Inspection on 30/05/08 for Unicorn House (16)

This inspection was carried out on 30th May 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Unicorn House (16) 10/12/07

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 28/09/2008.

CARE HOME ADULTS 18-65 Unicorn House (16) 16 Campden Road South Croydon Surrey CR2 7EN Lead Inspector James O`Hara Key Unannounced Inspection 30 May and 6th June 2008 10:00 th Unicorn House (16) DS0000025864.V361295.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.V361295.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.V361295.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 vacant post Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Unicorn House (16) DS0000025864.V361295.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. 3. Learning disability - Code LD The maximum number of service users who can be accommodated is: 12 No new service user with a mental health condition may be admitted to the home. Date of last inspection 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.V361295.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This service has an unchanged quality rating of zero stars. This means the outcomes experienced by the people who use the service remains poor. 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. The home will be required to provide us with an improvement plan setting out how it intends to make the lives of the people who use the service better, which we will continue to monitor closely. Lead Inspector James O’Hara was accompanied by Regulatory Inspector Lee Willis and Regulation Manager David Town on two separate site visits to the service. The inspection was carried out over two days. During these unannounced site visits we spoke to four people who live at Unicorn house, the proprietor, the new acting manager, and six other members of staff. We also looked at a variety of records and documents, including the care plans for two people we selected to case track their care. We received a number comment cards from residents, their relatives, and a General Practitioner. We looked at the information provided by the registered provider, Mr. Madhewoo, in the Annual Quality Assurance Assessment (AQAA) received by the Commission on the 25th of February 2008. We also looked at the information provided in action plans sent to the Commission following the key and random inspections. The remainder of this site visit was spent touring the premises. A random unannounced inspection was carried out on the 27th February 2008. The inspection involved a visit by an expert by experience. The expert spent three hours looking round the home and talking with some of the residents and members of staff. Some of our findings at the random inspection are included in this report. What the service does well: All the people we spoke to about what it was like to live at Unicorn House were in the main very positive about their experience. Typical comments included, “I like living here”, “I can do what I like when I want”, “most of the staff are very nice,” and “staff look after us here”. We saw that staff relate well with the people that live there and the Unicorn House (16) DS0000025864.V361295.R01.S.doc Version 5.2 Page 6 atmosphere remained very relaxed throughout the course of this two-day inspection. What has improved since the last inspection? What they could do better: All the positive comments made above notwithstanding their remains a lot for the new acting manager to do in order to improve the lives of the residents as well as keep them, their guests and staff safe: The home could do more to make sure that residents are aware of current arrangements for charging for the facilities and services so that they can make informed decisions about whether or not they are getting value for money. Generally staff are aware of the need to support the residents to develop their independent living skills, but there remains considerable scope to improve this process. The residents are still not being allowed to achieve their full potential with regards their independence as staff are still not spending enough of their time working with individuals helping them to maintain and develop their independent living skills. Unicorn House (16) DS0000025864.V361295.R01.S.doc Version 5.2 Page 7 Some progress has been made by the home to improve the number and variety of opportunities the residents to engage in more meaningful activities within the home. However, the opportunities residents have to pursue stimulating activities within the local community that are of interest to them remains limited. The new acting manager acknowledges that some of the residents may be somewhat ‘isolated’ as a direct result of the lack of opportunities they have to make contact with their local community contact and build links. There is a need for all staff including the proprietor to improve their understanding of reporting incidents in the home that affects the wellbeing of residents. The home needs to significantly improve the way it assesses behaviours that could potentially challenge the service and how it manages these risks. This process must involve all the relevant parties, including the individual residents and their representatives (family and professional), and agreement reached on any management strategies put in place to minimise any identify risk. In addition to this, if the service decides that it is in an individuals ‘best interests’ to allow staff to use physical intervention techniques as an ‘last resort’ and in exceptional circumstances when all other de-escalation methods have failed to secure the welfare of the individual and/or other people using the service then the homes policies and procedures must be up dated accordingly to reflect this approach. Furthermore, any staff authorised to use physical intervention techniques must receive British Institute of Learning Disability (BILD) approved training in its appropriate use, which will need to be refreshed at least once a year. Staff training could be improved to make it more targeted at relevant individual to ensure they are sufficiently skilled to meet the diverse needs of all the residents. Also, inconsistent and inadequate supervision of staff with infrequent individual sessions means the residents do reap the benefits of being supported by well-managed staff team. The latch fitted to the new ground floor toilet needs to be replaced with a locking device that can be overridden by staff in an emergency. The offensive smelling carpet in one bedroom needs to be replaced with more suitable floor covering. No documentary evidence could be produced on request to show the homes fire risk assessment had been reviewed for sometime and up dated accordingly to reflect all the changes required by the LFEPA during their last visit to the service. Finally, the ‘dorguard’ device fitted to the fire resistant kitchen door to ensure its automatic closure in the event of the fire alarm system being activated must be made operational. Unicorn House (16) DS0000025864.V361295.R01.S.doc Version 5.2 Page 8 There are weaknesses with the quality assurance and management systems that monitor the effectiveness of managers and their day to day management of the service. Finally, it has been recommended throughout this report that the home significantly improves its arrangements for ensuring the people who use the service have access to far easier to read versions of its policies and procedures, specifically those relating to weekly menus, social activity schedules, independent living programmes, complaints procedures, and the service users Guide. 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.V361295.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.V361295.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 & 5 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 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. The homes current arrangements for charging residents for the facilities and services provided are not particularly transparent and will need to improve to enable people to make informed decisions about whether or not they are getting value for money. 