Inspection on 27/06/06 for Unicorn House (16)

This inspection was carried out on 27th June 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 18 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) 10/12/07

Unicorn House (16) 18/06/07

Unicorn House (16) 05/03/07

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 27th June 2006 08:00 Unicorn House (16) DS0000025864.V299238.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.V299238.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.V299238.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 Care Home 12 Category(ies) of Learning disability (12), Mental disorder, registration, with number excluding learning disability or dementia (12) of places Unicorn House (16) DS0000025864.V299238.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A variation has been granted to allow two specified service users over the age of 65 to be accommodated until such time as the needs of the service users can no longer be met or until such time as the placements cease. No new service user with a mental health condition may be admitted to the home. 2. Date of last inspection Brief Description of the Service: Unicorn House is a twelve bedded home that is registered to provide care for service users who have a learning disability. At present there are ten service users living in the home. The location of the home is within easy reach of good public transport links and the centre of Croydon. This results in the service users being within easy reach of local amenities and services. Unicorn House (16) DS0000025864.V299238.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced site visit was carried out over nine hours between 8am and 5pm. Methods of inspection included a tour of the premises, observation of contact between staff and service users, discussion with service users, staff and the registered provider Mr. Madhewoo. Information from other professionals who provide services to the residents and discussion with care managers. Records examined included staff Criminal Records Bureau Checks; service users person centred plans, risk assessments, complaints, staffing records, training records, Statement of Purpose, Service Users Guide, and health and safety records. Evidence gathered at additional visits on the 12th April and 17th May 2006 is included in this report. What the service does well: What has improved since the last inspection? The Commission’s has had concerns regarding the homes inability to recruit and retain a core of full time/permanent staff. During a visit to the home on the 12th April 2006 staffing records indicated that staff retention had improved. Only two members of staff had left since the last inspection in November 2005 and three new members of staff had started work in the home. However since then three of these staff has resigned and the homes efforts to retain and develop a core group of staff is still very fragile. Methods of storage of medication in the fridge have improved. The home has acted in a positive nature to improve the staff teams’ understanding of the service users mental health needs however the value of the training can only be evidenced by improved outcomes for the service users and positive feedback from external independent professional staff. Unicorn House (16) DS0000025864.V299238.R01.S.doc Version 5.2 Page 6 What they could do better: There were thirty three (33) requirements and one (1) recommendation set at the previous inspection carried out on the 8th November 2005. Following that inspection a condition was placed on the home that no new service user with a mental health condition may be admitted to the home. However this condition is subject to an appeal to the Care Standards Tribunal. Some of the requirements were assessed at met at a meeting at the Commission office on the 22nd December 2005 others were assessed as met following additional visits on the 12th April and 17th May 2006. Four (4) requirements are unmet from the inspection 8th November 2005 and three (3) from the additional visits of the 17th May 2006. As a result of this inspection a further eleven (11) requirements and seven (7) recommendations have been set. There are now eighteen (18) requirements and seven (7) recommendations. The management of 16 Camden Road need to focus their attention on attaining all the National Minimum Standards and developing a permanent staff team that can provide services to a very complex and challenging group of residents. The management of 16 Camden Road also need to improve their admissions process in order not to admit service users out of category. It was noted during a visit to the home on the 17th May 2006 that Bromley Social Services Physical Disabilities Team had placed a service user at the home. The home is registered to support people with learning disabilities; the Commission has concerns that this service user has been placed outside the category for which the home is registered in respect of physical disabilities. It will be necessary to improve the management oversight of resident’s reviews as two service users personal files sampled during this inspection indicated that they had not had an annual placement/needs assessment carried out by care managers on behalf of their placing authority. The maintaining and monitoring of staff records of specialist training, needs to be improved in order to ensure that staff receive refresher courses at the appropriate intervals. Training records indicate that some members of staff attended training from the Diabetic Specialist Nurse on Insulin Administration on in 2004 and staff attended training on Blood Glucose monitoring in March and June 2004 and February 2005. Mr. Madhewoo is required to inform the Commission of the dates that members of staff will attend refresher mandatory training on Insulin Administration and mandatory training on Blood Glucose monitoring. The management need to ensure that staff receive regular supervision and support that enables them to provide appropriate services commensurate to the complex needs of the residents. Staff files indicated that staff has regular Unicorn House (16) DS0000025864.V299238.R01.S.doc Version 5.2 Page 7 supervision since the beginning of 2006, however some full time senior support staff are supervised by their peers (other senior support staff) and other staff are supervised by a part time senior support staff. It has been required that Mr. Madhewoo identifies staff that supervise the staff team and provide evidence to the Commission that they have the skills and abilities to carry out supervisions. The Proprietor Mr. Madhewoo, needs to ensure that the future manager of the service has the knowledge, experience and expertise to manage a service whose residents have very complex conditions and whose needs challenge the service. Although Regulation 26 visits have been carried out and reports have been sent to the Commission on a monthly basis the reports do not make reference to outstanding requirements set by the Commission or review whether these have been met. The protection of vulnerable service users is in need of greater attention in respect of the management and staffs knowledge of adult protection procedures, notifying the Commission of serious incidents in the home and decisions made about their personal expenditure. The inspector’s would like to thank the service users, staff and Mr. Madhewoo for their support on the day of the inspection. 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. Unicorn House (16) DS0000025864.V299238.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Unicorn House (16) DS0000025864.V299238.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. 