Inspection on 10/12/07 for Unicorn House (16)

This inspection was carried out on 10th December 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 20 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Unicorn House (16) 30/05/08

Unicorn House (16) 18/06/07

Unicorn House (16) 05/03/07

Unicorn House (16) 27/06/06

Unicorn House (16) 08/11/05

Unicorn House (16) 18/04/05

Unicorn House (16) 06/10/04

Unicorn House (16) 01/06/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Unicorn House (16) 16 Campden Road South Croydon Surrey CR2 7EN Lead Inspector James O`Hara Key Unannounced Inspection 10 & 11th December 2007 09:30 th Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Unicorn House (16) Address 16 Campden Road South Croydon Surrey CR2 7EN 020 8688 1907 020 8686 0135 unicornprojects@hotmail.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Maharajah Madhewoo Post Vacant Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No new service user with a mental health condition may be admitted to the home. Date of last inspection 18th June 2007 Brief Description of the Service: Unicorn House is a twelve bedded home that is registered to provide care for residents who have a learning disability. The location of the home is within easy reach of good public transport links and the centre of Croydon. This results in the residents being within easy reach of local amenities and services. The fee’s charged for living at the home range between £800 and £1500. Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. From all the available evidence gathered during the inspection process the Commission for Social Care Inspection (CSCI) has judged the service as having significantly more weaknesses than strengths with important elements of Key National Minimum Standards not being met. This remains a generally low performing service that has a poor track record of delivering satisfactory outcomes for the people who live at the home. This is the second key unannounced inspection carried out at the home this inspection year. We spent eight hours in the home spread over two site visits carried out on consecutive days. The first key inspection took place on the 18th of June 2007. A random inspection was also carried out on the 25th and 26th of October. This inspection was carried out over two days 10th and 11th of December. Two inspectors Mr James O’Hara and Mr Lee Willis carried out these inspections. At the key inspection in June a number of serious issues with medication handling were noted which could have put residents at risk. A referral was made to the Commission’s Pharmacist Inspector. The Pharmacy Inspector attended the random inspection to evaluate the requirements and assessed the homes procedures for administering and storing medication. At the random inspection in October it was assessed that nineteen out of twenty two requirements set at the last key inspection had been met and the home had addressed some of the recommendations for good practice. The three outstanding requirements were given new timescales for action of the 7th of January 2008. Twelve new requirements and a number of recommendations for good practice were set at the random inspection; the requirements had a timescale for action of the 7th of January 2008. During this inspection some of these requirements and recommendations were assessed and the home manager, Mr. Khan, provided evidence that some were met, he was advised that the home was still within the timescales to meet the outstanding requirements. During these site visits we spoke at length to four people who live at the home, the relatively new manager, and two other members of staff. Records examined at this inspection included the homes Statement of Purpose, medication, staff recruitment, staff training, and quality monitoring, health and safety, and fire safety. A number of comment cards were returned as feedback about the home to the Commission from residents, their relatives, and a care manager. Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 6 Methods of inspection included previous inspection experience of the home, observation of contact between staff and people who use the service, discussion with people living at the home, the home manager, the administrator and staff on shift. We also went on a tour of the premises. Evidence from the random inspection is also recorded in this report. What the service does well: What has improved since the last inspection? What they could do better: There have been some issues of concern at this service that have been ongoing since previous inspections or that have been identified during this inspection and are of very serious concern and the commission is now considering enforcement action in relation to those issues. The commission will take enforcement action to ensure future compliance and secure the safety of service users. Five members of staff (three support workers, a deputy manager and the previous acting home manager) have left the home since the June inspection. Two administration staff responsible for the homes finances has also left in Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 7 that time. The current home manager started work at the home in July. There has been a high turn over of staff and managers at the home over the last four years and each new manager has brought a new regime that residents have had to adjust to. Over this time the registered provider has failed to establish a team that could take into account the long-term needs of the residents. It was stated in the random inspection report that the Commission would continue to monitor the registered provider Mr Madhewoo ’s and the home manager’s approach to establishing a staff team that will meet the social care needs of the people they are offering a service to. A high number of requirements were set at the random inspection and further requirements have been set at this inspection. The home needs to make sure that people who may wish to use the service can be confident that their needs can be met as the home has failed to make sure that people’s needs are assessed by a suitably qualified or suitably trained person prior to admitting them to the home. The Commission will continue to monitor how the home admits new residents to the home. Progress has been made on reviewing residents Person Centred Plans and care plans however residents need to be sure that they will be supported to improve their independent living skills. The home needs to make sure that residents have sufficient opportunities to engage in a wide enough variety of meaningful social activities, or develop their independent living skills. At present these opportunities are limited because staff do not understand the importance of supporting personal development and helping people participate in suitable leisure activities. There is scope to improve this by involving all staff in delivering this care and making sure shift patterns and established routines are reviewed to take account of residents social care needs. The home needs to make sure that medication handling practices are improved. The home needs to make sure that the resident’s finances are properly managed. The home needs to make sure that residents live in an environment that meets their health care needs and does not restrict their independence and choice. The home needs to engage with specialist healthcare professionals when necessary so as to promote people’s rights. The high turnover of staff is of concern and the homes current recruitment practice is leaving residents at risk, they cannot be confident that they will be protected from harm or abuse until the home ensures that full employment checks are carried out prior to staff starting work in the home. Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 8 Residents cannot be sure that new staff are trained or properly inducted so that they are competent and capable of supporting them with their assessed needs. The registered person needs to make sure that the home is managed in a way that promotes the resident’s independence dignity and safety. The registered person needs to make sure that regulation 26 visits are carried out at the home on a monthly basis. The inspector’s would like to thank the residents, their relatives, the staff and the home manager, Mr. Khan, for their support in the inspection process. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 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 Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who may wish to use the service cannot be confident that their needs can be met as the home has failed to make sure that people’s needs are assessed by a suitably qualified or suitably trained person prior to admitting them to the home. The Commission will continue to monitor how the home admits new residents to the home. EVIDENCE: The last two admissions to Unicorn House have brought into question whether those responsible for the admissions process are putting those who are in need of services at the centre of all their activities. Both admissions have been on an emergency basis involving individuals who had elements of their needs that the staff in the home had not been trained or sufficiently experienced to immediately provide the care. The Statement of Purpose is an important document, as it should give a clear picture of what the home can offer and how it will deliver its core service. It should reduce the likelihood of inappropriate admissions. Because there were concerns that inappropriate admissions were likely to continue to occur a requirement was set at the last key inspection, (18th of June 2007) that the registered provider must make sure that the home Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 11 develops a Statement of Purpose that includes accurate and appropriate information and takes into account the