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. Unicorn House (16) DS0000025864.V361295.R01.S.doc Version 5.2 Page 11 At the last key inspection (10th and 11th of December 2007) a requirement was set that 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. There should also be appropriate consultation regarding the assessment with the resident or a representative of the resident. The assessment should also indicate that the care home is suitable for the purpose of meeting the individual’s needs in respect of their health and welfare. Following the inspection an action plan was sent to the Commission. This told us that the acting home manager would ensure that any new residents are duly assessed prior to their admission to the home. No new residents have moved into the home since the last key inspection. This prevents any further judgement on the ability of this service to ensure that assessments of new residents are appropriately carried out. The Commission will continue to monitor how the home admits new residents to the home. It was also recommended at the last key (10th and 11th of December 2007) inspection that the home’s Statement of Purpose be updated to reflect that the home supports people with physical disabilities and some people with elderly needs. The Statement of Purpose had been updated however, as the home now has a new acting home manager, the Statement of Purpose and Service Users Guide will need to be updated to include her details. On the 1st of September 2006 the Care Homes Regulations 2001 regarding the Service Users Guide were amended to request that residents should have access to ‘easy to read’ versions of the Service Users Guide. This has not yet been provided for the residents. We looked at the written terms and conditions of two people whose care we had selected to case track during this inspection. The new acting manager was able to produce these on request. Dates specified on the contracts revealed they had not been reviewed since 2004. Consequently, neither document accurately reflected the changes that had occurred in respect of these individuals’ terms and conditions of occupancy, including the fees they were currently being charged for the provision of accommodation and personal care. Furthermore, it was also unclear what arrangements the provider had in place for charging people who used the service for the provision of food and any so called ‘extras’ considered additional to items already covered by the basic cost of each individual’s placement. The new acting manager acknowledged that service users contracts were in urgent need of reviewing. The registered person will also need to assess whether or not the resident’s have the mental capacity to make informed decisions. If residents have been assessed as not having the mental capacity Unicorn House (16) DS0000025864.V361295.R01.S.doc Version 5.2 Page 12 to understand the contracts, a family member, advocate or care manager may support them to agree and sign their contract. The AQAA indicated that the home does not have policies on the discharge of residents or access to files by staff/residents. A requirement was set at the random inspection that the registered provider must develop policies on the discharge of residents and access to files by staff/residents. The new acting home manager produced the homes policies on the discharge of residents and access to files by staff/residents. Unicorn House (16) DS0000025864.V361295.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, & 9. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall, care plans do reflect what is important to the individual, their capabilities, and what support they need to achieve their personal aspirations. Progress has been made by the service to enable the residents to become involved in the day-to-day running of the home and to make more informed decisions about their lives. EVIDENCE: It was required at the last key inspection (10th and 11th of December 2007) that the registered provider moves a resident to a room more suitable to their needs. The previous acting home manager told us in his action plan that the resident occupying this room had made a decision that he did not want to move. This has been discussed with his key worker and his parents. Unicorn House (16) DS0000025864.V361295.R01.S.doc Version 5.2 Page 14 As required at the last key inspection (10th and 11th of December 2007), this resident’s Care Manager reviewed the placement. An element of this review took into account recommendations contained within Occupational therapist’s report commissioned by the proprietor. A requirement was set at the last key inspection (10th and 11th of December 2007) that residents who required additional support to promote continence must have in place up to date and detailed risk assessments and care plans. These would need to be shared with the relevant care professionals in order to ensure that they have their health care needs met and their dignity is maintained. At the random inspection (27th February 2007) the previous acting home manager produced risk assessments for residents who used continence pads. It was recommended at the last key inspection (10th and 11th of December 2007) that residents risk assessments are reviewed and updated on a regular basis. At the random inspection (27th February 2007) the previous acting home manager produced evidence that risk assessments are being reviewed and updated on a regular basis. It was recommended at the last key inspection (10th and 11th of December 2007) that if appropriate residents agree and sign their risk assessments. At the random inspection (27th February 2007) the previous acting home manager produced evidence that some residents have agreed and signed their individual risk assessments. The task needs to be completed for the remaining residents The care plans for the two people being case tracked were examined in depth. These plans were relatively person centred and covered every aspect of the people’s lives including, their personal, social, and health care strengths, needs, and preferences. One individual told us their keyworker had helped them “write stuff in their care plan”. Both care plans inspected had been reviewed in the past six months and up dated accordingly to reflect any recent changes in their provision. These positive comments notwithstanding one care plan examined in depth referred to an individual being ‘vicious’. The negative connotations of labelling someone in this way is totally unacceptable to the Commission and directly contravenes the underlying principles of person centred care planning, which should emphasise person’s strengths. We strongly recommend care plans are reviewed as a matter of urgency and any language found that is deemed inappropriate removed immediately. Unicorn House (16) DS0000025864.V361295.R01.S.doc Version 5.2 Page 15 As required at random inspection (27th February 2007) the new acting manager was able to produce documentary evidence to show that she had recently reintroduced residents meetings on a weekly basis. One person who uses the service told us they “usually attended them”, and thought they were “quite useful - sometimes”. Minutes from the last four meetings revealed a wide variety of topics had been discussed including, menu planning, household chores, and activities. Minutes seen also revealed staff had begun giving the people who use the service feedback about what actions they had agreed to take at the previous meeting. The registered provider told us in the AQAA (25th February 2007) that the sexual orientation of all eight residents was not known. However, under the section “equality and diversity” he stated, “We support sexuality through the Mental Capacity Act”. There was no statements in the care plans to indicate that the mental capacity of the residents had been assessed or guidance given to staff how this piece of legislation would assist them to support residents with their sexual orientation. There was no evidence that any attempt had been made to support residents in this area. The AQAA also indicated that the home does not have a policy on “sexuality and relationships”. A requirement was set at the random inspection (27th February 2007) that the registered persons develop a policy on “sexuality and relationships” and staff must be trained on the topic. The new acting home manager produced the homes sexuality and relationship policy and told us that “personal relationship training” was being planned and that all staff would be expected to attend. The issue of communication was discussed with the new acting home manager and the deputy manager. They told us that some residents could read the homes menu and some residents could not. We discussed the possibility of a communication board using words and pictures indicating what was on the menu, what staff were on shift and activities attended by the residents. It was