit service users. EVIDENCE: Three service users are fully independent in managing their finances and the remaining service user may need support in receiving benefits due to not having a bank account. Refer to standard 7 requirement. Two service users confirmed that they are able to maintain the activities and social contacts they had been engaged in before moving to the home. There is a referral system for getting support from the “Community Opportunity Service” in Deptford, to further develop community activities. There are opportunities for getting part time work, gardening, cooking and other leisure activities. Most service users have only recently moved to the home and one has taken up the opportunity of being referred to this service. Another service user had started an adult education course and is also looking at a possible part time job in a job centre. A co-ordinator from the job centre visits the home regularly to facilitate Tulips Care Home, The DS0000058570.V271475.R01.S.doc Version 5.0 Page 14 support and advice. Another service user does Yoga classes, cooking and printing and has been doing embroidery. This service user showed examples of her work and all service users said they are happy with the support the home is giving them. All service users are very independent with two people going out independently, and two go out with support, engaging in activities such as walking in Kent and West Wickham park areas, going to markets shopping, attending the library, the Hornimans museum, sometimes going to Catford Theatre, the pub and local cafes. Although most of the service users are new to the home and almost all staff are new to working at the home, there are good working relationships developing 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. There is some more work to be done in further developing these plans. (Refer to Recommendations YA16) The menus are now dated and planned on a rolling menu system showing weeks 1 to 4. The manager described how service users 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. Tulips Care Home, The DS0000058570.V271475.R01.S.doc Version 5.0 Page 15 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 Service users’ plans do not yet reflect the way they prefer to receive personal care/support, which may result in disempowerment. Service user’s physical and emotional needs are met. Service users 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 manager explained that some service users are totally independent in personal care while at least two require some prompting. Care plans or guidance do not reflect what level of prompting is required. Some work has been done to address this issue for one service user, and there is reference to support needs in her care plan. However more detailed instruction are required for staff to ensure that they offer consistent support but do not deskill the service user by offering too much support. Another service user who has some support needs in personal care does not currently have an adequate support assessment or guidance for staff. Where service users do not need any support this should be clearly recorded in care plans but currently is not. (Refer to Repeated Requirements YA 18) All health care needs are being properly assessed and met with the exception of some medication management issues. This was an issue at last inspection Tulips Care Home, The DS0000058570.V271475.R01.S.doc Version 5.0 Page 16 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 now recorded in their individual care plans. However the manager had delegated the duty of checking medication to a member of staff, who was checking the medication weekly, but was not however reporting to the manager properly when mistakes were being made. There were four occasions when medication was administered but had not been recorded, which the manager was not aware of. The system for recording incoming medication did not include a baseline count of medication, which made it impossible to be sure whether any subsequent count was correct. These are serious issues, which must be addressed by the manager to ensure that service users medication is being safely administered. (Refer to Requirement YA20) Tulips Care Home, The DS0000058570.V271475.R01.S.doc Version 5.0 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 Service users feel that their views are listened to and are acted on; however, the home’s written policy does not yet ensure that service users will be protected from abuse, neglect or self-harm, which currently presents a hazard for service users. EVIDENCE: The home’s 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 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 now had any training in adult protection, and the staff interviewed demonstrated understanding of this policy. However the homes policy on Adult Protection needs to be revised to reflect the local authorities current policy. (Refer to Requirements YA23) Risk assessments regarding service users managing their own finances have been discussed but there is no written evidence of this and no reference on care plans. (Refer to Repeated Requirement YA23) Tulips Care Home, The DS0000058570.V271475.R01.S.doc Version 5.0 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 Service users live in an environment that is generally homely, comfortable and safe; however, the location of the office impacts on service user’s privacy. EVIDENCE: The home is generally well maintained and kept clean and safe. There is sufficient light and ventilation and furnishings are adequate. The homes manager is now doing weekly health and safety checks and is using a comprehensive written system for recording findings and action required. The home has 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. However, access to the shower room involves going through the laundry area, which is visible from the kitchen/dining room. The shower room is currently small making changing difficult. The home’s management should give consideration make adjustments to the design of the shower-room to improve service users comfort. The manager said she is considering making improvements to the shower room area. (Refer to Repeated Recommendations YA24) Tulips Care Home, The