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 all the available evidence including a site visit to this service. In the main the home provides prospective service users and their representatives with the information they need to make an informed decision about whether or not to use the service. However in one admission the home has failed to carry out full assessments of service users needs prior to admitting them to the home. EVIDENCE: During a visit to the home on the 12th April 2006 Mr. Madhewoo produced a copy of the home’s Statement of Purpose (Issue April 2006). Under the section named Registered Manager there was unnecessary personal information in respect of the previous registered manager that was likely to contravene the Data Protection Act. Following the visit Mr. Madhewoo removed any references to the previous registered manager from the Statement of Purpose. The Statement of Purpose lists the staff in the home and their qualifications. There are currently six staff who work in the home who are identified as students. For some students there are limitations on the hours they work and the length of time they are permitted to remain in the country. Currently there are six part time students to seven full time staff. This has led the Commission to ask Mr Madhewoo to clarify how he intends to provide residents with continuity in their care and support whilst such a high proportion of his Unicorn House (16) DS0000025864.V299238.R01.S.doc Version 5.2 Page 10 staff are part time students. Also what long term plans are in place to recruit to these positions when the students obtain their qualifications and move on. Although the Statement of Purpose has been updated a previous requirement with timescales 31/01/06 and 31/05/06 that Statement of Purpose must state what staffing arrangements are in place offering service users continuing support while students are learning and what happens when students obtain their qualifications and move on has yet to be met. A requirement was set at the inspection on the 8th of November 2005 that the Service Users Guide will need to be reviewed to reflect any changes to the Statement of Purpose. A copy of the updated Service Users Guide has now been provided. It was observed when sampling two residents personal files that they had not had an annual placement/needs assessment carried by care managers from their placing authority. Mr. Madhewoo was advised to monitor the anniversary of the annual review date in order to request that the placing authority fulfil their statutory duty. Mr Madhewoo was also asked to notify the Commission in the event of delays occurring in excess of 12 months. It was noted during a visit to the home on the 17th May 2006 that Bromley Social Services Physical Disabilities Team had placed a service user at the home. There was no evidence on the file to evidence that the service user had a clinical diagnosis of a learning disability. This reflects badly on the assessment process prior to the admission to the home and if it is proven that the service user does not fall within registered category for the service this could necessitate the removal of the service user and enforcement action being taken against the home for admitting a service user out of category. As a result a requirement was set that Mr. Madhewoo contact the care manager of a service user in order to verify that they were suitably placed in the home. A copy of a letter sent to the service users care manager was received at the Commission 30th May 2006. However whilst the action of sending the letter has been evidenced the information whether the service user is appropriately placed had not yet to be determined. Unicorn House (16) DS0000025864.V299238.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is poor. This judgement has been made using all the available evidence including a site visit to this service. In general service user plans included detailed information on the service users needs and personal goals, which means that staff will be able to support them to develop a more independent lifestyle. Service users are consulted about aspects of life in the home through house meetings. However records of decisions about personal expenditure are not as clearly recorded which could lead to ill informed decisions being made to the detriment of the service users. EVIDENCE: Three service user personal files were examined. Service user’s files included a resident’s profile, a missing person profile, full risk assessments and Person Centred Plans. Person Centred Plans are reviewed on a six monthly basis and include a relationship circle, my likes and dislikes, personal care needs, physical health needs, mental health needs, my dreams and aspirations, social and spiritual Unicorn House (16) DS0000025864.V299238.R01.S.doc Version 5.2 Page 12 needs and a section on the service users needs, goals, implementation and review. There was evidence that a part time member of staff who is also a qualified Registered Mental Health Nurse (RMN) had carried out monthly mental health reviews for two service users and had advised staff to follow the service users care plan. However on the day of the inspection Mr Madhewoo said that this RMN trained person was no longer employed in the home. Service user files also included service user comment forms, evidence of regular health care appointments and management guidelines for staff to follow in order to support service users with diabetes, challenging behaviour and daily living skills. Records in the home identified one service user as having an independent psychological assessment arranged by the proprietor. This had not been agreed by the placing authority and resulted in the family of the service user being asked by Mr Madhewoo for a contribution of over £200 to cover part of costs of this assessment. One of the residents was discovered to have purchased a costly shower and toilet unit which now forms part of an en-suite facility in the room they occupy. The proprietor confirmed that there was no record of any discussion having taken place confirming how this decision came about. He also said that he had not involved or informed the Care Manager about this decision. Nor had he asked for an Occupation Therapy assessment in order to assess whether this unit was most suitable for her needs. There was also no record that this was discussed at a review meeting. However Mr Madhewoo confirmed that he had discussed this with a near relative of the resident. The proprietor is reminded that when drawing up plans for service users he should involve the service user, together with family, friends or advocates and relevant agencies/specialists. It is of paramount importance that significant discussions and decisions on personal finances are recorded accurately and clearly. Where a proprietor is also the appointee who approves financial expenditure for the resident, it is essential that all matters related to the finances of the resident are as transparent as possible in order to remove any suspicion of financial abuse. The proprietor is required to contact the Care Manager for the resident to discuss the implications of this decision and whether payment for this shower/toilet unit is justified. Unicorn House (16) DS0000025864.V299238.R01.S.doc Version 5.2 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, 15, 16 and 17. Quality in this outcome area is poor. This judgement has been made using all the available evidence including a site visit to this service. The home should work towards identifying service users social, leisure and recreational interests and provide them with more opportunities to take part in appropriate activities in the wider community. EVIDENCE: A previous requirement stated that The registered manager must record evidence of activities attended