agreed that this might be of benefit to a number of residents in the home. The deputy manager also thought it would be useful if a weekly rota was drawn up for some residents who wished to get involved in preparing meals, setting tables and washing up. This would be incorporated into their care plans. It is recommended that the new acting home manager contact Croydon Social Services Speech and Language Team for advice on “Total Communication”. Unicorn House (16) DS0000025864.V361295.R01.S.doc Version 5.2 Page 16 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 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. Some progress has been made by staff to enable the residents to engage in a wider variety of more meaningful activities within the home, although there remains considerable scope to improve these arrangements, especially with regards community based outings and events. Some progress had been made by the home to improve the range of opportunities residents have to maintain and develop their independent living skills, however overall arrangements for promoting independence remain limited. Dietary needs and preferences are not particularly well catered for because the residents are not provided with sufficient choice or nutritionally well-balanced meals at mealtimes. Unicorn House (16) DS0000025864.V361295.R01.S.doc Version 5.2 Page 17 EVIDENCE: A requirement was set at the last key inspection (10th and 11th of December 2007) that residents must be offered more opportunities to participate in a wider variety of meaningful activities that reflect their interests, especially within the home. This would ensure the residents have their social, leisure, and recreational needs more fully met. At the random inspection (27th February 2007) a member of staff was observed supporting a couple of residents to do puzzles in the small games room. During a tour of the premises a lot of games, toys, puzzles, art materials, and books were found. However not all the resources noted were particularly appropriate given the average ages and abilities of the residents. This was discussed with the new acting manager. Following the first day of this inspection she produced an action plan to purchase a Video/DVD player, DVDs, Video’s and books. A lot of feedback was received from a number of different sources about the opportunities residents had to participate in social activities of their choosing. The general consensus of opinion expressed was that although residents had some opportunities to take part in various activities, but community based ones remained limited. Typical comments included, “I want to go on more outings”, “I wish my loved one went out more”, and “there doesn’t always seem to be enough staff on duty to accompany people when they want to go out”. At the random inspection (27th February 2007) the expert by experience spoke to staff, three residents and two family members visiting their son. A resident who was in a wheelchair said he would like to be able to go out independently. He said he enjoyed going to the pub for lunch but the weather was too bad at the moment. From conversations with staff and residents, accessing the community was dependent on availability of staff. Another person who uses the service spoken with at length during this visit was very critical about the lack of opportunities they had to go out and participate in community-based activities. Typical comments made by this individual included, “it would be great to go out to the pub more often”, and ”I like going to the pictures, but don’t go much”. The new acting manager told us a number of the people who use the service had visited a local pub at the end of last week, but conceded opportunities for this to happen on a regular basis remained variable. At the time of this inspection the new manager told us she was actively seeking local links with interest groups and clubs that residents could access. She also told us that the staff team is now encouraged on a daily basis to support residents into the Unicorn House (16) DS0000025864.V361295.R01.S.doc Version 5.2 Page 18 community. Staff were observed taking a number of people out during the course of this inspection. Similarly, it was also evident that some progress has been made by the home to improve the opportunities residents have to maintain and develop their independent living skills by engaging in more domestic chores around the home. The new acting manager told us since her arrival she had noted a number of the residents being actively encouraged by staff to tidy their bedroom, bring their laundry down, and prepare drinks in the kitchen. We recommend care plans contain more detailed information and structured programmes that set out exactly what support each resident needs to develop their independent living skills. The new acting manager told us she did not believe the home needed to employ a separate activities coordinator as recommended at the last random inspection, but acknowledged there was a need for this specialist role to be delegated amongst her current staff team. We recommend that the home develops easy to read versions of daily activity schedules and independent living programmes the residents have agreed they would like to opportunity to engage in on a regularly basis. The new manager told us that she was not aware of the previous practice of setting bedtimes, but knew some residents have televisions in their bedroom, which they are free to stay up late and watch for as long as they choose. At the random inspection (27th February 2007) a member of staff told the expert by experience that residents had weekly meetings to plan the menus for the following week. Three residents told the expert that staff planned the meals and they did not have meetings to decide on food. One resident told the expert that there is no choice at mealtimes and that if you don’t like/want what’s offered staff offers a sandwich as an alternative. Other comments made by some residents about the quality of the meals served included, “I can pick what I want to eat”, and “food is nice – I like it”. One resident spent £16.81 on food from Marks and Spencer’s, the previous acting home manager told us that this resident didn’t want to eat the food offered so bought their own. The registered provider returned an Annual Quality Assurance Assessment (AQAA) to the Commission on the 25th of February 2008. He told us in the AQAA that as part of the day care activities, residents access the local open market and purchase fruits and vegetables for the home on a regular basis. However at the random inspection some residents told the expert that they did not go food shopping with staff and so did not experience the community aspect of the supermarket or learn about food. The expert looked at the menu, and identified that there were no healthy options such as salads or fruit. Lunch Unicorn House (16) DS0000025864.V361295.R01.S.doc Version 5.2 Page 19 on the day was a sandwich or hotdog and spaghetti hoops. One resident told the expert that he bought his own dinner sometimes, as there was no choice of food. The home’s food purchases and storage were examined. Some food was stored in a fridge and a freezer in the basement of the home and some food was stored in a pantry just off from the kitchen. There was a small quantity of fresh fruit and vegetables in the pantry. A member of staff was asked why the fruit was not left out for the residents to eat when they choose, she told us that some residents take away all of the fruit and leave none for the others, residents are encouraged to ask staff for fruit if they want some. The basement also had a stock room containing large quantities of economy tinned food such as meatballs, ravioli, spaghetti hoops, macaroni cheese and minestrone soup. The new acting home manager produced the homes menu for that week, the menu indicated that residents were offered meatballs, ravioli, spaghetti hoops, macaroni cheese and minestrone soup through the week and a roast dinner on a Sunday. The new acting home manager and the deputy manager told us that most of the food comes from these tins and that staff at present do not prepare fresh meat or fish on a daily basis. However there was a new proposed menu. This included freshly cooked meat dishes such as lamb chops, diced beef and chicken curry. The intention was to use all the all of the food in the stock room and then introduce the new menu on a trial period to see if the residents liked it. It is recommended that the new acting home manager contact a dietician for advice on nutrition when developing the new menus for the home. At the random inspection (27th February 2007) the expert by experience reported that the home’s menus were not in picture format and if you couldn’t read you would not know what was for dinner or any mealtimes. The expert felt it was important to have a choice of food and have pictures to help you make that choice. At this inspection the new acting home manager was in the process of developing a picture menu so that residents would know what food was being offered on the day. It was observed at the random inspection that the kitchen door was closed and not accessible independently for residents so they could not get drinks or snacks/healthy foods independently. They needed to be accompanied. On this visit the door was held open by a magnetic door holder, which allowed free access to the kitchen. Unicorn House (16) DS0000025864.V361295.R01.S.doc Version 5.2 Page 20 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, & 20. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally the home has suitably robust arrangements in place to ensure the residents receive the personal support in the way they prefer and require. Overall the home’s policies and procedures for handling medication are sufficiently robust to keep the residents safe. EVIDENCE: A requirement was set at the last key inspection (10th and 11th of December 2007) that all staff must attend training on physical disabilities. At the random inspection (27th February 2007) the previous acting home manager produced evidence confirming that staff had attended training on physical disabilities at the Unicorn Training Institute on the 18th or the 21st of December 2007. One bedroom viewed smelt rather unpleasant. The acting manager has been required to replace the carpet in this room (See outcome group – Environment) and seek some professional advice from a continence nurse Unicorn House (16) DS0000025864.V361295.R01.S.doc Version 5.2 Page 21 about how best to support this individual with this particular health care need. It was also asked that any risk management programmes agreed with the resident to promote their continence must be added to their care plan. Health Call Optical Services visited the home on the 3rd of June to check on the resident’s sight. During this inspection a community psychiatric nurse was visiting the home the new acting home manager told us that she had come to the home to draw up new guidelines for staff to support two residents with challenging behaviours. It was recommended at the last key inspection (10th and 11th of December 2007) and again at the random inspection (27th February 2007) that the registered provider considers how wheelchair users can access appropriate areas of their home. One resident was observed finding it difficult to manoeuvre her wheelchair through the hallway to her bedroom. She told us that she was fine and when offered support declined the offer. It appeared that the carpet flooring in the hallway was inhibiting her access; the new acting manager told us that she would consider providing flooring more appropriate to the needs of residents who use wheelchairs. The new acting manager told us that an assessment of this resident’s mobility had been arranged for the 17th of July 2008 and there was a possibility that the resident would be assessed as needing a new wheelchair. The resident told us that she would like an electric wheelchair so that she could visit the registered provider who lives near by. No recording errors were noted on medication administration records (MAR) sheets sampled at random. These records reflected current medication stocks held by the home on resident’s behalves, which were securely stored in a locked metal cabinet in the office. As required at the random inspection (27th February 2007) protocols for the use of ‘as required’ (PRN) medication had been developed that set out in detail when and how staff should administer this type of medicine. It was noted that there had been a significant reduction in the use of ‘as required’ (PRN) medication to deal with incidents that had challenged the service in the past month. One senior member of staff spoken at length about protocols for the use of ‘as required’ (PRN) medication was very clear when and how to administer it and told us they “would only use PRN when all other techniques had failed to defuse an aggressive incident that was placing the resident involved or other living at the home at risk of being harmed”. The new acting manager also demonstrated a good understanding of the appropriate use and role of ‘as required’ PRN medication. Unicorn House (16) DS0000025864.V361295.R01.S.doc Version 5.2 Page 22 In the main staff are keeping appropriate records of the use of ‘as required’ PRN medication, although we recommend staff authorised to handle it expand upon the reasons why it may be administered on the back of residents medication administration record sheets. For example, the rationale for the use of PRN medication recorded on the back of one medication administration sheet merely states the individual concerned was ‘aggressive’. This lack of detail makes it difficult for anyone authorised to inspect medication records to monitor whether or not PRN medication is being administered as a last resort in accordance with individualised protocols for its use. Documentary evidence in the form of up to date certificates of attendance of medication training course were produced on request for two staff the new acting manager told us were authorised to handle medication in the home on behalf of the people who lived there. The new acting manager told us that staff support one resident to dispense their own medication under supervision and believed with the right support a number of other residents might be willing and capable of handling their own medication to varying degrees. We recommend the views of the residents about the possibility of them having greater control over their medication be ascertained and their capacity to do so be risk assessed. The outcome of these assessments needs to be reflected in peoples care plans. Unicorn House (16) DS0000025864.V361295.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 & 23 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes arrangements for handling complaints are in the main sufficiently robust to ensure that the residents feel listened to and safe. The homes current procedures and staffs understanding of when to report incidents of physical abuse does not protect residents from abuse. Furthermore, staffs limited understanding about whether or not they are authorised to use physical intervention techniques within the home and under what circumstances is placing the residents at risk of harm and/or abuse. EVIDENCE: The service has a complaints procedure that was conspicuously displayed on a notice board in the dinning room. The new acting manager told us she felt it was not particularly easy to read and has therefore decided to develop a new version that she intends to illustrate with coloured pictures and symbols to enable everyone who uses the service to understand it. The new acting manager told us she would always keep a full record of any complaints made about the home, including details of the investigation and any actions taken. The homes complaints log was produced on request that Unicorn House (16) DS0000025864.V361295.R01.S.doc Version 5.2 Page 24 made no reference to any complaints or concerns being raised about its operation since it was last inspected. It was evident from the information contained in a number of care plans inspected and the nature of some of the incidents recorded in the past nine months that some of the people who live at Unicorn House can be verbally and/or physically aggressive at times. However, care plans inspected lacked any specific guidance to enable staff to manage aggressive/violent incidents in an effective or consistent manner. However on the day of the inspection, a community psychiatric nurse was visiting the home, in order to help staff draw up new guidelines to manage residents challenging behaviors. The home does not have a copy of the Department of Health’s Physical Intervention Guidance and the restraint policy it has in place is ambiguous. The policy does not make it explicit enough that physical intervention must only ever be used as part of a holistic strategy when the risks of using a physical intervention are judged to be lower than the risks of not doing so and then only as a ‘last