DS0000058570.V271475.R01.S.doc Version 5.0 Page 19 The home’s office space is located in a small annexe to the kitchen, which makes 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 is difficult to protect service user information adequately as the main phone, fax, computer and filing system is also located in this office. (Refer to Ongoing Requirements YA24) Tulips Care Home, The DS0000058570.V271475.R01.S.doc Version 5.0 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 Service users are currently supported by competent and qualified staff, who have begun working as an effective team having recently formed. Service users are not currently adequately protected by the home’s recruitment policy and practices, placing service users potentially at risk, and the home’s stafftraining programme does not yet ensure service users’ needs will always be met. EVIDENCE: The home has had an almost complete change in staff since the last inspection, and now employs staff experienced in providing care for this service user group. Two 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. It is recommended 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. It is also recommended that the home explore the possibility of offering service users independent advocacy support for involvement in care planning and related issues. (Refer to Recommendations YA32) The staff team has increased in numbers since last inspection from less than four staff to more than five staff including the manager, and the manager is Tulips Care Home, The DS0000058570.V271475.R01.S.doc Version 5.0 Page 21 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. The home has done risk assessments regarding support for each service user, which the manager has been trying to have formally agreed with the commissioning agents. It is recommended that this be achieved. (Refer to Recommendations YA33) There is now a minimum of two staff on each daytime shift and a rota of permanent staff providing sleep-in cover at night, and there is a detailed rota showing the hours worked by each member of staff. Staff meetings have started to take place on a regular basis. The home did not accept referrals after the last inspection until the management and staffing arrangements had stabilised. After the last inspection the home suspended use of staff who had not undergone Criminal Record Bureau checks, and employed agency staff until permanent staff were employed. However the following recruitment issues remain a concern and must be addressed by the home as a priority: 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 YA34) Some work has been done in developing structured induction and training for staff, and some good training has been facilitated for new staff. However the manager confirmed that the home does not yet have staff training and development plans in place. (Refer to Repeated Requirement YA35) Staff records did not reflect good adherence to methodically inducting staff in line with recommended good practice such as TOPPS or LDAF induction Tulips Care Home, The DS0000058570.V271475.R01.S.doc Version 5.0 Page 22 frameworks, and individual staff records were inconsistent. These issues must be addressed. (Refer to Repeated Requirements YA35) Tulips Care Home, The DS0000058570.V271475.R01.S.doc Version 5.0 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): 37,39 and 42 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 qualifications. She has now enrolled on an NVQ level 4 course in Care and Management due to commence in January 2006. Feedback from two social workers described the manager as hard working and as having been successful in providing a service for their service users referred. The manager now needs to complete the NVQ level 4 course. (Refer to Requirements YA37) Tulips Care Home, The DS0000058570.V271475.R01.S.doc Version 5.0 Page 24 Since the last inspection the manager appointed a temporary assistant manager to provide support while she was absent and to continue until it was felt that the home is being competently managed. The manager confirmed that this had proven helpful, and that she has experienced difficulty in getting to grips with the many management and administrative tasks, is now considering creating a permanent assistant manager post. Given the level of development required in the home it is recommended that this appointment be made. (Refer to Recommendations YA37) The home has now operated for six 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 questionnaire and is planning to implement these and to develop an annual Quality Audit system. (Refer to Continuing Requirements YA39) The home’s management has done some work in improving the safety of the environment and now keeps a good record of visitors to the home. There is a continuing need to address the following issues: 1.The home needs to have a hot water regulator installed for the shower and bath and to sinks in both of these rooms. 2. The manager needs to carry out risk assessments for each service user regarding access to hot water in the kitchen sink. 3. The manager needs to install a window restrictor to the window of one of the service user’s bedrooms on the first floor. 4. The home must carry out fire evacuation drills at least every three months. 5. There are currently no door closing mechanisms fitted to internal doors to reduce the risk in the event of fire. The London fire brigade have inspected the home and not raised this as an issue. This issue needs to be checked again with the London Fire Brigade and appropriate action taken. (This issues was not raised at last inspection) (Refer to Repeated Requirements YA42) Tulips Care Home, The DS0000058570.V271475.