Inspection on 14/05/08 for Victoria Court

This inspection was carried out on 14th May 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Victoria Court 15/05/07

Victoria Court 13/07/06

Victoria Court 23/02/06

Victoria Court 22/07/05

Victoria Court 29/03/05

Victoria Court 18/11/04

Victoria Court 02/03/04

Similar services:

Whiteley House

Tyndale Avenue

2-10 Norfolk Road

Bennfield House Nursing Home

Eastfield Residential Home

Sign Health

Springwood

Fairburn Mews

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Victoria Court 39-41 Victoria Road Bridlington East Yorkshire YO15 2AT Lead Inspector Jean Dobbin Key Unannounced Inspection 14th May 2008 09:30 Victoria Court DS0000019766.V361334.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 Victoria Court DS0000019766.V361334.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. Victoria Court DS0000019766.V361334.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Victoria Court Address 39-41 Victoria Road Bridlington East Yorkshire YO15 2AT 01262 676205 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 Arthur Lindley Ms Sheila May Wilson Care Home 19 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (19) of places Victoria Court DS0000019766.V361334.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th May 2007 Brief Description of the Service: Victoria Court is a large detached double fronted property, originally two separate homes, and located in a residential area of Bridlington. It is conveniently situated for all of the main community facilities including the public transport network. Victoria Court is registered for people who have a mental health problem and require personal care such as support and guidance. Accommodation is on three floors. The home is only suitable for people who can manage the stairs. There are ten single bedrooms and two double or shared rooms, two lounges on the ground floor, one of which is a smoker’s lounge, and a dining room. Limited parking is available at the rear of the building along with a small garden and patio area, and there is some outside seating at the front of the house. The home has a statement of purpose that explains the aims, objectives and philosophies of the home. The most recent inspection report is not available at the home. The current fees at the time of the visit on 14th May 2008 are £297 per week. An extra charge is made for chiropody and portable appliance testing, when a person has more than two personal items. Because of TV Licensing Regulations people with their own television in their room are charged £7.50 extra each year. Victoria Court DS0000019766.V361334.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This is what was used to write this report. • • • Information about the home kept by the Commission for Social Care Inspection. Information asked for, before the inspection. This is called an Annual Quality Assurance Assessment (AQAA) Information from surveys, which were sent to people who live at Victoria Court, their relatives, and other professional people who visit the home. 3 were sent to people at the home and all were returned. 2 were sent to people’s relatives but neither were returned. 3 were sent to health and social care professionals. One person said they didn’t know the home and so were unable to comment, although the manager had provided their name. The other two were not returned. Two professionals though were contacted by telephone, and they provided information about how the home runs. A visit to the home by one inspector, which lasted about 7.5 hours. This visit included talking to people who live there, and to staff and the manager about their work and training they had completed. It also included checking some of the records, policies and procedures that the home has to keep. • Information about what was found during the inspection was given to the registered manager and the Quality Assurance manager at the end of the visit. What the service does well: The staff have good listening skills and help and encourage people to make choices about the way they live their lives. This promotes independence and self-confidence. People are able to come and go as they please. One person said. “I often go out walking to the pier. The home is central and I’m living a life of luxury”. There is a well-established and loyal staff group who know the people living at Victoria Court very well. One relative commented in a survey completed for Victoria Court DS0000019766.V361334.R01.S.doc Version 5.2 Page 6 the home. ‘The staff are brilliant. They look after (my relative) like family – in fact better’. This helps to ensure people’s physical and mental health needs are well met. People living there like the special relationship, which they have with their keyworker, and feel able, to talk with that person about any issues they may have. One person said. “ I feel very safe but would tell (my carer) if I had any concerns.” More than three quarters of the staff have achieved a minimum Level 2 National Vocational Qualification in Care. This means that people are more likely to receive safe consistent care and staff are more likely to understand why they do what they do. Staff receive supervision, both formally and by working with the manager, so that their work can be discussed and monitored. This helps to make sure that they have a good understanding of their role and their work is appropriate. People say that the food is plentiful, hot when it is meant to be hot and they help to choose the menu on a week-by-week basis. This demonstrates that staff listen and act on what they say. What has improved since the last inspection? A senior person assesses people thinking of moving to the home to check that the staff have the skills and knowledge to support them properly and whether they will fit in with the other people there. The service user guide has been updated so that charges, extra to the weekly fees, are clearly stated. A record is kept of people’s individual accounts and people can request some of their money anytime. Several people spoken with confirmed this. All staff now undertake training as required by the manager, so that they all have updated knowledge to support people appropriately. There has been some redecoration and refurbishment of some of the rooms in the house to improve the environment for the people living there and a plan has now been drawn up to say which areas will be decorated in the coming year. A quality monitoring system has been introduced, whereby the views of the people living there, their relatives and other people with an interest in how the home operates are being sought. This is so that these people can start to influence how the home runs. All the people’s personal records, which provide information about their health, personal and social care needs, are put together in the same way so that staff can easily find the ‘section’ that they are looking for, making them more userfriendly. Victoria Court DS0000019766.V361334.