resort’ when a person presents a risk to themselves or to others. Four staff interviewed, which included the new acting and deputy managers and two support workers, all told us they were not aware of any incidents where they used physical intervention techniques on a resident to deal with challenging behaviour in the past twelve months. However these same staff were unclear whether or not they were authorised to use physical intervention techniques on residents, even if they considered this action to be in the individuals best interests. E.g. One member of staff told us they “would only ever use physical intervention techniques as a last resort when all other methods had failed”, while another advised us that they, “would never restrain anyone in the home”. This lack of clarity about when to use physical intervention techniques needs to be addressed as a matter of urgency and appropriate policies and procedures established, including a reference to them in the home’s Statement of Purpose. If physical intervention techniques are to be used there should be clearly documented instructions regarding how and when this type of intervention can be employed. Any behaviour management plan should be agreed with the resident where possible, placing authority, other professionals, and family where appropriate. Staff must also have received appropriate training in its use, which is British Institute for Learning Disabilities (BILD) approved and refreshed at least once every twelve months. Staff training files sampled at random showed that while one member of staff had received physical intervention training from the proprietor in the past twelve months in line with BILD approved guidance; two other members of staffs training had expired, while another had not received any training at all in this area of practice. Unicorn House (16) DS0000025864.V361295.R01.S.doc Version 5.2 Page 25 As required in the home’s last inspection report a written record of a limitation regarding the number of cigarettes one resident could smoke a day was in place. The individual involved in this programme told us they “I get all the cigarettes I need and I don’t mind staff holding on to them in the office”. Also during a tour of the premises it was noted that the unacceptable practice of limiting the amount of toilet paper available in the toilets had ceased. On arrival ample supplies of toilet tissue and hand drying paper towels were found in both the ground floor and first floor toilets. Several members of staff and residents spoken with about the availability of toilet tissue in the home all told us they were not aware this was now an issue. Following our findings at the last key inspection (10th & 11th December 2007), a formal warning letter was sent to the Registered Provider on the 8th of February 2008 as a result of the standards of health and safety were not of an acceptable standard which placed residents at risk of harm due to • • • • the building not being suitable for use by all people who use the service. staff not receiving appropriate training (including induction training) to meet the needs of people who use the service. medication not being administered safely to people who use the service. not having procedures in place to ensure the home is clean and infection controls not being followed. Standards of care are not high enough and there are significant problems in the following areas • • People who want to use the service are not having their needs effectively assessed in order to establish if the home could meet their needs. Care plans and risk assessments do not fully reflect the needs of people who use the service. People who use the service were being placed at risk of harm or abuse due to • • Recruitment procedures not being operated effectively and therefore the skills, abilities and identity of potential employees are not being checked thoroughly. Financial procedures are not in place to protect the money of people who use the service. The registered provider was informed in writing that that we would be holding regular management review meetings to monitor whether required improvements were being made within the timescales agreed. Failure to make the required improvements, within the timescales, would lead to the Commission would taking enforcement action. Unicorn House (16) DS0000025864.V361295.R01.S.doc Version 5.2 Page 26 Appropriate action has been taken as there have been improvements relating to medication administration and the home now has procedures in place to ensure the home is clean and infection is controlled. New bathrooms and shower rooms have been built and staff has attended training on infection control. It was recommended at the last key inspection (10th & 11th December 2007) that as the homes administrator was once again in charge of the homes finances that she read the random inspection report, 20th of September 2006. The administrator told us that she had read the random inspection report, 20th of September 2006. However the issue of the home’s procedures in relation to resident’s finances are still in the process of being introduced to a standard that will allow family and advocates to monitor them with confidence that the system is open and transparent. Further changes to the system may be introduced at the conclusion of a current safeguarding investigation by the London Borough of Croydon into the finances of one of the residents. On the second day of the inspection the finance officer for Unicorn services was unavailable. However the individual financial records of the residents were being kept to a standard that allowed information to be extracted and cross referenced with other records of financial systems in the home. As a result the systems are more transparent and easier to audit. The home’s written communication records were examined. The Occurrence Book is used by staff to record significant incidents of concern about the residents. We noted that in May a violent incident had taken place between two residents. This was raised with the new acting home manager who told us that she had informed the registered provider about this incident but she had not considered notifying anyone else, as the resident had not appeared to suffer any physical injury. However the written records indicated that the incident was of a serious enough nature to warrant reporting to the Commission and under the local authorities safeguarding protocols. As this is not the first instance of non-reporting of serious concerns a requirement has not been made here because enforcement action is being considered regarding this issue. Unicorn House (16) DS0000025864.V361295.R01.S.doc Version 5.2 Page 27 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, 28, 29, & 30. 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. Improvements have been made to the home’s environment, although there remains significant scope to up grade the interior décor and soft furnishing of communal areas to ensure the residents live in a more homely and comfortable environment. EVIDENCE: A requirement was set at the last key inspection (10th and 11th of December 2007) and again at the random inspection (27th February 2007) that suitable ramps must be fitted to all the homes backdoors to ensure all the homes wheelchairs users have independent access to the rear garden. At the random inspection the expert by experience observed that ramp to access the garden was of poor quality and would not allow for a wheelchair user to access the garden independently. Unicorn House (16) DS0000025864.V361295.R01.S.doc Version 5.2 Page 28 A requirement was set at the last key inspection (10th and 11th of December 2007) and again at the random inspection (27th February 2007) that the registered provider 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. An action plan was sent to the Commission stating that a new ramp had been fitted and the door to the hallway had been modified to ease access for residents using wheelchairs. At the random inspection (27th February 2007) we noted that a ramp had been fitted at the front door. The registered provider, Mr. Madhewoo told us that he had plans to replace the existing front entrance of the home with one more accessible to people that use wheelchairs. He told us that he had plans to improve parts of the home over the coming year. It was agreed that these requirements would be fully assessed at the random inspection (27th February 2007) and a requirement was set that the occupational therapist was to be invited back to the home to