by service users other than that provided by the Unicorn Workshop and Unicorn Training Institute. This was made because the Commission had concerns that the residents were increasingly becoming a closed community, which in effect was recreating the environment of the long stay communities from which they had spent the major part of their lives, prior to their placement in the community. Unicorn House (16) DS0000025864.V299238.R01.S.doc Version 5.2 Page 14 Records in the home indicated that residents have had opportunities for monthly trips out. Activities during the day are still focussed on the Unicorn Day Service. There had been greater efforts under the previous manager (Mr Seewoolall) to involve service users in activities not provided by Unicorn services. This was in order to allow the residents variety and choice and to increase their opportunities to feel part of the local community. Whilst the requirement has been met in terms of the record of activities further monitoring will support whether this approach is being sustained. Some service users as part of their day service programme were attending the Unicorn Training Centre to develop basic IT skills. However as the planning application for use of this building as a training Centre had been refused, the Commission requested that Mr Madhewoo write to the Planning Department to verify whether he could continue to use the premises whilst an appeal was made. Whilst the involvement of residents in acquiring IT skills is commendable, the Commission had concerns that the planning refusal would invalidate the insurance cover for any accidents that might occur to service users whilst on those premises. Mr Madhewoo decided not to contact the Planning Department but withdrew the service users from attending the Training Centre. The homes visitors book was examined. There was evidence that some service users had regular visits from relatives and friends. One service user said that he visits his family on a regular basis. It was observed that two service users had visits from relatives on the day of the inspection. However not all visitors to the home record their visits. The registered must ensure that all visitors to the home sign the visitor’s book. However a resident brought to the attention of the inspector that a family visit had not taken place. The resident believed that this had occurred as a result of involvement in an incident (see section Concerns Complaints Protection) It was observed during the visit to the home on the 17th May 2006 that food is stored in a fridge and a fridge freezer just off the kitchen and a freezer in the basement. Tinned food is also stored in a room in the basement. Some cooked meat, milk and cheese were stored in the fridge however during that visit and this inspection there was no evidence of fresh fruit and fresh vegetables. A member of staff on shift stated that there was some but it had been eaten, a service user said that people just go in and take it, we should get more fruit. Menus were checked. The deputy manager stated that service users are offered a choice of meals; records indicate the choice meals and what service users chose. It is recommended that the home purchase fresh fruit and fresh vegetables on a more frequent basis and monitor its consumption and whether specific service users diets are affected detrimentally by over consumption of fruit. Unicorn House (16) DS0000025864.V299238.R01.S.doc Version 5.2 Page 15 Unicorn House (16) DS0000025864.V299238.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is adequate. This judgement has been made using all the available evidence including a site visit to this service. The arrangements for health care needs of the service users appear good and service users receive personal support in the way they prefer. The homes policies and procedures for handling medicines in the home ensure the service users are so far as reasonably practicable protected from harm and/or abuse. Although the homes has acted in a positive nature to improve the staff teams understanding of the service users mental health needs the value of the training can only be evidenced by improved outcomes for the service users and positive feedback from other professionals. EVIDENCE: Unicorn House (16) DS0000025864.V299238.R01.S.doc Version 5.2 Page 17 As a result of information received and from evidence from previous inspections the Commission held the view that the mental health needs of the residents had not been met. Following the inspection on the 8th November 2005 a condition was placed on the home that no new service user with a mental health condition may be admitted to the home and a requirement was set that Mr. Madhewoo must provide evidence of how the mental health needs of the current service users are being met by the current staff team. Staff training records show that all staff attended two days training courses on management of mental ill health at the Unicorn Training Institute in May 2006. Training took place on the 10th, 12th, 17th, 19th, 24th, and 31st of May. Certificates indicated that most of the staff team attended training on the 24th and 31st of May but the homes staffing roster showed that some of the staff was also on shift in the home during the training. The home’s administrator stated that this was an oversight by the Unicorn Training Institute and that staff had attended on different dates but certificates were produced for the 24th and 31st of May. Mr. Madhewoo is required to provide evidence of the actual dates that staff attended mental health training at the Unicorn Training Institute and training certificates should be amended. In March 2006 the home employed a member of staff who was also a Registered Mental Nurse (RMN). This was with the intention to offer support and guidance to service users and staff on the service users mental health needs. On sampling service users personal files there was evidence that the RMN had carried out monthly mental health reviews for two service users with mental health conditions and had advised staff to follow the service users care plan. However since then the RMN has resigned. Mr. Madhewoo stated that the home has recruited a new RMN and is awaiting Criminal Records Bureau clearance prior to starting work at the home. It is very important that there is no confusion in respect of role of and function of this individual and those medical staff outside the home who have clinical responsibility for service users mental health needs. In a letter to the Commission on the 11th April 2006 Mr. Madhewoo stated that service users with mental health are under Dr Max Pickard at Geoffrey Harris House or Dr Mufti at Tamworth Road. The Commission is also aware that service users with mental health needs are being monitored by Community Psychiatric Nurses. The homes has acted in a positive nature to improve the staff teams understanding of the service users mental health needs. However it is very important that the home continues to train and develop staff in the area of mental health. The Commission will continue to monitor how the home support service users with mental health and the development of the staff team. Unicorn House (16) DS0000025864.V299238.R01.S.doc Version 5.2 Page 18 Medication is stored in a locked cabinet in the office. Medication administration records checked on the day of the inspection were up to date and accurate. The home has the support of a Boots pharmacist who visits on a six monthly basis to offer advice. A report was seen from the pharmacists visit to the home on the 3rd February 2006. It was observed during the visit to the home on the 17th of May 2006 that medication in the form of hydrocortisone cream and insulin was stored on the top shelf of the fridge