registration category of the home. A Random Inspection was carried out at the home on 25th of October 2007 to monitor outstanding requirements. A revised Statement of Purpose was provided by Mr Khan the recently appointed manager for Unicorn House. He told us that the previous acting manager Mr Venkaya had updated the Statement of Purpose. The Statement of Purpose now included more accurate and appropriate information however a few minor adjustments were requested which were amended before the end of the inspection. Mr Khan confirmed that he would keep the Statement of Purpose under review. No new residents have moved into the home since the last inspection. The Commission sent all of the residents’ care manager’s questionnaires for their comments about the service, only one care manager responded. The care manager commented, “The service has a broad mixture of residents with different needs. I do not feel the grouping is conducive to maximizing peoples potential or catering properly for individual requirements. It feels as if little consideration has been given to compatibility issues at the admission stage and the service has just accepted anyone”. A requirement was set at the last key inspection (18th of June 2007) that the registered provider, Mr. Madhewoo, must make sure that the home develops an appropriate admissions procedure that takes into account the registration category of the home and the Statement of Purpose. At the random inspection (25th of October 2007) Mr Khan produced the home’s admissions procedure. He told us that the previous acting manager Mr Venkaya had updated it. The procedure concentrated on the commencement of a service however it did not take into account information included in the Statement of Purpose. Mr Khan amended the admissions procedure during the inspection which is now appropriate. As the manager of the service Mr Khan was asked about the process of admitting new residents and how he would go about making sure that any prospective resident was compatible with the current group of residents. He told us that as he was very busy with the day-to-day management of the home he would leave this to the Registered Provider, Mr Madhewoo, and the newly appointed Administrator. He was of the view that they would take the responsibility for assessing and admitting new residents to the home. Mr Khan was advised that a statutory requirement notice had been served on the Registered Provider, Mr Madhewoo, in May 2007 for failing to ensure that the needs of a new resident were assessed by a suitably qualified or suitably trained person prior to being admitted to the home. Also for failing to ensure that there was appropriate consultation regarding the assessment with the resident or their representative and failing to confirm in writing to the Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 12 resident that having regard to the assessment the care home was suitable for the purpose of meeting his needs in respect of his health and welfare. Mr. Khan and Mr. Madhewoo must make sure that the needs of any new residents are assessed by a suitably qualified or suitably trained person prior to admitting them to the home, that there is appropriate consultation regarding the assessment with the resident or a representative of the resident and having regard to the assessment the care home is suitable for the purpose of meeting their needs in respect of their health and welfare. Notwithstanding the alterations to the Statement of Purpose and the Admissions Procedure the Commission will continue to monitor admissions to Unicorn House. Any further breeches in the regulations in this area may result in further enforcement action being undertaken. The Commission has revised its procedures for setting categories as conditions in keeping with the principles of Inspecting for Better Lives. It is no longer required that providers should seek a variation to support adults over the age of 65. The previous conditions to allow two people over the age of 65 and two people with physical disabilities to live at the home have been removed and a new certificate is displayed in the home. The condition that no new service user with a mental health condition may be admitted to the home will remain on the homes registration certificate. The primary care need of all of the people who use the services at Unicorn House is learning disabilities. However some people also have a physical disability and use wheel chairs. Once Mr Madhewoo has carried out the recommendations from the Occupational Therapist report in respect of the suitability of the home environment for wheelchair users, it is recommended that the homes’ Statement of Purpose be updated to reflect that the home supports people with physical disability and some people with elderly needs. Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 13 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Progress has been made on reviewing residents Person Centred Plans and care plans however residents cannot be sure that they will be supported to improve their independent living skills. EVIDENCE: A requirement was set at the last key inspection (18th of June 2007) that a service user plan/care plan is developed in partnership with a new resident, based on his assessment. The plan should clearly set out how specialist requirements will be met through positive and planned interventions. The plan should focus on current needs, development of skills, and his future aspirations. This resident’s file was examined at the Random Inspection (25th of October 2007). The file included a person centred plan with details of the persons likes and dislikes, personal care, social and spiritual and physical health needs, a communication profile, details of activities and community participation, his Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 14 dreams and aspirations and finance. The plan also included a description of how his challenging behaviour is presented and how staff can meet his needs. The file also included a certificate signed by the former manager Mr Venkaya and the key worker confirming that they had been involved in the completion of the person centred plan. Mr Khan agreed to make adjustments in the plan to any words or phrases that described the individual or his behaviours in a negative way. A comment card returned to the Commission from a care manager for a resident with associated mental health condition commented, “Care plans are not drawn up with professionals. Language did not reflect an understanding of mental health needs. I am not convinced that staff have sufficient knowledge or skills to manage mental health”. During the first morning of the random inspection (25th of October 2007) only one person who lived at the home was observed helping themselves to a hot drink in the kitchen. We saw a number of instances where people were either sitting in the dinning room waiting to be served breakfast or just ‘milling’ around having just eaten. Staff did not seem to have much time to spend ‘chatting’ or interacting with them. Staff spoken with had a good knowledge about what person centred care was, but seemed to require more support to put this into practice. One staff member said they would “like more time to support the residents to develop their domestic skills”, while another said “our work schedule does not allow us to actively support people who use the service to develop their independent life skills”. Care plans should contain more individualised information to help staff deliver programmes for promoting independent living. We did see some good detailed records about people’s health care needs, but not much about the support people needed in order to become more independent. It was recommended that the staff team discuss this area further and decide what additional information should be recorded in care plans. A requirement was set at the last key inspection (18th of June 2007) that the home manager must make sure that all residents’ risk assessments be reviewed and updated on a regular basis. One person’s file was examined at the random inspection (25th of October 2007). This persons risk assessments had been reviewed and updated on a regular basis. Mr khan told us that all other peoples risk assessments are kept under review. Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 & 17 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service cannot be confident that the staff have appropriate time to provide them with sufficient opportunities to take part in social activities and be part of the broader community. EVIDENCE: In order to gain feedback about the quality of service provided in the home it was recommended at the last key inspection (18th of June 2007) that the home offer residents the opportunity to complete a service user comment form. At the Random Inspection (25th of October 2007) Mr Khan told us that the previous acting home manager Mr Venkaya had developed new comment forms and that residents had completed these. This was not assessed during this inspection and will be examined at the next inspection. Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 16 It was also recommended at the last key inspection (18th of June 2007) that the home develop a more appropriate activities record for individual residents. This was not assessed during this inspection and will be examined at the next inspection. A number of comment cards were returned to the Commission from residents. Unicorn staff had supported all of the residents to complete these. From all the questions there was never less than 75 positive rating for the service. Only one of the eight residents who completed the questionnaire asked to speak to the inspectors. This resident told us that he was quite happy living at the home and that he was looking forward to Christmas, he said that he was going home to stay with his mum and had regular visits to his family home. Two residents had staff record for them that they were feeling happy in the home and with staff and had no complaints. One comment card was returned to the commission from a relative. The relative commented that “residents appear content and well cared for, I have never had cause for concern about the treatment my brother receives, I am made welcome and I receive invitations for special days, when my brother went into hospital I was most impressed to find a staff member from the home was in attendance 24 hours”. At the key inspection on the 5th of March 2007 the previous acting home manager Mr Venkaya told us that following the registered provider, Mr. Madhewoo, moving out of the top floor of the home that work was under way to redecorate and furnish this part of the home and use it to support residents with cooking and independent living skills. A recommendation was made to support this initiative. It was recommended at the random inspection (25th of October 2007) that Mr Khan look at new ways to help his staff provide residents with the support they need to maintain and develop their independent living skills. In order to promote independence and support people to acquire new skills it was also recommended that people be supported to prepare and cook meals. At this inspection Mr. Khan told us that the newly recruited Administrator now occupied the top floor of the home and as a result the previous plan to use this part of the home to support residents with cooking and independent living skills had been shelved. During this inspection a member of staff was observed serving tea and toast to a resident who was sat in the dinning room. It was noted that the kitchen door remained opened throughout the inspection but none of the residents were observed entering the kitchen at any stage during the visit. Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 17 During the course of this two-day inspection none of residents were observed participating in any household chores, such as making a hot drink, cleaning their bedroom, or doing their laundry. The person eating their breakfast told us after they had finished that staff always made their breakfast for them, which indicated that residents were not actively encouraged or supported by staff to develop their independent living skills. This same resident was observed repeatedly asking for a hot drink, on one occasion he also asked Mr. Khan, who responded by telling the resident to go to his room and lay down and have a rest. As the home manager Mr. Khan should be a beacon of good practice to his staff, however this interchange with the resident could be viewed as disrespectful and not one that would normally be expected from a manager of a social care home. Having arrived just before 10am on both days of the inspection we observed on two separate occasions approximately half the residents either sitting having breakfast or wandering around in the dining room. During these periods no members of staff who were on duty at the time were observed interacting with them. It was not clear whether this was planned part of the daily programme. Around lunchtime one resident was observed helping themselves to a puzzle from the games room. This individual told us “they liked to do puzzles and to draw”. Another resident told us they were going shopping in the afternoon. Other comments from residents included “there are trips”, “I go to a day centre”, and “I get out in the garden”. Another person spoken with was very positive about a recent swimming trip they had been on, which they had obviously enjoyed. These positive comments from the residents are encouraging however it will be important that the range of activities on offer, especially within the home are broadened and are generated from the person centred care plans. Staff spoken with knew what person centred care was, but were not so clear about how this could be put into practice. One of their concerns was the higher level of support that many people needed with their personal care each day. They felt that this did not allow them the quality time to be with the residents. One staff member said they would “like more time to sit, chat, and engage in activities” with people during their shift and another person said “the homes daily routines make it difficult to allow for this”. Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service cannot be confident that they are protected by the practices in the home for dealing with medication. EVIDENCE: At the last key inspection (18th of June 2007) a number of serious issues with medication handling were noted which could have put residents at risk. The following five requirements were made. The Commissions Pharmacy Inspector attended the Random Inspection (25th of October 2007) in order to evaluate the requirements and assess the homes procedures for administering and storing medication. All staff must be made aware of the home’s policies and procedures for handling medicines and up date their training in medication to ensure service users are, so far as reasonably practicable, protected from harm. Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 19 The registered manager and staff must comply with the homes policy and procedures for the recording of medicines administered in the home ensure service users are protected from harm. The registered manager must establish a procedure for receiving all medication into the home and ensure staff keeps an accurate record of this process. The registered manager must establish protocols for the use of as required (PRN) medication to ensure staff are clear when and how to administer this type of medication, and who authorises its use. Drugs used for medically invasive procedures, which staff have not been suitably trained or authorised to administer, must be returned to the dispensing pharmacist and appropriate advise sought from the relevant health care professionals about who should be responsible for handling this type of medication. The Pharmacy inspector reported that progress had been made to meet these requirements, the standard of recording had improved and the manager had plans to make further improvements, however a number of new issues were noted which must be addressed. Medication Administration Record (MAR) charts for all residents were inspected for the current and previous months, together with records of medication received and returned, policies, training and storage facilities. Medication is stored appropriately in a locked cabinet. A sample of the medication in stock was counted and compared to the quantities on the MAR charts, these were accurate, indicating medication is being given as prescribed and there is no mishandling. Staff have been supporting people to take their medication and there were no missed doses. All medication was available at the home at the time of the inspection, however one item, lactulose, was out of stock in the last month for 2 days. In this case the person did not miss their medication as lactulose prescribed for another person was used. Although it was understandable why this was done, to avoid intestinal blockage, medication must only be administered to the person it is prescribed for, and must not be used for other people. Staff must ensure that all medication is reordered with sufficient time to avoid being out of stock. One person uses a nasal spray as and when required. On one occasion they did not receive their medication at lunchtime as they attended a day centre. Appropriate arrangements must be in place for people to receive their medication when away from the home. Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 20 A requirement was made at the last key inspection (18th of June 2007) to ensure receipts of medication are recorded. This is now being done in the majority of cases however receipts were missing for three prescribed items. There was a box of injections in stock, which is administered at a clinic, however the quantity in stock did not appear on the MAR chart. Receipts for all medication must be recorded so that the home can account for all of the medication it holds on behalf of residents. Some changes have been made to MAR charts. There was evidence in the care plan for the changes, however the MAR chart must be initialled and dated by staff so it is clear who made the change, and when. There are some prescribed items that are given “as required”. Although staff interviewed knew when to use these medications, and the interventions to use before administering medication, this needs to be written down in a protocol. Medication Profiles detailing start and stop dates have been produced, which is good, practise. These should be reviewed for accuracy and kept up to date. Photographs are not available in the MAR chart folder for one resident this must be rectified. Allergy information is missing on some MAR charts although noted in the care plan. Allergy information should be available in the MAR chart folder for all residents. The home manager is in process of assessing the training and competence of staff and there is now a list of trained staff authorised to administer medication. It was recommended that the Skills For Care Knowledge Set for medication be used to determine whether any training given is adequate. During this inspection no recording errors were noted on Medication Administration Record (MAR) sheets sampled at random, which all indicated that medicines are being given as prescribed. Furthermore, as required in the Random Inspection report improvements had been made to the way the service kept accurate records of all medicines it received on behalf of the people using the service. MAR sheets sampled at random revealed that all the medicines received into the home in the past two months had been checked in by a member of