assess if the changes made to the home to improve mobility for people with physical disabilities meet the recommendations in her original report. The occupational therapist returned to the home on the 17th of April 2007 and reported that all of the recommendations set in her original report have been met. We saw during a tour of the ground floor that the home generally provides the people who use the service with a relatively pleasant place to live, although the leather sofas in the main lounge are beginning to look rather worn and there is a distinct lack of soft furnishings in communal areas (e.g. cushions, throws ect…). Since the last inspection a number of photographs and pictures had been hung on the walls in several bedrooms viewed during a tour of the premises, which made these private areas look more personalised and homely than at previous inspections. A rather offensive odour was noted to be emanating from one of the bedrooms. The new acting manager told us the carpet had been damaged because of incontinence issues associated with the current occupant. In order to rectify this the carpet in this room needs to be replaced as a matter of urgency with a more suitable floor covering. The proprietor has installed a new bathroom suite with a Jacuzzi and shower unit, retiled these areas, and fitted paper towel and liquid soap dispensers in all the homes toilets since the last inspection. One resident told us that she is very pleased with the new shower room and has enjoyed using the Jacuzzi. Unicorn House (16) DS0000025864.V361295.R01.S.doc Version 5.2 Page 29 As previously mentioned in this report there were amble supplies of toilet tissue, paper towels and soap in these areas. The latch style lock fitted to the door of the new ground floor toilet and shower facility needs to be replaced with a more suitable mechanism that can be opened from the outside in the event of an emergency. The temperature of hot water emanating from the new ground floor bath and first floor shower unit were both found to be safe (i.e. below 43 Degrees Celsius) when tested between 10.30am and 10.45am. The new acting manager told us that there are plans to redecorate all of the resident’s bedrooms and all of the communal spaces. The new acting home manager sent an action plan for 2008 to the Commission indicating that all of the resident’s bedrooms would be decorated to their choice in August, September, and October. All corridors, landings, and staircases would be decorated in July, August, and September and new lounge furniture would be purchased in November. As required at the last key inspection (10th and 11th of December 2007) radiator covers had been fitted in resident’s bedrooms. The new acting manager produced the homes policy for preventing infection and managing infection control and the Department of Health’s guide “Essential Steps” employed to assess their current infection control management. The home has a large garden at the rear of the building. There are some tables and chairs for residents to relax on warm days. There is a fishpond at the rear of the garden that appears neglected the new acting home manager told us that they might consider cleaning the pond and adding some fish. She also agreed to remove building debris from around the garden. Unicorn House (16) DS0000025864.V361295.R01.S.doc Version 5.2 Page 30 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, 35, and 36. People using 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 using the service have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are generally met by staff however staff need to have a clear understanding of when to report incidents of abuse and staff supervision sessions need to take place more often. EVIDENCE: A requirement was set at the last key inspection (10th and 11th of December 2007) that the registered person must ensure that a full employment history is included on the application form for any potential member of staff. The previous acting home manager told us in an action plan that the application for any potential staff is scanned to ensure that a full employment history is included. Any gap in employment is enquired about during the Unicorn House (16) DS0000025864.V361295.R01.S.doc Version 5.2 Page 31 interview process. The registered provider told us in the Annual Quality Assurance Assessment document that selection and recruitment is made through personal interview, satisfactory job references and CRB checks. New members of staff had obtained Criminal Record Checks, two written references, and full employment checks including a full employment history before starting work at the home. Apart from the new acting home manager no new staff have been employed at the home since the random inspection. The new acting home manager’s file was examined and included a completed Criminal Record Check and two written references. A requirement was set at the last key inspection (10th and 11th of December 2007) that the registered person must clarify the role and responsibilities of the administrator. If the administrator was to be employed as a support worker then her contract and the homes staffing rota must be amended to include these details. At the random inspection (27th February 2007) the previous acting home manager produced the administrator’s amended contract, the contract indicated that the administrator would attend training in relation to caring for the residents and the home’s staffing rota had been amended to include these details. The registered provider told us that he was in the process of moving his head office and training school to another setting in Croydon. This would mean that all activities and staff not specific to Unicorn House would transfer to the new office. This will be a very significant development as it reduce the level of unnecessary visitors to the resident’s home. The new home manager told us that the administrator had gone on holiday and on her return would no longer carry out sleepover duties at Unicorn House. The new acting home manager’s plan is for all staff to do sleepover shifts. A requirement was set at the last key inspection (10th and 11th of December 2007) that the previous acting home manager must satisfy himself as to the authenticity of two new members of staff’s references and establish under what circumstances they were taken up. At the random inspection (27th February 2007) the previous acting home manager produced letters from people as character references for the two members of staff. The previous acting home manager also provided a reference for another member of staff redeployed from another care home within the Unicorn Projects. Requirements were set at the last key inspection (10th and 11th of December 2007) that the registered person must ensure that the home’s staffing levels Unicorn House (16) DS0000025864.V361295.R01.S.doc Version 5.2 Page 32 were recorded accurately on the rota. This was partly due to proprietor’s name being included on the rota even though he was not physically present. It was also unclear when his name appeared on the rota whether he was a supernumerary manager or covering for one of the care staff. Staffing at the home at the random inspection and at this inspection was accurately reflected on the rota. The rota also indicated that the registered provider is available from 9am to 4pm at his office which is located at another address in the same road. However this information contradicted information he had previously provided to the Commission that he was the manager responsible for the day-to-day control of another registered service. On the day of the random inspection the registered provider told us that he was training people at the Unicorn Training Institute. Although the home is registered to support people with learning disabilities there have been some residents who have been admitted to the home outside this category. When this occurs, it is important that the staff receive the appropriate training that enables them to support the resident and meet their need. At a random inspection of the 25th of October 2007 the previous acting home manager told us that he wanted to acquaint him self with staff training records in order to consider the teams training needs. It was recommended at the last key inspection (10th and 11th of December 2007) that the previous acting home manager develop a staff-training programme that takes into consideration the diagnosed conditions and assessed needs of the residents. At the random inspection (27th February 2007) the previous