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X X 3 Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 2 X 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X X X X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 3 2 2 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Tulips Care Home, The Score 2 3 2 X Standard No 37 38 39 40 41 42 43 Score 2 X 2 X X 2 X DS0000058570.V271475.R01.S.doc Version 5.0 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 YA6 Regulation 15.1 and 2 Requirement Timescale for action 31/01/06 2 YA6 15.1 and 2 3 YA7 12 4. YA9 13.4 (b,c) The registered manager must ensure care plans for service users are revised to include areas identified in this report and are agreed with individual service users. The registered manager must 31/01/06 ensure that all service users placements are reviewed by the placing authority, and provide evidence that the home has requested these reviews. The registered manager must 28/02/06 ensure that all service users are involved in decision making with regard to all of their financial support arrangements, especially in relation to the receipt and management of benefits The registered manager must 28/02/06 ensure that that risk assessments for all service users are reviewed and revised to include any relevant information from Social Services and CPA assessments. These must be reviewed at least every 6 months. In doing so the risk assessments must be clearly DS0000058570.V271475.R01.S.doc Version 5.0 Tulips Care Home, The Page 27 5. YA18 15.1and 2 6. YA20 13.2 7. YA23 13.6 8. YA23 12.3 dated, showing who was involved and risk assessments showing medium or high levels of risk must be supported by written guidance for staff in how to support service users. Such guidance must be kept in a place easily available to staff and individual service users. This is a repeat of a previous requirement, Timescale 30/11/05 partially met. Failure to meet this requirement may result in enforcement action. The registered manager must ensure that all service users personal care/support needs are reflected in their care plans in order to maintain individual levels of independence. This is a repeat of a previous requirement, Timescale 30/11/05 partially met. Failure to meet this requirement may result in enforcement action. The registered manager must ensure that records of incoming medication are appropriately maintained, and that an effective weekly system for checking the administration and recording of medication is implemented by the manager. The registered manager must ensure that the homes Adult Protection policy is reviewed to reflect the requirements of the local authorities current policy The registered manager must ensure that all service users are protected from financial abuse and in doing so ensure that risk assessments are put in place for service users independent management of their finances and involve the service user and DS0000058570.V271475.R01.S.doc 28/02/06 31/01/06 31/03/06 28/02/06 Tulips Care Home, The Version 5.0 Page 28 9. YA24 10. YA34 11. YA34 12. YA35 relevant social workers in these assessments. This is a repeat of a previous requirement, Timescale 30/11/05 partially met. Failure to meet this requirement may result in enforcement action. 12.4 (a) & The registered manager must 23.2 put in place a system for planning development and maintenance of the property, to include consideration for relocating the office area. This was a requirement from last inspection, but is still within the timescale of 31/01/06, now revised. 19.1(a,b,c) The registered provider and manager must operate a thorough recruitment procedure, ensuring that all staff employed are confirmed in post only following completion of satisfactory police checks, and following receipt of two satisfactory written references. (The issue of Staff currently employed without the necessary two written references and CRB checks carried out by the home must be addressed) This is a repeat of a previous requirement, Timescale 07/10/05, partially met. Failure to meet this requirement may result in enforcement action. 19.1(a,b,c) The registered manager must 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. 18.1(a,b,c) The registered manager must DS0000058570.V271475.R01.S.doc 31/03/06 28/02/06 28/02/06 28/02/06 Page 29 Tulips Care Home, The Version 5.0 13. YA35 14. 15. YA37 YA39 16. YA42 ensure that the home has training and development plan in place, which is linked to service user’s assessed needs, and ensure that all staff employed have an individual training and development profile. This is a repeat of a previous requirement, Timescale 31/12/05, partially met. Timescale is now revised. 18.1(a,b,c) The registered manager must ensure that all staff are inducted in accordance with a structured schedule, which meets the Sector Skills Council specifications. (LDAF or TOPPS induction) This is a repeat of a previous requirement, Timescale 30/11/05, partially met. Failure to meet this requirement may result in enforcement action. 9.2 (b, I) The registered manager must complete an NVQ level 4 course in management and care. 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, ongoing and partially met. Timescale has now been revised. 13.4 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 under this DS0000058570.V271475.R01.S.doc 28/02/06 31/10/06 31/03/06 31/01/06 Tulips Care Home, The Version 5.0 Page 30 standard. This is a repeat of a previous requirement, Timescale 30/11/05, partially met. Failure to meet this requirement may result in enforcement action. 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. 4. 5 6 7 Refer to Standard YA2 YA16 YA24 YA32 YA32 YA33 YA37 Good Practice Recommendations The registered manager should involve social services in making improvements to service users care assessments The registered manager should include household tasks in each service users support plans which are specifically relevant to each service users personal development needs The homes management should give consideration make adjustments to the design of the ground floor showerroom to improve service users comfort. The registered manager should seek service users views on the staffing arrangements for the home to ensure their cultural needs are being fully considered The registered manager should explore opportunities for involvement of advocacy for service users and inform them of these opportunities The registered manager should have the current staffing levels formally agreed with the commissioning agents The registered provider and manager should consider the appointment of a permanent assistant team manager Tulips Care Home, The DS0000058570.V271475.R01.S.doc Version 5.0 Page 31 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. 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