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Victoria Court DS0000019766.V361334.R01.S.doc Version 5.2 Page 8 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. Victoria Court DS0000019766.V361334.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 Victoria Court DS0000019766.V361334.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): 2 and 5 People who use this service experience adequate quality outcomes in this area. Whilst people are assessed prior to moving to the home, information about the home could be improved so that people have as much information as possible to help them decide if the move is right for them. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: There have been no new admissions to the home in the last year. One prospective resident had visited the home for the day the previous week. The manager completed an assessment of their mental health, physical and social needs whilst they were visiting. She also had a copy of the assessment, which had been completed by a care manager, and this provided more information including the person’s mental health needs and how they were to be managed. People spoken with on the day and those who had completed a survey all said that they had been given enough information before they moved to the home, to know that the move was the right one for them. It would however be good practice to produce an information pack, which would contain a variety of information, like photographs and people’s comments and experiences about Victoria Court DS0000019766.V361334.R01.S.doc Version 5.2 Page 11 living there, so that people would get a better understanding of what it might be like to live there. The home has a service user guide and Statement of Purpose, which are kept in the entrance hallway. These have been reviewed earlier this year and now include a breakdown of costs, which are not included in the weekly fees. The service user guide has details about contacting the Commission for Social Care Inspection, however contact details for the commission changed earlier this year, so this information needs amending. Although people spoken with do not see it as an issue, they do not know whether they have an individual contract informing them of the terms and conditions about living there. Making sure that people received a contract was a requirement following the last inspection one year ago. Victoria Court DS0000019766.V361334.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People who use this service experience adequate quality outcomes in this area. Whilst people are supported and enabled to make choices, the written records do not provide enough information, so that people may not always receive the right support. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Three people’s care plans and other records were looked at during this site visit. All had a service user plan, in which there was evidence of some contributions by the individual with people’s signatures in some parts of the documents. People’s short and long term goals were written down, however there was no records of whether these had been reached or what the home was doing to help them to achieve these. The records were reviewed each month with their key-worker, and people spoken with all talked positively of the help and support they received from Victoria Court DS0000019766.V361334.R01.S.doc Version 5.2 Page 13 their ‘special carer’. One person commented. “She takes my cardigan home and hand washes it”. These monthly reviews though need to be a meaningful discussion with the individual. One person said they thought the review was “more or less a tick box exercise”, and another person had refused to sign their agreement for several months. The manager explained that this was because the individual did not agree with what was written in the care plan. There was however no record of how this disagreement could be worked through and resolved. There is no evidence of the use of local advocacy services that may be useful in supporting people in their decision-making, nor any information displayed in the home advising people that this service is available. Risk assessments had been completed according to people’s care needs and these also included how people’s independence and choice could be supported whilst out in the community. Risk assessments relating to managing challenging behaviours or self-harm need to be in much more detail though, to describe how these behaviours could be managed so that the difficult situation could be resolved. Care staff spoken with were very alert to the ‘triggers’, which can cause people to become upset and agitated, and equally knew how to deal with these events in a calm manner. The care plans however do not provide this information, so an unfamiliar care worker could unintentionally cause upset to someone living there and then not know how to remedy the situation. For example one person was assessed as ‘high risk’ of mental aggression, but the action to manage this was ‘to report it to the manager’, not a description of how the situation was to be diffused. These issues were discussed with the manager. Resident’s meetings, for which there are minutes, are held periodically but more informal meetings are held more frequently, where the meals are discussed and menus chosen. It would be good practice to record these meetings, and who attends, in order to demonstrate that everyone is regularly contributing to the day-to-day decisions in the home. People are also consulted about colour schemes when redecorating, about holidays, trips out from the home and special events, like Christmas. Written feedback is provided though the information about the response rates were not easy to understand. People spoken with were happy with the financial arrangements at the home. They all said that they could get money at any time, by asking whoever was in charge. People’s monies are recorded individually and signatures of both the staff member and the individual are evident for each transaction. Victoria Court DS0000019766.V361334.