acting home manager showed that he was currently collating training attended by staff. Although there was evidence that he had contacted the National Autistic Society and was planning to arrange training for staff on autism there was no evidence that he was developing a programme taking into account the diagnosed conditions and assessed needs of the residents. This recommendation was discussed again with the new acting home manager she agreed that a staff-training programme staff would need to be developed so that staff could attend training on the diagnosed conditions and assessed needs of the residents. The registered provider must make sure that a staff-training programme is developed that takes into consideration the diagnosed conditions and assessed needs of the residents. Unicorn House (16) DS0000025864.V361295.R01.S.doc Version 5.2 Page 33 The new acting home manager told us that “personal relationship training” was being planned and that all staff would be expected to attend. She was unsure of the venue for the training. The registered provider told us that he was in the process of moving his training college to Barclays Road in Croydon. A requirement was set at the last key inspection (10th and 11th of December 2007) that the registered person must make sure that the staff team are appropriately supervised. Staff should receive formal recorded supervision at least six times per year. The new acting home manager produced evidence that staff are receiving supervision. The new acting home manager and her two deputy managers are responsible for supervising staff. The new acting home manager produced a supervision-planning list indicating that staff would receive supervision at least six times a year. The deputy manager produced staff team meeting minutes for 30th of April and 4th of June 2008. At the meetings staff discussed issues such as the last inspection report, occupational therapist report, medication and residents cigarettes. Unicorn House (16) DS0000025864.V361295.R01.S.doc Version 5.2 Page 34 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 adequate. This judgement has been made using available evidence including a visit to this service. The ethos, leadership and management of the home has not always benefited the resident. The lack of a registered manager for two years means the residents cannot be confident that they will benefit from an competent and accountable management of the service. EVIDENCE: The home has not had a manager registered with the Commission to run the home since the 2nd of March 2006. Since that time the registered provider has employed a number of people to run the home. Unicorn House (16) DS0000025864.V361295.R01.S.doc Version 5.2 Page 35 On the 16th of August 2006 Mr Venkaya was employed on a part time basis and continued to work full time for the NHS as a ward manager (nights). The registered provider failed to notify the Commission that his role had been changed to an on call basis from December 2007 until after Mr Venkaya resigned as manager on 23/08/07. Another manager was appointed in June 2007 but ceased to be manager in July 2007 following discrepancies on her application form. In August 2007 the previous acting home manager was appointed however his application to become the registered manager was refused by the Commission on March 2008. The new acting home manager started work at the home on the 9th of May 2008. She holds an NVQ 4 in management, the Registered Managers Award, and an NVQ assessor’s award. The new acting manager appears to have the necessary skills and abilities to manage a service for people with learning disabilities. She has made a number of improvements in the short time that she has been in post. She told us that she planned to apply to the Commission to become the registered manager for the home. It was recommended at the last key inspection (10th and 11th of December 2007) that the registered provider seek the views of the resident’s families, advocates, and care managers about the standard of care provided at the home and how these can be improved further. The new acting home manager told us that she is planning to develop resident’s and relative’s questionnaires. She has invited relatives to Unicorn House on the 27th of June 2008 to seek their views about the home. She told us that a member of staff is also arranging a barbeque for relatives and friends to attend. A number of Commission surveys were returned from relatives, residents, and a General Practitioner. Comments from relatives included “staff at Unicorn House are very friendly and always ready to help. Staff show understanding to the everyday needs of the patients and try to make it as homely as possible”. “My relative has had two stays in hospital, I was informed and when I visited him in hospital I was surprised and pleased to find that staff was with him 24 hours a day. I have never had reason to express any concerns about his treatment. Unicorn house excels in the care of all of the residents and visitors are made most welcome. The premises are kept clean and I could not fault it”. “I have always been impressed by Unicorn House and its care for my relative. I would like a copy of the homes complaints procedure”. Unicorn House (16) DS0000025864.V361295.R01.S.doc Version 5.2 Page 36 “They look after my relative well”. A General Practitioner commented, “Staff are excellent”. A report compiled by the London Fire and Emergency Planning Authority (LFEPA) following a recent visit by one of their officers to the home on 27th February 2008 noted a number of conditions required by the fire safety Regulations (2005) were being contravened. The first area of concern related to the homes fire risk assessment that the officer from the local fire authority stated was ‘not suitable and sufficient’. The new deputy manager believed the homes fire risk assessment had been reviewed following the LFEPA visit, but was unable to produce the most up to date version on request. According to documents produced the homes fire risk assessment was last reviewed in October 2007. It was noted that all the other areas of concerns regarding fire safety and the steps considered necessary by the LFEPA to remedy them had been taken by the home in a timely fashion. This included, ensuring sufficient numbers of the homes staff participate in fire drills at regular intervals, repairing faulty fire resistant doors to ensure they are effectively self-closing, encasing the top floor boiler, removing the external fire escape staircase, and installing a suitable means of detecting fire within the bedrooms on the 2nd floor. Fire records revealed that the homes fire alarm system continues to be tested on a weekly basis. Certificates of worthiness also revealed the alarm system and fire extinguishers strategically placed throughout the home had been checked by a suitably qualified engineer in the past twelve months. One member of staff spoken with at length about the homes fire evacuation procedures was very clear about their roles and responsibilities would be in the event of a fire starting in the home and where the assembly point for residents and staff would be. During a tour of the premises the fire resistant kitchen door was found inappropriately wedged open at 11.22am. The new acting manager told us it had been wedged open to “enable the residents to gain access to the kitchen”, but acknowledged propping the door open in this matter contravened fire safety regulations (2005). The manager removed the wedge, immediately rectifying the breach. On the second day of the inspection it was observed that a fireguard had been fixed to the bottom of the kitchen door, the fireguard had been connected to the homes fire alarm system, the deputy manager told us that the fireguard would release when the homes fire alarm system was activated. The deputy manager was asked to test the homes fire alarm system. After informing the residents and staff, the fire alarm system was activated. All of the homes fire Unicorn House (16) DS0000025864.V361295.R01.S.doc Version 5.2 Page 37 doors closed however the fireguard on the kitchen door failed to release the door. The registered provider must ensure that all parts of the homes fire containing arrangements are fully functioning at all times. Up to date Certificate of worthiness were made available on request to show that suitably qualified engineers had checked the homes portable electrical appliances test and gas installations in the past twelve months. Unicorn House (16) DS0000025864.V361295.R01.S.doc