along side an open packet of cheese slices and other foods. A requirement was set that medicines must not be stored alongside food. If the same fridge is to be used then the storage area needs to be clearly separate form any food. It was noted during this inspection that medication stored on the top shelf of the fridge is now kept separate from food in a plastic box. Person Centred Plans include details on individual service users personal care needs, physical health needs and mental health needs. There was evidence that the RMN had carried out monthly mental health reviews for two service users and had advised staff to follow the service users care plan. Service user files also included evidence of regular health care appointments and management guidelines for staff to follow in order to support service users with diabetes and challenging behaviour. A requirement was set at the last inspection that the registered manager must ensure that all members of staff who administer insulin are trained on administering insulin and monitoring blood glucose levels. On the 21st of June 2006 Mr. Madhewoo sent a copy of a letter to Commission from M. Prentice a Diabetic Specialist Nurse confirming that Mr. Madhewoo had attended a training session on Blood Glucose monitoring on the 15th June 2006. The letter also states that training of all staff performing blood glucose monitoring is mandatory and is a once only session with annual updates as required. Audit of quality control books is also required and frequency of this will be agreed with Mr. Madhewoo and the Diabetic Specialist Team. Certificates indicate that some members of staff attended training from M. Prentice the Diabetic Specialist Nurse on Insulin Administration on the 16th February and the 14th of May 2004. Staff attended training on Blood Glucose monitoring in March and June 2004 and February 2005. Mr. Madhewoo is required to inform the Commission of the dates that members of staff will attend mandatory training on Insulin Administration and mandatory training on Blood Glucose monitoring. Unicorn House (16) DS0000025864.V299238.R01.S.doc Version 5.2 Page 19 Unicorn House (16) DS0000025864.V299238.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is poor. This judgement has been made using all the available evidence including a site visit to this service. All staff at the should attend Protection of Vulnerable Adults training so that service users can be sure that the whole staff team know what to do to protect them from abuse and neglect. EVIDENCE: The home has a complaints procedure included in the Service Users Guide. The complaints procedure is available in widget and text and states that all complaints will be responded to in an efficient, effective and fair manner and were possible within 28 days. Service users are advised that they can raise their concerns with staff, their key worker, their care manager or the home manager. Service users are also advised that they can contact the Commission For Social Care Inspection and a telephone number is included. A visit was carried out at the home on 17th May 2006. The reason for the visit was to follow up a report to the Commission that there had been a failure to notify the Commission of an event in the care home which adversely affected the well being or safety of a service user. In that a service user had been involved in a violent incident at Unicorn House, which involved the police. The incident had not been reported to the Commission or the service user’s care manager within a reasonable time following he occurrence of the incident. An adult protection investigation was also carried out under Croydon Councils Protection of Vulnerable Adults Procedures. A statutory enforcement notice has also been issued for failure to notify the Commission of a serious incident. Unicorn House (16) DS0000025864.V299238.R01.S.doc Version 5.2 Page 21 The proprietor Mr Madhewoo is currently managing the home on a day-to-day basis whilst the manager’s post remains vacant. As the acting manager at the time of the incident he was asked to confirm whether the care manager for the resident had been notified. He confirmed that the care manager was being informed and provided a letter-dated 15.05.06. However there was no mention in the letter of police involvement. Mr Madhewoo confirmed that there had been an internal review of the needs of the resident on the morning of the visit. The report made reference to delaying a planned visit to the resident’s parental home by a week, as a direct consequence of the incident. Mr Madhewoo stated that this was as an agreed arrangement with the family. However, Mr Madhewoo could not confirm whether this had been discussed and agreed with the care manager. If the care plan is not complete and is not regularly updated in order to cover all contingences: staff will be unsure about how to respond and communicate effectively with the resident and the resident may construe the actions taken by staff as punishment and inform other people that this is the case. The restriction of contact with family or the community for whatever purpose is a very serious matter and should not be taken without clear authority and prior approval of all parties and only then in the interests of safety. Any other reason for this action could be deemed as a restriction of liberty. Subjective assessments by staff in the home without clear guidance and written procedures can be misused and be deemed as a punishment. This incident could be interpreted as such as the resident expressed unhappiness to the inspector that his visit home had been stopped for a week. Following the visit a requirement was set that the Mr. Madhewoo must contact the service user’s care manager in order to review the service user plan in respect of aggressive behaviour in order to focus on positive reinforcements and not punishments. In an action plan sent to the Commission 31st of May 2006 Mr. Madhewoo stated that no punishment had been imposed on the resident concerned. This requirement will be met once the issue of aggressive behaviour and positive reinforcements have been reviewed by the service user’s care manager and recorded in the service users care plan. As a result this requirement has been repeated. A requirement was set at the last inspection that that all new staff are trained on the Unicorn House’s and Croydon Council’s Protection of Vulnerable Adults Procedure. A letter was sent to the Commission dated 31st May 2006 indicating that the home was taking steps to address this requirement. However the recent Unicorn House (16) DS0000025864.V299238.R01.S.doc Version 5.2 Page 22 vulnerable adult investigation brings into question whether the learning acquired from the training has been put into practice. There is an internal adult protection document available in the home. The substantive part of the document is the adult protection procedure and flow chart that has been taken from the Croydon Local Authority guidelines. All this information has been presented on Unicorn House headed paper that indicates that this is the policy of Unicorn House. However the guidance is misleading as at one section it requests that staff should notify their personnel department if the alleged perpetrator is a member of staff. It is recommended that this section should be clarified or removed, as Unicorn Services has no personnel department. Mr Madhewoo has made reference to the Commission that he is prepared to undertake Adult Protection training to enable him to train his own staff. Due to another adult protection investigation now taking place the Commission has serious concerns considering the current lack of understanding of what constitutes safeguarding adults. A requirement has been made that external