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 People who use this service experience adequate quality outcomes in this area. Whilst people are happy with the way they choose their daily routines, there needs to be a more flexible, person-centred approach so that people can be supported in maintaining or developing new pastimes and interests. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: People living at the home are able to come and go as they please. On the day of the visit two people had been shopping in Bridlington and three went out to lunch at the local church hall. One person said. “This is freedom. I can go where I want. I go into Bridlington for a walk. I don’t do anything else. I don’t want to do anything else”. There is a sitting area at the front of the house and on the day of the visit people were sat out there speaking with local people as they walked passed. This general banter helps people to feel part of the local community. Victoria Court DS0000019766.V361334.R01.S.doc Version 5.2 Page 15 People spoken with all said they enjoyed a new venture at the home, where links had been made with the local library service. This included fortnightly visits to the library, where people were supported in both choosing books and using the Internet. One person told of their recent visit to York to choose books for the home. Another said they now had pictures of their favourite personalities relating to their interest, which had been printed off for them. This link also helps people to feel valued and part of the community. One person spoken with and one survey both commented that they would like ‘more communal outings as they are always popular’. One commented that they “keep themselves entertained, as there is not much else to do.” The manager states that most people at Victoria Court do not want to undertake any training or voluntary work although the records looked at did not record any discussions about opportunities that may be available locally. One carer said. “People don’t want anything”. One person though has completed a gardening course and there is a first aid certificate that an individual has achieved, displayed in the hall. One person was born in a different European country and moved to England as a child. They can speak their mother tongue fluently, but have no opportunity to speak with anyone. They said that they would like to do that. There is no acknowledgement of their background or culture in their service plan or how differences, compared with a British background, could be acknowledged. Whilst records describe people’s interests, the home could explore ways of developing these interests further. For example one person is interested in the garden birds and enjoys maintaining a bird table. However there is no evidence of for example, posters in their room, walking to the coast to look at the seabirds, or obtaining binoculars to help them with their hobby. One person has a strong catholic faith, which is recorded in their service plan. Whilst they said that they visited the nearby church to pray most days there was nothing in their room to indicate that this was important to them. Another person though travels on the bus each week to the Quaker meetinghouse in the next town. Visitors are welcomed at any time. The home writes a newsletter periodically, with contributions by the people living there. This is sent to people’s relatives as well as being available at the home. Two surveys sent to relatives of people living there, as part of the inspection process were not returned. Following the last inspection a requirement was made that people should have a key to their own rooms. Although this has been explored, the age of the doors has meant that standard door furniture is unsuitable. So the senior manager is hoping to provide these locks on an individual basis to start with. This facility should however be made available as soon as possible, although bedroom doors can be locked from the inside. Victoria Court DS0000019766.V361334.R01.S.doc Version 5.2 Page 16 The daily menu is displayed on a blackboard in the dining room. On the day of the site visit the dining room was being decorated, which inevitably was causing some disruption to the dining experience. People spoken with confirmed that the meals were plentiful, hot and that they helped to choose what was on the menu. One person said that they helped with the washing up each day and the food shopping, but the AQAA said that people were not allowed to help with food preparation and serving. People should be able to assist with these domestic duties and make themselves a drink, as long as they have been assessed as not at risk of coming to harm from, for example scalding or cutting themselves. One person had been shopping and had missed coffee. They said that they couldn’t have a drink because they had come back too late, however the carer made them one. Staff at the home must make sure people feel able to ask for drinks at any reasonable time if they cannot make their own. Victoria Court DS0000019766.V361334.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use this service experience adequate quality outcomes in this area. Whilst people’s personal and healthcare needs are being met, the records underpinning this care are not written in enough detail, so people may not receive the appropriate support. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Staff were observed interacting in a respectful and caring manner with individuals living there. They encourage people to be independent and to take responsibilities for maintaining their own personal hygiene. People spoken with talked fondly about their key-worker and the support she provided. One said. “If I wanted to see the doctor then (carer) would go with me”. Carers spoken with had a good understanding of people’s needs, interests and personal history, which helped them to be responsive to their changing needs. People spoken with said that they would either arrange their own healthcare appointments or staff would do it for them. One person said that they liked a member of staff to attend with them and this would be arranged. There was a Victoria Court DS0000019766.V361334.R01.S.doc Version 5.2 Page 18 record in the service file of consultation with the local doctor, community psychiatric nurse, and chiropodist and information and advice from these visits are recorded in the daily record. With the passage of time however this information becomes less easy to locate and it would be good practice to record this information on one record sheet, which can be easily read. Whilst carers were treating people as individuals the personal care plans did not always evidence that this was happening. One person had to wear an aid, but there was no record of the specific support that would be needed. The individual said they had to wear it all the time, but the manager said this wasn’t the case. So whilst familiar staff knew exactly what help was required an unfamiliar carer would not know what to do. Another record highlighted that a person had been seen and supported by a dietician, because of their weight loss. Whilst this person has now been discharged from that professional’s care it was unclear, from the records, what staff at the home were doing to monitor whether they might need referring to the dietician again. One person at the home looks after their own tablets and systems have been put in place to support them with that. Another individual went out for lunch and had been given their lunchtime tablets to take with them to have with their meal. Their risk assessment though for managing their own tablets, assessed them as ‘high risk’ for forgetting or deliberately omitting to take their drugs. The manager provided an assurance that the assessment was relating to managing all their drugs on a regular basis. Risk assessments for medication must accurately reflect all aspects of people looking after their own drugs. The medication systems at the home were not formally looked at as a local pharmacist, about a month earlier, had completed a satisfactory audit. The home does not have any homely remedies, with the manager reporting that all symptoms are referred to the local doctor or NHS Direct for individual guidance. It may be helpful for the manager to speak with local doctors to check whether ‘over-the-counter’ remedies can be given for common complaints, like indigestion or a headache without seeking professional advice. Victoria Court DS0000019766.V361334.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use this service experience adequate quality outcomes in this area. People feel able to complain if they are unhappy about something and staff know about keeping people safe. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The home has a complaint’s policy, which is written in the service user guide. All the people spoken with at the site visit said they would feel able to complain if they were concerned about something. All said that initially they would tell their key-worker, before talking with the manager if necessary. The home has received one complaint in the last year, when one individual wrote a letter complaining about the behaviour of another person living there. Although the complaints policy states that there will be a written response to any complaint, this complaint was dealt with by speaking with the two people involved. If the decision is made not to follow the policy then the reasons for this need to be clearly written down. It would also be good practice to get the complainant’s signature, where possible to confirm that they are happy with the outcome. People spoken with all said they felt very safe living at Victoria Court. The manager, staff and residents work closely together in the home, so can monitor each other’s practice. There is a copy of the multi agency safeguarding adult’s policy in the home and carers spoken with were clear Victoria Court DS0000019766.V361334.R01.S.doc Version 5.2 Page 20 about the importance of keeping people at the home safe. They also said they knew they must report bad practice, even if this meant reporting a colleague. The home’s policy on ‘Abuse’ however is quite brief, and does not clearly identify different types of abuse. It also needs updating to include information about the role of the police, local authority and other agencies in the process and about the local point of contact if a safeguarding referral is needed. The annual quality assurance assessment (AQAA) states that the home does not have a separate Whistle blowing policy that staff can refer to. Some staff had attended recent Protection of Vulnerable Adults training and more training is planned. Most of the staff have achieved a National Vocational Qualification in Care, and Safeguarding Adults is one of the topics studied. The manager like her staff has some theoretical knowledge of her responsibilities should an allegation of abuse be made. Following discussion the manager should remind herself of the procedure and make sure she has the appropriate information and contact details readily available to help her in the event of a future allegation. She should also satisfy herself that her staff are very clear about what constitutes abuse and people’s responsibilities should an incident happen. Victoria Court DS0000019766.V361334.R01.S.doc Version 5.2 Page 21 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 and 30 People who use this service experience adequate quality outcomes in this area. Victoria Court is clean and homely and more updating and decoration is planned, however the toilet hygiene facilities need addressing in order to maintain people’s dignity and health. We have made this judgement using a range of evidence including a visit to this service. . EVIDENCE: A tour of the communal areas and three bedrooms showed the home to be homely and clean and comfortable with no unpleasant smells. One relative said in one of the home’s surveys. ‘The home is clean, and on the whole comfortable looking’. There