staff who had signed and dated the appropriate documents. Mr. Khan told us that none of the other outstanding requirements identified at the Random Inspection regarding medication handing practices in the home had been dealt with, but was nonetheless confident they would be addressed within the prescribed timescales for action (i.e. 7/01/08). He was reminded that he had less than a month to address all the shortfalls previously identified in relation to medication handling practices in the home. Mr. Khan reiterated Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 21 his earlier statement that he felt confident these issues would be resolved by 7th January 2008. A requirement was set at the last key inspection (18th of June 2007) that manual handling assessments must be carried out in respect of all residents with physical needs and where risks are identified appropriate management strategies developed to enable staff to provide healthcare support in the way these individuals prefer and require. At the Random Inspection (25th of October 2007) we looked at the care plans for two people who have been assessed as requiring support to make sure their physical needs are met. Each care plan contained up to date manual handling assessments that had been undertaken by Mr Khan. The assessments were sufficiently detailed to enable staff to provide these individuals with all the support they required and in the way they prefer. Mr Khan told us he understood the importance of carrying out thorough assessments of people’s health care needs before they come to live at the home as part of an effective approach to care planning. A requirement was set at the last key inspection (18th of June 2007) that suitably qualified occupational therapists must assess the physical needs of people who require mobility aids/adaptations, and the physical environment. At the Random Inspection (25th of October 2007) Mr Khan produced a report from an Occupational Therapist dated 9th of October 2007. The Occupational Therapist made a significant number of recommendations in her report based on her knowledge and skills in adapting environments for people with physical disabilities. The recommendations relate to the entrance of the home, hallways, shower rooms, and bedrooms, dining area, sun lounge, and back access. As the registered provider is providing a service to people with physical disabilities then the environment should meet their assessed needs. A requirement was set at the Random Inspection (25th of October 2007) that the registered provider Mr Madhewoo must provide the Commission with an action plan indicating how he will address the recommendations made in the occupational therapists report. At this inspection Mr Khan told us that Mr Madhewoo had not informed him if he had completed the action plan. Mr Khan was advised that Mr Madhewoo was still within the timescale for action to send an action plan as this was set for the 7th of January 2008. It was recommended at the Random Inspection (25th of October 2007) that Mr Khan send a copy of the Occupational Therapist’s report to the care managers of those people that have physical needs or require mobility aids/adaptations. Mr Khan told us that he had not yet done this. Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 22 The Occupational Therapist’s report recommended that bedroom number two is not used for a wheelchair user. A wheelchair user currently occupies this bedroom. It was recommended at the random inspection (25th of October 2007) that Mr Madhewoo relocate the occupant to a room more suitable for wheelchair use. This has not yet occurred. It is unfortunate that not only has the care manager for this resident not been notified that the current bedroom is unsuitable but a more appropriate room has not been identified. It has now been required that the Mr Madhewoo relocates this resident to a room more suitable to his needs. It was recommended at the key inspection (18th of June 2007) that the home manager contact the National Autistic Society for further advice on TEACCH Training and autism. At the Random Inspection (25th of October 2007) Mr Khan told us that he had not personally followed this up but produced evidence that he and another member of staff had attended a two-day course on autism in July 2007. He informed us that other staff had also attended autism training but he needed to familiarise himself with and update staff training records before he could ensure that this recommendation could be fulfilled. Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 23 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents cannot be confident that they will be protected from financial abuse until the home develops and maintains a consistent, robust and transparent finance system. EVIDENCE: A requirement was set at the last key inspection (18th of June 2007) that the home must establish a far more accessible complaints procedure that enables residents to know how and to whom they can make complaints to. At the Random Inspection (25th of October 2007) Mr Khan told us the home’s complaints policy and procedure had recently been updated to include more detailed information about how long a complainant can reasonably expect to wait for a response to their complaint, who deals with it, and what they can do if they are dissatisfied with the action taken (if any). Mr. Khan told us no formal complaints had been made about the homes operation in the past six months. He was also aware that any concerns or complaints received must be recorded including details about any action taken in response. At the Random inspection (25th of October 2007) some residents commented, “never needed to complain” and “staff listen to me”. Two residents told us they felt able to speak to staff and/or the home manager about any issues they may have. Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 24 During a tour of the premises at the Random Inspection (25th of October 2007) no versions of the homes’ complaints procedures (revised or otherwise) were found displayed in any part of the home or in the Guide for the people living there. A requirement was set that the home should look at making sure that the complaints procedure is available in different formats as appropriate to the needs of the people using the service and ensure written copies are given to them and/or conspicuously displayed in the care home. This shortfall had been identified during the homes last key inspection (18th of June 2007) failure to address this within the new timescale may result in the Commission considering taking enforcement action to ensure future compliance. During this inspection there was again no version of the homes complaints procedures displayed in any part of the home. When this was pointed out to Mr Khan he placed copies of the complaints procedures on a wall in the hallway and on a notice board in the living room. Although the timescale for action for this requirement was set for the 7th of January 2007 quality assurance systems or the required monthly visits by Mr Madhewoo should have identified and rectified this outstanding requirement. Mr Khan agreed that it would have been easy to meet this requirement following the random inspection. The Administrator for Unicorn Services shares an office with Mr Khan. This is the Administrator’s second period of employment having returned to Unicorn services on 12th of November 2007 after an absence of over a year. During this period two other people have had as part of their contract responsibility for the residents and Unicorn services finances. Concerns were expressed by the Administrator about the way the resident’s monies were held in a pool account, as it was difficult to divide the individual interest accrued for each resident. The Administrator was unclear why this account was set up in this manner. It was recommended that she read the random inspection report, 20th of September 2006, which contained a number of requirements in respect of resident’s finances. The report also referred to the fact that Mr Madhewoo had had three personal assistants in the previous three years to assist him in the monitoring and maintenance of the financial records of the home and the residents. This regular change of personnel had not contributed to a robust and transparent system for financial billing of residents or the monitoring of their personal finances. Residents hold some personal spending money in the home this was inspected. The home has one book to record all of the resident’s expenditure and a tin Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 25 holds plastic wallets with cash and receipts. On one occasion a member of staff took £15 out buy a resident some personal items and returned some change and a receipt some weeks later. There was no evidence to suggest that the resident had been involved in the purchase of these items. Mr Khan told us that he was not happy with this system. Neither the Administrator or Mr Khan were able to agree on an alternative system. This resulted in request by the Administrator for the Commission to recommend an appropriate alternative. The Administrator was advised that it was not the role of the Commission to make management decisions on the day-to-day running of the home. Mr Khan and Mr Madhewoo must make sure that there are robust and transparent financial procedures in place so that residents can be sure that their finances are protected. Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 26 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who use the service live in an environment that is relatively comfortable, but weak management of some complex health care issues is restricting their independence and choice. Unclear care planning and failure to engage specialist healthcare professionals when necessary has comprised people’s rights. EVIDENCE: Since the Random inspection (25th of October 2007) improvements have been made to the furniture and fittings of the home, with new carpet laid in the hallway and stairs, and a set of new chairs brought for the dining room. A requirement was set at the last key inspection (18th of June 2007) that suitable wheelchair ramps must be fitted to all the homes backdoors to ensure wheelchairs users have independent access to the rear garden. Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 27 At the Random inspection Mr Khan pointed out that ramps had been installed. However this did not comply with the recommendations of the Occupational Therapist. Mr Khan was referred back to the recommendations in the Occupational Therapist’s report. A requirement was set at the last key inspection (18th of June 2007) that laundry must not be sorted on tables where food is eaten, especially during mealtimes, as this practice contravenes environmental hygiene standards and is undignified for the people who live at the home. Mr. Khan told us that this practice has now ceased. Another requirement set at the key inspection (18th of June 2007) was that hand washing facilities must be located in the laundry room to prevent the spread of infection. A sink, soap and a paper towel dispenser’s have been fitted in the laundry room. During the random inspection (25th of October 2007) it was noted that in the laundry facilities a bin, without a lid, was being inappropriately used to dispose of clinical waste, such as latex gloves and plastic aprons. The home was required to purchase a pedal bin for disposing of this type of waste in accordance with good infection control guidelines. This requirement has been met. A requirement was set at the last key inspection (18th of June 2007) that Mr Venkaya the previous home’s manager must ensure that staff were appropriately trained in infection control. Mr Khan produced evidence that all staff had attended training on infection control in October 2007. A requirement was set at the last key inspection (18th of June 2007) that Mr Madhewoo must ensure that suitable arrangements are made at the entrance to the home so that residents who use wheelchairs can gain access to the home without the need for physical assistance from staff. A ramp has been installed at the front door and the flooring raised in the porch way however this arrangement still does not enable people who use wheelchairs to gain access to the home without the need for physical assistance from staff. The Occupational Therapists report also makes a number of recommendations in relation to wheelchairs. The report recommended that the shower unit be accessible to wheelchairs and that it has a thermostatic lock. Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 28 A requirement was set at the last key inspection (18th of June 2007) that then home manager Mr Venkaya ensure that the hot water temperatures in the home are regulated based on assessment of the capabilities and needs of residents (i.e. temperature close to 43º C). During the Random inspection (25th of October 2007) Mr Khan produced evidence that hot water temperatures in the home are being recorded on a daily basis. However during this visit the hot water temperatures in two showers downstairs were tested on a number of occasions between 11 and 11.30am, the temperatures fluctuated between 35 and 50 degrees centigrade. An immediate requirement notice was served on the home. The immediate requirement stated that the showers must not be used to shower people until they are made safe, serviced or replaced. Mr Khan told us that he would obtain the services of a CORGI approved engineer to service the showers. Following the inspection a heating engineer visited the home and advised that the home take action to replace the existing showers to ones with a thermal cut out. The showers were replaced on the 27th of October and the 2nd of November 2007. The temperature of hot water emanating from both the shower units fitted in bathrooms on the first floor were found to be below 43 Degrees Celsius when they were tested on the morning of the first day of this inspection. It was recommended at the last key inspection (18th of June 2007) that radiator covers in resident’s bedrooms and communal areas throughout the home be replaced. During this inspection it was observed that work was taking place to address this recommendation. At the Random Inspection (25th of October 2007) a tour of all toilets and bathrooms on the ground floor and one bedroom was undertaken, it was noted that none of the wooden radiator covers identified as damaged at the (18.6.07) homes last inspection had been replaced. As a result a requirement was set that the Mr Khan assess the risk posed by the faulty radiator covers and take appropriate action to minimise any identified risks to residents. This requirement was not assessed during this inspection. The time scale to meet this requirement is the 7th of January 2008. It was recommended at the last key inspection (18th of June 2007) that a shower curtain be fitted to the bath that has an overhead shower. A shower curtain has been fitted to the bath that has an overhead shower. It was recommended at the last key inspection (18th of June 2007) that the boiler at the top of the home be serviced. Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 29 Mr. Khan told us that the boiler at the top of the home had been serviced. It was noted during the Random Inspection (25th of October 2007) that the overall appearance of the kitchen was poor. Although the kitchen is domestic in scale and relatively well equipped most of the kitchen cupboards looked rather ‘worn’ and had clearly seen ‘better days’. Furthermore, the removal of a damaged dishwasher had left an unsightly gap where it once stood. The décor in the adjacent dining room also appeared to be rather ‘shabby’ in places and some of the wooden chairs placed around tables were rickety. The deputy manager, who had worked at the home for over five years, told us she “could not remember the last time the kitchen or dinning room were decorated”. It was stated in the Occupational Therapists report that the kitchen and laundry room were not assessed residents rarely access these areas. It was recommended that the registered provider consider replacing the kitchen and redecorating the dining room. If and when a new kitchen is installed then the registered provider should seek the advice of the Occupational Therapist so that a kitchen suitable for the residents. In order to promote independence and acquire new skills it was recommended that residents be supported to prepare and cook meals. During this inspection Mr. Khan showed us that a new dishwasher had been installed in the kitchen and new chairs had been purchased for the dining room. Mr. Khan told us the owner was reluctant to establish a time specific rolling programme to upgrade the kitchen units or redecorate the dinning room, despite this being recommended in the home’s last report. Mr. Khan appeared reluctant to ask for things from the registered person, Mr. Madhewoo. He told us that he had just got new carpet and that he would ask for other things in a few weeks time. He didn’t want Mr. Madhewoo to view him as a manager that was always asking for money to be spent. He was reminded that this was essential expenditure in order that requirements made by the Commission and recommendations from an Occupational Therapist’s report could be met. During a tour of the premises faeces was found on a toilet seat on the ground floor. The faeces were dry and had clearly been there for sometime. No toilet paper or facilities for drying hands were found in either of the ground floor toilets or one on the first floor at 11.40am. A member of staff told us toilet rolls and paper towels are locked away at night and put back in the morning because one resident uses this paper to block up toilets. We were informed that a copy of the risk assessment and management strategy were in place to deal with this identified risk. However these could not be produced on request. Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 30 The member of staff was also unable to explain why the toilet rolls and paper towels that had been locked away at night had not been returned to their rightful place earlier in the day. Furthermore, a soiled incontinence pad was also found on top of a bin in the toilet at 11.30am contrary to basic infection control standards. Mr. Khan told us the unwrapped pad had probably been left by a resident who had a history of disposing of their soiled pad in this manner. Mr. Khan was unable to produce a copy of the risk assessment that should have been in place to help staff support this individuals personal care needs. The home had a visit from Croydon Councils Environmental, Cultural and Public Protection team on the 4th of October 2007. Following the visit the home received a five star rating certificate from the London wide Scores on the Doors scheme, a pilot project supported and funded by the Food Standards Agency (FSA). The certificate was awarded (Excellent) for very high standards of food safety management and being fully compliant with food safety legislation. Mr. Khan is required to assess the risk of the homes radiator covers and take appropriate action to minimise any identified risks to people who use the service. Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 31 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Quality in this outcome area poor. This judgement has been made using available evidence including a visit to this service. The high turnover of staff is of concern and the homes current recruitment practice is leaving residents at risk, they cannot be confident that they will be protected from harm or abuse until the home ensures that full employment checks are carried out prior to staff starting work in the home. Residents cannot be sure that new staff are trained or properly inducted so that they are competent and capable of supporting them with their assessed needs. EVIDENCE: A care manager commented that the high turnover of staff at the home was a cause for concern and that staff did not properly understand her client’s main disability and symptoms. The home’s rotas for 2007 indicated a high number of staff has left employment and new staff have been recruited. It is correct that there has been a high turn over of staff and managers over the last four years. Each new manager has brought a new regime that residents have had to adjust to. Over this time the registered provider has Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 32 failed to establish a team that could take into account the long-term needs of the residents. It was reported at the key inspection in June 2006 that the recruitment policies for Unicorn House needed to be reviewed in order to be adjudged to comply with it being an equal opportunities employer as identified in the recent CSCI publication Safe and Sound. Checking the suitability of new care staff in regulated social care services. A recommendation was made in respect of the below points; Advertise vacancies widely and in a manner that ensures equal opportunities to all prospective candidates. A full job description and person specification should be available for all applicants clearly outlining the expectations and responsibilities of the role. Application forms should be generic and should be completed fully by every applicant. Develop a standard interview template. Keep evidence of short-listing and those invited for an interview. It is good practice to keep evidence of decision making even where there are a small number of applicants. Ensure that two or more senior members of staff are present at interviews to reduce bias. Record answers given by the candidate to questions. Ensure that employment gaps are fully explored. Ensure that references taken up are on headed paper. It was stated in the random inspection report that the Commission would continue to monitor the registered provider’s and the home manager’s approach to establishing a staff team that will meet the social care needs of the people they are offering a service to. The home’s staffing rota was examined at the Random Inspection (25th of October 2007); Mr. Khan told us that Mr. Venkaya, the Administrator, and another member of staff had left employment. Three new members of staff had started work at the home and all had experience in working with people with learning disabilities. Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 33 Two new staff personnel files were examined. Both had passports, criminal record checks, application forms with employment history, contracts and two references. It was noted however that although both had references from their previous employers both had a second reference originating from their home address. Mr. Khan told us that both staff were in post when he started work at the home. The references did not indicate the relationship between the referee and the members of staff i.e. relative, employer, landlord or if the references are character references. A requirement was set that Mr. Khan satisfies himself as to the authenticity of the two new members of staff’s references and establish under what circumstances they were taken up. At this inspection Mr. Khan produced evidence that he is following this requirement up and is awaiting confirmation from the referees as to the circumstances the references were taken up. Mr. Khan told us that the deputy manager and two other support staff had left since the Random Inspection (25th of October 2007). The newly appointed Administrator present on the day of the Random Inspection had also left employment at the home. When asked if she had completed a Criminal Record Check Mr. Khan told us that her Criminal Record Check was being processed when she left. The registered person must ensure that Criminal Record Checks are carried out on all new members of staff prior to them commencing employment at the home. A requirement has not been made here because enforcement action is being considered regarding this issue. Three new staff has started work in the home. Two support workers and an Administrator. One new member of staff had been redeployed from The Turrets, another care home in the Unicorn Project. Mr. Khan told us that her personnel file was sent to Unicorn House when she started work. This was inspected; the file included a completed criminal record check, passport, proof of identification, an employment contract, a completed application form and one reference. The file also included a completed induction record. Mr. Khan told us that he had not checked personnel file to see whether all the essential information was present as a result he was not aware that she had only one reference on file. The registered person must ensure that a second reference is taken up for the member of staff redeployed from The Turrets. Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 34 A requirement has not been made here because enforcement action is being considered regarding this issue. It was also observed that the employment history section on both new support workers application forms had not been properly completed to include dates of employment. However one member of staffs file had a CV with her past employment including dates. The registered person must ensure that a full employment history is included on the application form for any potential member of staff. The newly appointed Administrator had previously worked at the home until August 2006. She returned to work for Unicorn Projects on the 12th of November 2007. The Administrator has been provided with accommodation by Mr Madhewoo on the top floor of Unicorn House. The rota identified that she had been responsible continuously for the on call sleep over shifts during the night between the hours of 9pm and 7.30am since she started work on the 12.11.2007. This requires the person to assist the waking night duty staff in the event of an emergency. This could also mean that this individual is left responsible for the adults in the house. When questioned about her qualifications and experience she admitted she had not worked in the capacity of a care worker in a similar establishment. She referred to her previous experience of working at the home as the Administrator and that she was completing an NVQ level 2 in care. However when requested Mr. Khan could not produce any evidence that the administrator was completing the qualification. Mr. Khan later told us that the administrator had shown him a letter indicating that she was on an NVQ course with Unicorn Projects however he was also unable to locate this letter. Mr. Khan was also asked if he had carried out an induction training programme in order that the Administrator could have the basic understanding and awareness to work safely in the home. Mr Khan was unable to confirm this however; the Administrator insisted that Mr. Khan had begun the induction process. There appeared to be some confusion over this and when Mr. Khan was asked to produce evidence of her induction he said that he didn’t know where the induction record was. The Administrator’s personnel file was inspected. Her contract indicated that she was appointed by Mr Madhewoo as a manager (finance and administration) and teacher at (Unicorn Projects). Mr. Khan told us that he had not appointed the Administrator as she was employed by Mr. Madhewoo. Mr. Khan told us that she was an Administrator for the Project by during the day and a Support Worker on sleepover during the night. There appeared to be some confusion as to the role and responsibilities of the Administrator and to whom she should report. Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 35 Mr. Madhewoo must clarify the role and responsibilities of the Administrator. If the administrator is also to be employed as a support worker then her contract and the homes staffing rota must be amended to include these details. The registered person must ensure that the administrator completes a full induction and attends all training that is provided to all other support workers at the home before she is given the responsibility of sleep over shifts. A requirement has not been made here because enforcement action is being considered regarding this issue. The Administrators file included, a training certificate from Unicorn Projects on the Mental Capacity Act (23/11/07), a student registration form London City Institute for Bachelor of Business Administration, one reference, copy of her passport, national insurance number card, a work permit, an employment agreement, her previous criminal records bureau check. The file also included a completed disclosure application form to the Criminal Records Bureau 12th November 2007. As was the case with the previous administrator her Criminal Record Check was being processed, but she was permitted to commence employment without proper employment checks being carried out by the management at the home. The file also included a letter from the National Identification Service indicating that there was no information held about her in the Person Record category of the Police National Computer. However the file did not include a POVA (Protection of Vulnerable Adults) first check. Mr. Madhewoo has allowed the administrator to work as an administrator/ sleepover staff and live in the home without carrying out the appropriate Criminal Record Check, POVA first check, obtaining appropriate references or completing appropriate training or a proper induction. An immediate requirement was handed to Mr. Khan stating that the Administrator must not reside or work on the premises until a POVA first