training should be provided preferably from the Croydon Council. As previously mentioned the Commission has expressed concerns about how decisions are made about service users spend their personal finance. The Commission had asked for historical financial records to be made available. However when these records were asked for at this inspection, the inspector was informed that they had all been sent to Mr Madhewoo’s accountant to be audited. Mr Madhewoo is the appointed person for making financial decisions on behalf of the residents. The regulations state that as the proprietor Mr Madhewoo should ensure as far as practicable that persons working at the care home do not act as the agent of the service user. Currently Mr Madhewoo is in day-today control of the home whilst the manager’s post is vacant. He has always put himself on the rota even as a proprietor as working in the home five days a week and regularly undertakes sleeping in duties. He lives on the premises and has a general office on the ground floor of the home. To all intents and purposes even when a manager is in post Mr Madhewoo is very actively involved in the day to day running of the home. A requirement has been made that Mr Mr Madhewoo ceases to be the appointee for the service users and should write to the placing authorities requesting they take responsibility for this function. It was noted during the visit to the home on the 17th of May 2006 that the daily notes for one service user had been scribbled out. The deputy manager was advised that if mistakes are made in the records a line should be drawn through the notes and signed by staff. A requirement was set in respect of this. Unicorn House (16) DS0000025864.V299238.R01.S.doc Version 5.2 Page 23 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 and 30. Quality in this outcome area is adequate. This judgement has been made using all the available evidence including a site visit to this service. In general the service users bedrooms were in good decorative order and had appropriate furnishing however the home could do more to ensure that one service user is supported to eliminate the smell of urine in his bedroom. EVIDENCE: On the visits of 17th and 19th of May 2006 it was noted that one particular service user was in bed on both occasions. These visits were between 3pm and 4pm. The service users care manager, the service users relatives and Mr. Madhewoo confirmed that this was the usual routine of the service user and the home was endeavouring to provide activities however the service user sometimes preferred to stay in his room. On the 17th there was a strong smell of urine emanating from his bedroom. Mr Madhewoo stated that the carpet had been changed to a contract carpet and an electric fan was installed. He held the view that the only solution left was to leave the ventilation system on at all times and also get agreement from the service user that he should be changed when wet, even when asleep. Unicorn House (16) DS0000025864.V299238.R01.S.doc Version 5.2 Page 24 This issue was to be discussed at his review with the care manager on the 13th of June. However the meeting did not take place. It is recommended that Mr Madhewoo seek professional advice before, (in conjunction with the service user) devising a programme to support the service user with his enuresis. A requirement was set at the inspection on the 8th of November 2005 that Mr. Madhewoo must write to the Commission indicating the nature of business carried out in his office, the role of the administration staff, their practice regarding contact with service users and access to other areas of the home, and if Criminal Records Bureau Checks have been completed. Mr Madhewoo has complied with this requirement. Mr. Madhewoo lives on the premises. If Mr Madhewoo has guests they must go through the ground floor of the home and upstairs passing service users bedrooms. This infringes on the privacy of the service users. During a visit to the home on the 12th April 2006 Mr. Madhewoo indicated that he had plans to build a staircase to his flat at the top of the home so as the service users privacy can be respected when visitors call to see him at the home. Mr. Madhewoo confirmed in an action plan dated 11th April 2006 that this work would take place in December 2006. Mr Madhewoo has a general office that deals with the general business of Unicorn Services as well as for Unicorn House. The Commission was concerned that this brought unnecessary visitors to the resident’s home who would infringe on their privacy. Mr Madhewoo gave assurances that this was not the case. However on arrival at Unicorn House at 8.05 am the inspector found two men sitting in the small lounge off of the dining room. The residents were coming down to breakfast and in full view of these visitors. When staff were questioned about their presence, the inspectors were informed that these men were builders undertaking work for Mr Madhewoo at another property he owned down the road and were waiting for keys in order to begin work. A resident also confirmed this. There was no reason for these men to be in the resident’s communal areas and neither of them had signed the visitor’s book. Mr Madhewoo by bringing unnecessary visitors to the resident’s home is not making suitable arrangements to ensure that Unicorn House is conducted in a manner which respects the privacy and dignity of service users. Ideally this office should not be situated in the resident’s home where the only access is through the resident’s communal areas. Mr Madhewoo must make other arrangements for conducting business non-essential to daily function of Unicorn House in the residents home. Unicorn House (16) DS0000025864.V299238.R01.S.doc Version 5.2 Page 25 Mr Madhewoo must ensure that all visitors to the home sign the visitor’s book. Mr. Madhewoo confirmed that service users had amicable relations with the office staff and they often came into the office to talk to them. He said that the office staff did not make requests of service users or act in a way that they could be confused with care staff. A completed Criminal Records Bureau Check for the administration member of staff was seen. Although one resident’s room had been redecorated last year it was evident that their wheelchair had badly marked the walls and the room is again in need of redecoration. However in general the other service users bedrooms were reasonably decorated and had appropriate furnishings. It is recommended that Mr. Madhewoo develops a programme of painting and redecoration for the home and considers the impact of the service users wheelchair on her bedroom walls. It was also noted that the downstairs toilet was heavily lime scaled. It is recommended that the homes toilets be treated for lime scale. Unicorn House (16) DS0000025864.V299238.R01.S.doc Version 5.2 Page 26 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): 31, 32, 33, 34, 35 and 36. Quality in this outcome area is poor. This judgement has been made using all the available evidence including a site visit to this service. The home needs to maintain and monitor staff specialist training records so that staff receive refresher courses at the appropriate intervals. The management of the home needs to ensure that staff receive regular supervision and support so that they are able to provide appropriate services commensurate to the complex needs of the residents. EVIDENCE: There is currently no registered manager at Unicorn House. Mr Madhewoo is providing the day-to-day management cover for the service. The staff team at the time of the inspection consisted of six part time staff and 9 full time staff. All the part time staff are students, some of whom have limitations on the hours they are permitted