Version 5.2 Page 38 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 2 3 X 4 X 5 2 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 2 25 X 26 2 27 2 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X X X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 2 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 1 X 2 X X 1 X Unicorn House (16) DS0000025864.V361295.R01.S.doc Version 5.2 Page 39 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 YA5 Regulation 5(1)(ba)(bb) & (bc) Requirement All the people using the service must be provided with up to date, signed, and costed contracts that cover the accommodation, food, and personal care they can expect to receive. These contracts must also detail the total fees payable for facilities and services provided and what arrangements are in place for charging for so called ‘additional’ items not covered by the basic cost of each placement. This will enable the people who use the service and their representatives to determine whether or not they are getting value for money, as they will know exactly how much they should be charged for facilities and services provided. Timescale for action 21/07/08 2. YA14 16(2)(m) (n) People who use the service must be consulted about the frequency and availability of community activities, in order that individual programmes DS0000025864.V361295.R01.S.doc 12/08/08 Unicorn House (16) Version 5.2 Page 40 can be developed. This will ensure the people who use the service have their social, leisure, and recreational needs more fully met 3. YA14 12(1) to (4) People who use the service must have far greater opportunities to maintain and develop their independent living skills. This will promote the independence of the people who use the service. Previous timescale for action of 30th April 2008 partially met. All the people who use the service must be offered a more healthier and nutritionally balanced diet that includes; fresh meat, fruit and vegetables. This will ensure that they maintain a healthy lifestyle. 12/08/08 4. YA17 12(1)(a) 12/08/08 5. YA19 13(1)(b) Advice must be sought from 21/07/08 the relevant health care professionals to help the home develop management strategies to promote peoples continence. This must be recorded in care plans and closely monitored. This will ensure the people who use the service have their health care needs met. How behaviours that challenge 21/07/08 the service are risk assessed and managed must be reviewed. Any strategies developed to enable staff to deal with identified risk must never be put in place without the express agreement of the service user and their representatives (family and DS0000025864.V361295.R01.S.doc Version 5.2 Page 41 6. YA23 14(1), 15(1) & 17(1)(a) – Sch 3.3(q) Unicorn House (16) professional where applicable), and must always be included in the relevant care plan. This will minimise the risk of people who use the service being harmed. 7. YA23 4(1)(c) – Sch 1.18 & 13(6) If in agreement with all the relevant professionals it is decided that it is in a service users ‘best interests’ to allow suitably trained staff to use physical intervention techniques in exceptional circumstances to secure their welfare the home must obtain a copy of the Department of Health’s physical intervention guidance; review its own physical intervention policy to ensure it reflects current ‘best practice’, and up date its Statement of Purpose accordingly. All staff ‘authorised’ to use physical intervention techniques within the home must receive British Institute of Learning Disability (BILD) approved training in its appropriate use, which must be refreshed at least once every twelve months. This will ensure the people who use the service have their needs met by suitably trained and competent staff, thus minimising the risk of them being harmed and/or abused. The offensive smelling carpet in one bedroom must be replaced with more suitable floor covering. This will ensure the individual who occupies this room lives in a more pleasant environment. DS0000025864.V361295.R01.S.doc 21/07/08 8. YA23 13(6) & 18(1) 12/08/08 9. YA26 16(2)(c)&(k) 21/07/08 Unicorn House (16) Version 5.2 Page 42 10. YA27 13(4) The latch fitted to the new 21/07/08 ground floor toilet door must be replaced with a more suitable locking device that can be overridden by staff in an emergency. This will ensure the people who use the service are kept safe. The registered provider must 12/08/08 make sure that a staff-training programme is developed that takes into consideration the diagnosed conditions and assessed needs of the residents. The registered person must make sure that the staff team are appropriately supervised. Staff should receive formal recorded supervision at least six times per year. The homes fire risk assessment must be reviewed and up dated accordingly to comply with the Reformed fire safety Regulations (2005). This will ensure the safety of the people who use the service. 21/07/08 11. YA35 12(1) & 18(1) 12. YA36 18(2)(a) 13. YA42 23(4)(a) 21/07/08 14. YA42 23(4)(a) & (c)(i) All the fire resistant doors 21/07/08 fitted with devices to ensure their automatic closure in the event of the fire alarm system being activated must be fully functional at all times. This will ensure the people who use the service, their guests and staff are kept safe because the homes fire containment arrangements meet fire safety regulations. Unicorn House (16) DS0000025864.V361295.R01.S.doc Version 5.2 Page 43 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 YA2 Good Practice Recommendations It is recommended that the Service Users Guide be reviewed in line with the amended September 2006 the Care Homes Regulations 2001. Residents should have access to ‘easy to read’ versions of the Service Users Guide. The way in which the service describes certain individuals who use the service in their care plans should be reviewed as some of the language used has very negative connotations. This should be done to ensure all the people who use the service receive the person centred support they need through positive interventions that focus on an individuals strengths. People who use the service should be able to access more ‘age appropriate’ social resources within the home (e.g. Books, games, puzzles ect…). This good practice recommendation was made at the homes last inspection, but has yet to be considered by the new manager. How activities are coordinated in the home should be reviewed and the new manager may wish to consider delegating this role to a suitably competent member/s of staff to ensure the people who use the service have far greater opportunities to engage in stimulating activities of their choosing, both at home and in the wider community. A similar good practice recommendation was made at the homes last inspection, but has yet to be considered by the new manager. The weekly activities charts could be improved to contain more detailed information to help staff deliver the actual support individuals need to maintain and develop their independent living skills. People who use the service should have access to ‘easy to read’ versions of their social activity schedules and DS0000025864.V361295.R01.S.doc Version 5.2 Page 44 2. YA6 3. YA12 4. YA14 5. YA14 6. YA14 Unicorn House (16) independent living programmes. 7. YA17 All the people who use the service should have far greater opportunities to help staff plan the weekly menus and the home should review its current arrangements for consulting people about the menu planning process in order to look at ways of improving it. People who use the service should have access to far easier to read versions of the published menus. This will enable everyone who uses the service to make more of an ‘informed’ decision about what they eat each day at mealtimes. It is recommended that the new acting home manager contact a dietician for advice on nutrition when developing the new menus for the home. People who use the service should have access to “easy to read” versions of the homes complaints procedure. The home should replace all the worn out leather sofas in the main lounge and provide this communal space with some cushions to make it more a comfortable place for people who use the service and their guests to sit. 8. YA17 9. YA17 10. 11. YA22 YA24 Unicorn House (16) DS0000025864.V361295.R01.S.doc Version 5.2 Page 45 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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.V361295.R01.S.doc Version 5.2 Page 46 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!