check had been applied for and received at the home. A copy of a POVA first check for Administrator was received at the Commission on 12th of December 2007. The registered person must ensure that a second reference is taken up for the administrator. A requirement has not been made here because enforcement action is being considered regarding this issue. The Unicorn House Duty Rota for the week beginning 10th December 2007 indicated that Mr. Madhewoo was on shift in the home from 9am to 5pm Monday through to Friday however he was not present during these hours on the first day or the early part of the second day of the inspection. This Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 36 indicates that the homes staffing levels do not accurately reflect the level of cover as indicated on the staffing rota. The registered person must ensure that the homes staffing levels accurately reflect the level of cover as indicated on the staffing rota. A requirement that staff files must include a recent photograph has been met. It was also noted at the last key inspection (18th of June 2007) that the staff rota had only the Christian names of some members of staff. A requirement was set that the home manager ensure that the full names of all staff are included on the staff rota. This requirement has been met. A requirement was set at the last key inspection (18th of June 2007) that registered manager must ensure that all staff attends training on physical disabilities. At the random inspection Mr. Khan told us that this training had yet to be arranged for the staff team. At this inspection Mr. Khan told us that staff had not yet attended training on physical disabilities. It was recommended at the last key inspection (18th of June 2007) that all members of staff receive formal recorded supervision at least six times per year. At the random inspection Mr. Khan told us that he was supervising all members of staff. He said that the previous arrangement that senior staff supervised their peers was not appropriate and was not conducive to maintaining confidentiality. Mr. Khan agreed that it would be difficult to make sure that the whole staff team receives formal recorded supervision at least six times per year if he was the only supervisor. It was recommended that Mr. Khan delegate a team leader to support him with supervising staff. The team leader should attend supervision training. This recommendation was not assessed on this visit. Records examined during this inspection indicated that staff meetings had been held in May, June, July and August however there was no record of staff meetings since then. It is recommended that the home manager facilitate regular staff meetings. It was recommended at the key inspection (18th of June 2007) that the home manager develop a staff-training programme that takes into consideration the diagnosed conditions and assessed needs of the residents. During the Random Inspection Mr. Khan told us that he wanted to acquaint him self with staff training records in order to consider the teams training needs. This recommendation was not assessed on this visit. A number of comment cards were returned to the commission from staff. Most staff had ticked the boxes indicating that they feel positive about the service however some made written comments. Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 37 When asked the question “what does the service do well?” one staff commented “taking care of and the well being of residents”, another staff said “the service gives a holistic approach to care and also makes the home homely for residents and staff” another staff commented “residents are well cared for, their concerns and views are heard, activities are organised and choice of meals are provided”, another staff commented “there is a choice of meals for residents and residents are involved in decision making” another staff commented “ respect residents rights and plenty of choices”. When asked the question “what could the service do better?” a staff commented, “be more professional at work” another staff commented, “more outings for residents, more choice of meals, take away, pub or restaurant”. One staff made the following comment “everything is getting better thanks to our manager and his positive innovations”. Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 38 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area poor. This judgement has been made using available evidence including a visit to this service. The residents cannot be sure that the home is managed in a way that promotes their independence dignity and safety. EVIDENCE: There has been a high turn over of staff and managers at the home over the last four years. Each new manager has brought a new regime that residents have had to adjust to. Over this time the registered provider has failed to establish a team that could take into account the long-term needs of the residents. People have not had a consistent approach to their needs. The home has not had a manager registered with the Commission to run the home since the previous registered manager resigned his post in February 2006. Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 39 On the 7th of September 2006 Mr. Madhewoo confirmed in a letter to the Commission that Mr Jay Venkaya would hold overall responsibility for the management of the home. The letter also indicated that the deputy manager would be the second person in leading and fulfilling expected and designated tasks. This was agreed as a temporary appointment until such times as Mr. Madhewoo appointed a new home manager to run the home. Mr Venkaya also had a full time job with the NHS and was employed on a part time basis. At the Random Inspection (25th of October 2007) Mr. Khan told us that Mr Venkaya had recently left employment. The homes rotas indicated that Mr Venkaya was on shift up until December 2006 however from the 1st of January 2007 the rota indicated that he worked on an on call capacity. This is contrary to the original information provided by Mr. Madhewoo about the management cover of Unicorn House. It is also contrary to requirements that the Commission is notified of the absence of the manager who is in day-to-day control of the service. A requirement has not been made here because enforcement action is being considered regarding this issue. At the last key inspection (18th of June 2007) Mr. Madhewoo confirmed he had recruited a new home manager however she left soon afterwards. A requirement was set that Mr. Madhewoo recruits a home manager and have them registered with the Commission to run the home. Mr. Khan commenced employment at the home in July 2007. At the Random Inspection (25th of October 2007) he produced a criminal record check and a completed Commission registered manager application, which he confirmed, would now be forwarded to the Commission. Since then Mr. Khan has attended a fit persons interview a decision in respect of his fitness to be registered has yet to be made. During the Random Inspection (25th of October 2007) Mr. Khan told us that he has a clear view of what his staff team will offer to the residents and that he has plans to recruit only staff with experience in the social care field. However during this inspection there were concerns about his ability to manage the service. He had difficulty in understanding some of the regulations in particular recruitment of staff and POVA clearance. When a notice was handed to Mr. Khan that a member of staff must not work or reside in the home until POVA clearance was obtained he had difficulty in asserting his authority with the member of staff. Over the course of the inspection Mr. Khan appeared flustered and not totally in control, at times uncertain of what he was able to do in his role and Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 40 responsibility. There appeared to be some confusion as to the role and responsibilities of the Administrator and to whom she should report. Neither Mr. Khan nor the Administrator was clear about the homes and resident’s finances. On one occasion Mr. Khan was advised that his attitude towards one particular resident could be seen as disrespectful and not that which would be expected from a manager of a social care home. The Commission will continue to monitor Mr. Madhewoo’s approach to establishing a staff team that will meet the social care needs of the residents living at the home. A requirement was set at the last key inspection (18th of June 2007) that the home manager and staff comply with the fire safety procedures for the home and keep an up to date record of every (weekly) fire alarm equipment test conducted. At the Random Inspection (25th of October 2007) Mr. Khan produced documentary evidence that regular weekly fire alarm checks and equipment tests are conducted. A requirement was set at the last key inspection (18th of June 2007) that the home manager and staff must comply with the homes fire safety procedures and keep an up to date record of every fire drill practice conducted in the home. At the Random Inspection (25th of October 2007) Mr. Khan produced documentary evidence that fire drill practice’s had been conducted in the home. It is recommended at the last key inspection (18th of June 2007) that the home manager seek the views of the service users families, advocates and care managers about the standard of care provided at the home and how these can be improved further. It was agreed that this recommendation would be examined at the key inspection. This recommendation was not examined on this occasion. A warning letter was sent to Mr. Madhewoo on the 22nd of January 2007 informing him that he must ensure that regulation 26 visits be carried out at the home on a monthly basis. Regulation 26 reports were examined at the random inspection (25th of October 2007). Mr. Khan produced regulation 26 reports for June, July and August 2007. Mr. Khan told us that Mr. Madhewoo had carried out a visit in September but had not provided him with the report. Mr. Madhewoo was away Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 41 on holiday. Mr. Khan was advised that it is no longer a requirement under the Care Homes Regulations that regulation 26 reports are sent to the Commission unless it is requested, however copies of the reports must be available in the home for inspection. On the first day of this inspection Mr. Khan was asked to produce regulation 26 reports for September, October and November 2007. Mr. Khan told us that Mr. Madhewoo had carried out regulation 26 visits but that the reports had not been received at the home. Mr. Khan told us that he had informed Mr. Madhewoo on the first day of this inspection that regulation 26 visit reports had been sought by the inspectors. Mr. Khan told us that Mr. Madhewoo advised him that he would bring them to the home. On the second day of the inspection copies of the Regulation 26 reports were not in the home for inspection. A requirement has not been made here because enforcement action is being considered regarding this issue. Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 42 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 1 3 2 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 2 25 2 26 2 27 2 28 X 29 X 30 1 STAFFING Standard No Score 31 X 32 1 33 X 34 1 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 2 12 2 13 2 14 2 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 1 X 1 X X 2 X Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 43 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 YA29 Regulation 23(2)(n) & (o) Requirement Timescale for action 07/01/08 2. YA29 23 (2) a 3. YA32 18 (1) c 4. YA24 23 (2) a Suitable ramps must be fitted to all the homes backdoors to ensure all the homes wheelchairs users have independent access to the rear garden. (Requirement set at last key inspection). The registered provider must 07/01/08 ensure that suitable arrangements are made at the entrance to the home so that residents who use wheelchairs can gain access to the home without the need for physical assistance from staff. (Requirement set at last key inspection). The registered manager must 07/01/08 ensure that all staff attends training on physical disabilities. (Requirement set at last key inspection). The registered provider must 07/01/08 provide the Commission with an action plan indicating how it will address the recommendations made in the occupational therapists report. (Requirement set at the random inspection). DS0000025864.V353073.R01.S.doc Version 5.2 Unicorn House (16) Page 44 5. YA20 13 (2) 6. YA20 13 (2) 7. YA20 13 (2) 8. YA20 13 (2) 9. YA24 13 (4) 10. YA34 19 (1) c 11. YA2 14 (1) a. Staff must ensure that all medication is reordered with sufficient time to avoid out of stocks. (Requirement set at the random inspection). Arrangements must be made for people to receive their medication when away from the home. (Requirement set at the random inspection). MAR chart must be initialled and dated by staff so it is clear who made the change, and when. (Requirement set at the random inspection). There are some prescribed items, which are given “as required”. Although staff interviewed knew when to use these medications, and the interventions to use before administering medication, this needs to be written down in a protocol. (Requirement set at the random inspection). The home manager is required to assess the risk of the homes radiator covers and take appropriate action to minimise any identified risks to people who use the service. (Requirement set at the random inspection). The home manager must satisfy himself as to the authenticity of the two new members of staff’s references and establish under what circumstances they were taken up. (Requirement set at the random inspection). The registered persons must make sure that the needs of any new residents are assessed by a suitably qualified or suitably trained person prior to admitting them to the home, that DS0000025864.V353073.R01.S.doc 07/01/08 07/01/08 07/01/08 07/01/08 07/01/08 07/01/08 31/07/08 Unicorn House (16) Version 5.2 Page 45 12. YA18 13. YA23 14. YA34 15. YA34 16. YA34 17. YA14 there is appropriate consultation regarding the assessment with the resident or a representative of the resident and having regard to the assessment the care home is suitable for the purpose of meeting their needs in respect of his health and welfare. 14 (1) a & b. It is required that the registered provider relocates the person that occupies bedroom number two to a room more suitable to his needs. 17 (2) The home manager and the registered provider must make sure that there are robust and transparent financial procedures in place so that residents can be sure that their finances are protected. 19 (1) b The registered person must ensure that a full employment history is included on the application form for any potential member of staff. 17 (2) The registered person must clarify the role and responsibilities of the administrator. If the administrator is also to be employed as a support worker then her contract and the homes staffing rota must be amended to include these details. 17 (2) The registered person must ensure that the homes staffing levels accurately reflect the level of cover as indicated on the staffing rota. 16(2)(m) (n) People who use the service must be offered more opportunities to participate in a wider variety of meaningful activities that reflect their DS0000025864.V353073.R01.S.doc 31/01/08 31/01/08 11/12/07 31/01/08 12/12/07 01/02/08 Unicorn House (16) Version 5.2 Page 46 18. YA27 12(1) to (4), 13(3) & 17(1)(a), Sch 3.3(q) 19. YA30 17(1)(a), Sch 3.3(m) 20. YA30 13(3) & 23(2)(d) interests, especially within the home. This will ensure the people who use the service have their social, leisure, and recreational needs more fully met. The practice of restricting access to supplies of toilet roll and paper towels must be reviewed as a matter of urgency. When making decisions that place limits on resident’s freedom of choice in this way their agreement, as well as the views of all the relevant professionals must be sought, and appropriate records kept. This will ensure that all the people using the service have their needs met. All the people using the service who require additional support to promote continence must have up to date and detailed risk assessments and care plans in place, which the people using the service and the relevant care professionals agree too. This will ensure people using the service have their health care needs met and their dignity is respected. The routines the service has in place to control the spread of infection must be reviewed to ensure all parts of the home are kept reasonably clean at all times. This will ensure the safety of the people using the service. 15/01/08 15/01/08 15/01/08 Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 47 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 YA32 Good Practice Recommendations It is recommended that the home manager contact the National Autistic Society for further advice on TEACCH Training and autism. It is recommended that residents risk assessments are reviewed and updated on a regular basis. It is recommended that if appropriate residents agree and sign their risk assessments. So that the home can gain feedback about the quality of service provided in the home it is recommended that the home manager offer service users the opportunity to complete a service user comment form. It is recommended that the home develop a more appropriate activities record for individual residents. It is recommended that radiator covers in resident’s bedrooms and communal areas throughout the home be replaced. It is recommended that the home manager seek the views of the residents families, advocates and care managers about the standard of care provided at the home and how these can be improved further. It is recommended that all members of staff receive formal recorded supervision at least six times per year. It is recommended that the home manager develop a staff training programme that takes into consideration the diagnosed conditions and assessed needs of the residents. The registered provider needs to consider how wheelchair users can access appropriate areas of their home. It is recommended that the homes Statement of Purpose be updated to reflect that the home supports people with DS0000025864.V353073.R01.S.doc Version 5.2 Page 48 2. 3. 4. YA9 YA9 YA39 5. 6. YA12 YA24 7. YA39 8. 9. YA36 YA32 10. 11. YA29 YA1 Unicorn House (16) 12. 13. YA23 YA11 14. YA28 physical disability and some people with elderly needs. As the administrator was once again in charge of the homes finances it is recommended that she read the random inspection report, 20th of September 2006. The way in which the service supports people who use it to maintain and develop their independent living skills should be reviewed, as current arrangements do not actively promote personal development and growth. This good practice recommendation was made at the homes last inspection, but has not been implemented. The way in which the service ensures old furniture and fittings are kept in a good state of repair and upgraded as and when required should be reviewed. The home should consider establishing a time specific rolling programmes to replace the old kitchen units and redecorating the dinning room. This good practice recommendation was made at the homes last inspection, but has not been implemented. Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 49 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Unicorn House (16) DS0000025864.V353073.R01.S.doc Version 5.2 Page 50 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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