to work. This ratio has now changed as a result of three full time staff leaving. Mr Madhewoo had previously in January informed the Commission that he did not employ students who were also attended Unicorn Training Institute. However there are three people who are in this category. This means that as part of training in social care they are in certain circumstances permitted to Unicorn House (16) DS0000025864.V299238.R01.S.doc Version 5.2 Page 27 have work placements in social care settings (20 hours per week) and if it is beneficial to their training needs a further 9.5 hours. As the owner of the Training Institute, Mr Madhewoo requested of himself as the employer of these students that it was beneficial that they worked these extra hours. The students are assessed for their training as described by the Unicorn Training Institute as when at work being under the direction of an NVQ Assessor. A requirement was set at the inspection on the 8th of November 2005 that Mr. Madhewoo must write to the Commission to clarify the current arrangements for assessments and external verifiers for Unicorn Projects staff. This information was received at the Commission on the 11th May 2006. However, the rotas provided by Mr Madhewoo clearly show that they work 30 hours per week and more when they undertake a sleep in duty of 9.5 hours, or a waking night duty. It was also noted that two of these part time students were also the designated shift leaders on a number of shifts. The Commission is concerned that Mr Madhewoo is putting these overseas students in breech of the working and studying arrangements. Mr Madhewoo is required to limit the hours worked to 29.5 hours per week and to include the sleep in duties of 9.5 in the total of hours worked. As part of ongoing assessment of the staffing in the home and in order to clarify the status of the staff a requirement was set at the inspection on the 8th of November 2005 that the registered manager must retain copies of current passports for all members of staff employed at the home. It also stated that where passports have been removed a record of the reason for their absence must be recorded and the employee’s arrangement with the Home Office regarding Restrictions on Working and work permits should be kept in the home for inspection. However the Commission realised its error in applying this to all staff as this is not covered by regulation under The Care Standards Act 2000 but only those where restrictions on working apply. However the Commission needs to be assured that due diligence is applied to the recruitment of staff from abroad. Part of the process is the need to ensure that overseas applicants have a legal right to work in this country and abide by any limitations imposed by the appropriate authorities. Whilst this is Mr. Madhewoos specific responsibility, the Commission will continue to monitor these arrangements in order to test the robustness of the homes recruitment and checking systems. Unicorn House (16) DS0000025864.V299238.R01.S.doc Version 5.2 Page 28 A requirement was set at the inspection on the 8th of November 2005 all staff files must include appropriate references, contracts, passports and work permits. It was noted during the visit on the 12th of April 2006 that one new member of staff had a personal reference from a manager of another registered service for learning disability service users. On closer scrutiny the reference had been sent via the registered service’s fax and was also supported by registered service’s compliments slip. This gave the impression that the new appointee had been an employee of this service and the referee was writing the reference as the line manager. In point of fact the new member of staff was never employed at that organisation. A requirement was set at the last inspection that Mr. Madhewoo seek clarification as to the authenticity of the reference obtained for one new member of staff, the company’s policy on their managers supplying personal references using company stationary and the relationship of the referee to the new member of staff given that they share the same surname. Mr. Madhewoo provided evidence to the Commission that this requirement had been met. The member of staff in question has since resigned his post at the home. Staff files now include appropriate references, contracts, passports and work permits. A requirement was set at the inspection on the 8th of November 2005 the registered manager must ensure that the employment of any persons on a temporary basis in the home will not prevent service users from receiving such continuity of care as is reasonable to meet their needs. The Commission’s has had concerns regarding the homes inability to recruit and retain a core of full time/permanent staff team who are suitably qualified, competent and experienced. A requirement was made in respect of this. The registered manager must ensure that at all times suitably qualified, competent and experienced persons are working in the home in such numbers as are appropriate for the health and welfare of the service users. Similar requirement included in inspection report 5th and 19th April 2003. Requirement 58. Similar to Requirement 30 in inspection report 17th and 18th June 2002. Previous Timescale 08/11/05. The Commission continued to have concerns that resulted in the serving of a proposal to restrict admissions of learning disabled service users with enduring mental health conditions. The full notice was subsequently served but is now subject to an appeal to the Care Standards Tribunal. Unicorn House (16) DS0000025864.V299238.R01.S.doc Version 5.2 Page 29 During a visit to the home on the 12th April 2006 staffing records indicated that staff retention had improved. Only two members of staff had left since the last inspection in November 2005 and three new members of staff had started work in the home. Since then three full time staff have resigned and as previously mentioned half of the remaining staff team are part time students. A requirement was set at the inspection on the 8th of November 2005 that all members of staff that work in the service users home and are in contact with vulnerable adults must have a Criminal Records Bureau Check. During the inspection on the 12th of April Criminal Records Bureau Checks were seen for all members of staff employed at the home. During this inspection the home’s administrator advised that a new member of staff had been inducted at the home after completing a enhanced Criminal Records Bureau Check. She also stated that another member of staff had been recruited and was awaiting Criminal Records Bureau Check clearance. The administrator stated that she had been advised the Criminal Records Bureau Umbrella agency that under some circumstances that the Commission agreed that staff could start work with a POVA clearance only. She was advised that this would only be in exceptional circumstances where there is pressure to recruit staff quickly and service users would be at risk where staff were not recruited. The following guidance was made known to Mr Madhewoo. A number of conditions need to be in place if a new member of staff can start work with POVA clearance only. • The employer must write to the Commission For Social Care Inspection requesting and have agreement that new staff start work at the home with POVA clearance only. The home must explain the critical risk to the service user/s. The employer must provide evidence that all other documentation as stated in Schedule 2 of the Care Standards Regulations has been obtained for the new staff. The employer must ensure that the new staff does not work alone with service users. The employer must ensure that the new staff has identified senior members of staff to supervise them on each shift. The employer must ensure that the new staff completes induction training during this period. DS0000025864.V299238.R01.S.doc Version 5.2 Page 30 • • • • • Unicorn House (16) It was noted during the visit on the 17th of May 2006 that the home has three vehicles and nominated staff drive service users to the day service and on recreational outings. The deputy manager stated that there are three nominated drivers. Two of the drivers held full UK driving licences and the other has a Mauritian driving licence. The deputy manager was not sure of when the member of staff became resident in the UK. DVLA Guidance states provided your full licence remains valid, you can drive any category of small vehicle shown on your licence for up to 12 months from the time you became resident. To ensure continuous driving entitlement a provisional GB licence must have been obtained and a driving test(s) passed before the 12-month period elapses. However, if you do not pass a test within the 12-month concessionary period you will not be allowed to drive as a full licence holder and provisional licence conditions will apply. A requirement was set that Mr. Madhewoo provide documented evidence of when the member of staff with a Mauritian driving licence became resident in the UK. A copy of the member of staffs Mauritian driving licence expiry date 05/01/07 was sent to the Commission on the 31st May 2006. Also on the 17th of May 2006 MOT certificates were observed for two vehicles Mr. Madhewoo agreed to send a copy of the other vehicle to the Commission. All three vehicles were taxed and insured. A requirement was set that a copy of the MOT certificate to be sent to the Commission, this was received on 31st May 2006. Staff files indicated that staff have had regular supervision since the beginning of 2006. However as the designated supervisors provide supervision to colleagues of a similar grade and some of these supervisors are part time students it is not clear how professional development and oversight of these staff is managed, It is required that Mr. Madhewoo identifies staff that supervise the staff team and provide evidence to the Commission that they have the skills and abilities to carry out supervisions. A requirement on a similar theme to one below has been made over a number of inspection visits. Mr. Madhewoo must make suitable arrangements to ensure that the care home is conducted with due regards to the sex, religious persuasion, racial origin, and cultural and linguistic background and disability of service users. Similar to Requirements 43 and 44 in inspection report 17th and 18th June 2002. Previous Timescale 08/11/05. Unicorn House (16) DS0000025864.V299238.R01.S.doc Version 5.2 Page 31 Due to staff retention problems Mr Madhewoo has increasing come to rely on non British National staff from within and outside the expanded EEC. This has resulted in the Commission raising concerns about how quickly these staff can acquire a knowledge and understanding of the culture in which the service users have been predominantly raised. It is important that whoever works with vulnerable adults has appropriate experience knowledge and skills regardless of their own cultural background. Residential care homes do not always have the staff that match the cultural backgrounds of their residents, however it is important if they cannot match their cultural needs that they know where to access information and support that can compensate for this shortfall. The Commission will continue to monitor how the resident’s cultural needs are identified and met. Unicorn House (16) DS0000025864.V299238.R01.S.doc Version 5.2 Page 32 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using all the available evidence including a site visit to this service. The management of 16 Camden Road need to focus their attention on attaining all the National Minimum Standards and developing a permanent staff team so that it can provide services to a very complex and challenging group of residents. EVIDENCE: Mr. Madhewoo stated that he plans to employ a registered manager to run the home and is the process of advertising at the local job centre. The administrator stated that the home was not having much luck. Mr. Madhewoo was advised that advertising in professional journals might be more fruitful and attract applicants with the skills and experience required for running the home. He should also be mindful of level of knowledge and skills required for an applicant to the post as listed in the National Minimum Standards. Unicorn House (16) DS0000025864.V299238.R01.S.doc Version 5.2 Page 33 The recruitment policies for Unicorn House need 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 has been 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. A requirement was set at the inspection on the 8th November 2005 that the home must develop an annual development plan for the home, based on a systematic cycle of planning - action - review, reflecting aims and outcomes for service users. During the inspection on the 12th of April the Commission For Social Care Inspections Inspecting for Better Lives 2 was discussed with Mr. Madhewoo. Mr. Madhewoo stated that he had not received any information about this from the Commission. He was strongly advised to access this information on the Commissions website: www.csci.org.uk to find out about Inspecting for Better Lives 2 and the Commission’s new inspection procedures. Mr. Madhewoo was advised that the annual development plan for the home should reflect the aims and objectives of the home and should consider the needs of the service users and recruitment, selection and retention of a staff Unicorn House (16) DS0000025864.V299238.R01.S.doc Version 5.2 Page 34 team. During this visit Mr. Madhewoo did not produce an annual development plan for the home however an action plan dated 11th April 2006 included an Annual Development Plan for the year 2006. Evidence was seen for Landlords Gas Safety Certificate 25/04/06, Portable Appliance Testing Certificate 12/08/05, Electrical Installation certificate 20/01/06, environmental health 19/01/05, a letter is on file stating that the home does not have a storage tank on the premises and therefore there is no need for Legionella testing and is signed by registered provider. London Fire checked the homes fire safety equipment on the 30/30/06 and the fire alarm system on the 09/03/06. Unicorn House employs a handyman. There is a separate metal storage container situated at the end of the garden where his tools, paint and hazardous substances are stored. This was found to be unlocked with hazardous substances paint and petrol within easy access. This was brought to the attention of Mr Madhewoo who will now ensure that the door is kept locked or secure when not in use. A requirement has been made as a result of this. It was noted that Regulation 26 visits have been carried out and reports sent to the Commission on a monthly basis. The value of the reports is limited as they do not make reference to the progress of meeting the outstanding requirements and indicate that there is no action required to be undertaken as a result of their visit. It is recommended that registered provider develop a format for regulation 26 visits/reports that takes into account some of the following as this list is not prescriptive; adult protection, regulation 37 reports, complaints, medication administration, service user finances, service users meetings, Person Centred Plans, staff supervision records, staff meetings, menu’s, fire precautions, health and safety, staff recruitment, staff training, environment, comments from service users and staff during the visit and requirements set by the Commission For Social Care Inspection. Unicorn House (16) DS0000025864.V299238.R01.S.doc Version 5.2 Page 35 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 1 2 3 3 1 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 2 32 1 33 1 34 2 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 1 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X 2 X 2 X X 2 X Unicorn House (16) DS0000025864.V299238.R01.S.doc Version 5.2 Page 36 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. Mr. Madhewoo(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 4 (1) a and b. Requirement Timescale for action 27/06/06 2. YA23 13 (6) 3. YA33 12 (4) b. Statement of Purpose’s must state what staffing arrangements are in place offering service users continuing support while students are learning and what happens when students obtain their qualifications and move on. Previous Timescales 31/01/06 and 31/05/06. The previous timescales have not been met as of the date of this inspection. It is required that all new staff is 27/06/06 trained on the homes and Croydon Council’s Protection of Vulnerable Adults Procedure. Previous Timescale 31/01/06 and 31/05/05. The previous timescales have not been met as of the date of this inspection. External training should be provided preferably from the Croydon Council. Mr. Madhewoo must make 27/06/06 suitable arrangements to ensure that the care home is conducted with due regards to the sex, religious persuasion, racial origin, and cultural and linguistic background and disability of service users. Similar to DS0000025864.V299238.R01.S.doc Version 5.2 Unicorn House (16) Page 37 4. YA33 18 (1) b. 5. YA32 17(2) 6. YA6 15(2)(b) Requirements 43 and 44 in inspection report 17th and 18th June 2002. The previous timescales have not been met as of the date of this inspection. Previous Timescales 08/11/05 and 31/05/06. 27/06/06 The homes staffing rota must indicate the role of the member of staff, if they are full time or part-time. If they are students the qualified staff members of staff designated to supervise them. Previous Timescale 08/11/05 and 31/05/05. The previous timescales have not been met as of the date of this inspection. The staff roster should indicate 27/06/06 which staff are students. Previous Timescale 31/05/06. The previous timescales have not been met as of the date of this inspection. The Proprietor must contact the 27/06/06 service user’s care manager in order to review the service user plan in respect of aggressive behaviour in order to focus on positive reinforcements and not punishments. This requirement will be met once the issue of aggressive behaviour and positive reinforcements have been reviewed by the service user’s care manager and recorded in the service users care plan. The Proprietor must contact the care manager of a service user in order to verify that they were suitably placed in the home. A copy of a letter sent to the service users care manager was received at the Commission 30th May 2006. However whilst the action of sending the letter has DS0000025864.V299238.R01.S.doc 7. YA3 14 (1) 27/06/06 Unicorn House (16) Version 5.2 Page 38 8. YA6 17 (1) a Schedule 3 (3) q. been evidenced the information whether the service user is appropriately placed had not yet to be determined. Previous Timescale 31/05/06. The previous timescales have not been met as of the date of this inspection. The registered provider must keep a record of any limitations agreed with the service user as to the service users freedom of choice, liberty and movement. The registered provider must ensure that all service users have an annual review carried out by the placing authority. The registered provider must contact the service users care manager to discuss the service users payment for the shower/toilet unit and whether payment is justified. The registered provider must ensure that all visitors to the home sign the visitor’s book. The registered provider is required to provide evidence of the actual dates that staff attended mental health training at the Unicorn Training Institute and training certificates should be amended. The registered provider is required to inform the Commission of the dates that members of staff will attend mandatory training on Insulin Administration and mandatory training on Blood Glucose monitoring. A requirement has been made that the registered provider, Mr Madhewoo, ceases to be the appointee for the service users and should write to the placing DS0000025864.V299238.R01.S.doc 31/08/06 9. YA6 14 (2) a. 31/10/06 10. YA6 14 (1) a & c. 31/08/06 11. 12. YA15 YA32 17 (2) Schedule 4 (17). 18 (1) c. Schedule 4 (6) g. 27/06/06 31/08/06 13. YA32 13 (1) b, 18 (1) c. Schedule 4 (6) g. 31/08/06 14. YA23 20 (1) 31/08/06 Unicorn House (16) Version 5.2 Page 39 15. YA15 12 (4) a. authorities requesting they take responsibility for this function. The registered provider must restrict unnecessary visitors to the home and make other arrangements for conducting business non-essential to daily function of Unicorn House in the resident’s home. The registered provider is required to limit the hours worked by students to 29.5 hours per week and to include the sleep in duties of 9.5 in the total of hours worked. The registered provider is required to identify staff that supervise the staff team and provide evidence to the Commission that they have the skills and abilities to carry out supervisions. The registered provider must ensure that the metal storage container situated at the end of the garden where his tools, paint and hazardous substances are stored is kept locked or secure when not in use. 27/06/06 16. YA33 18 (1) a. 31/07/06 17 YA36 18 (2). 31/08/06 18. YA42 13 (4) a & c. 27/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA17 Good Practice Recommendations It is recommended that the home purchase fresh fruit and vegetables on a more frequent basis and monitor its consumption and whether specific service users diets are affected detrimentally by over consumption of fruit. DS0000025864.V299238.R01.S.doc Version 5.2 Page 40 Unicorn House (16) 2. YA23 3. YA20 4. YA24 The Adult Protection procedure requests that staff should notify their personnel department if the alleged perpetrator is a member of staff. It is recommended that this section should be clarified or removed, as Unicorn Services has no personnel department. It is recommended that Mr Madhewoo seek professional advice before, (in conjunction with the service user) devising a programme to support the service user with his enuresis. It is recommended that Mr. Madhewoo develops a programme of painting and redecoration for the home and considers the impact of the service users wheelchair on her bedroom walls. It is recommended that the homes toilets be treated for lime scale. A recommendation has been 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. 5. 6. YA24 YA31 7. YA7 It is recommended that registered provider develop a DS0000025864.V299238.R01.S.doc Version 5.2 Page 41 Unicorn House (16) format for regulation 26 visits/reports that takes into account some of the following as this list is not prescriptive; adult protection, regulation 37 reports, complaints, medication administration, service user finances, service users meetings, Person Centred Plans, staff supervision records, staff meetings, menu’s, fire precautions, health and safety, staff recruitment, staff training, environment, comments from service users and staff during the visit and requirements set by the Commission For Social Care Inspection. Unicorn House (16) DS0000025864.V299238.R01.S.doc Version 5.2 Page 42 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Unicorn House (16) DS0000025864.V299238.R01.S.doc Version 5.2 Page 43 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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