is outside seating areas at the front and back of the house and a small garden area at the back, where vegetables are being grown. The dining room was being redecorated on the day of the site visit and people living there had chosen the new colour scheme. Other refurbishment over the Victoria Court DS0000019766.V361334.R01.S.doc Version 5.2 Page 22 past year includes new furniture and redecoration of two bedrooms, and new carpets in the lounge, bathroom, and first floor landing and a third bedroom. Two beds have also been replaced. Although this work has been completed many of the remaining furnishings look tired and worn. The management have an annual plan for redecoration and maintenance and a domestic works five mornings each week. There is a lounge with television and a dedicated smoke room. There was no smell of cigarettes elsewhere in the house. The home complies with requirements from the fire safety officer. A visit earlier this year found the home to be satisfactory. The environmental health officer last summer made two requirements, which were addressed promptly. People’s rooms are on three floors and those looked at were presented in a very individual way, with items that were important for them. One person said they liked to keep their own room tidy and dusted, but then usually had to ask for help as it became too hard for them to do. They said they didn’t do any other domestic tasks around the home. Some private rooms had a television and one person was keen to show their books and videos. All private rooms have a wash hand basin, and there are toilets on all three floors, with bathrooms on the first and second floor. Although some toilet rooms have soap dispensers others without one did not have any soap and some did not have any toilet paper. This situation affects people’s rights to be treated with dignity, puts them at risk of getting an infection and needs remedying. The manager explained that toilet rolls, soap and sink plugs are sometimes ‘removed’ from the toilet rooms and on other occasions the whole roll is put down the toilet. If this situation cannot be resolved by speaking with people in the home then the management needs to get guidance about purchasing toilet roll storage systems which cannot be tampered with and ensuring that all sinks have soap dispensers. The kitchen and laundry areas are domestic in design. Following a plumbing incident the laundry room floor has been damaged and needs repainting to render it impermeable and easily cleaned. There are appropriate aids available in the home for carers to use, to make sure that the way they work protects people living there from infection. Victoria Court DS0000019766.V361334.R01.S.doc Version 5.2 Page 23 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, 33, 34 and 35 People who use this service experience adequate quality outcomes in this area. Whilst carers are generally well trained there are not enough of them to be able to meet people’s social needs. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: On the day of the site visit there were two carers working though the manager came into work, because of the inspection and the quality assurance manager was also present. There is a domestic who works five mornings a week, but she was on leave. The senior manager said that care staff undertake cleaning duties when the domestic isn’t working. As there are no dedicated catering staff this would have meant the care staff undertaking all three roles. The rota confirms that two staff work the early shift, one works through the night and one works the late shift, with a second person working from 4 until 8. The manager’s hours are included in those numbers. The senior manager says that agency staff are never used. The rota though also highlighted that over a four week period one part time carer worked six sixteen hour shifts, Victoria Court DS0000019766.V361334.R01.S.doc Version 5.2 Page 24 where she worked a late immediately followed by a night shift. This was discussed with the manager. Whist the night worker primarily carries out domestic work, the manager needs to be satisfied that people’s health and safety are not being put at risk, by being in the care of someone who is likely to be very tired by the end of the night. Most people living at Victoria House require little help with ‘hands on’ care. The care staff provide primarily emotional care, and have listening and enabling skills to support people in making decisions about their day-to-day lives. One relative said in a survey for the home. ‘The staff are brilliant. They look after (my relative) like family – in fact better’. Whilst people said that staff were available when they needed someone and staff spoken with felt that the staffing levels were satisfactory the numbers do not allow for carers to provide much social stimulation within the home, nor to support individuals away from the home in developing and maintaining leisure activities. One person said they really liked dominoes, but they hadn’t played for a long time. There have been no staff changes at the home for more than two years, so they know the people there very well. More than half the staff have achieved a National Vocational Qualification in Care at least to Level 2 so that people are more likely to be supported in a safe and consistent way. Carer’s individual training needs are kept in their portfolios, so it is not easy to work out who needs refresher training, and when. Most of the staff have a current food hygiene certificate, and several have attended a first aid course. Senior staff, who give medicines to people, have attended training to enable them to do this in a safe manner. The manager says that more safeguarding adults training is planned. All staff need fire safety update training and the quality assurance manager has bought some training aids so that this can be provided in the weeks following the site visit. There needs to be a clear record of when staff require updating training each year so that this can be planned for in a methodical way. People sign to say they have read specific health and safety policies each month but the manager needs to satisfy herself that staff understand how the individual policies affect their working practise. Staff receive supervision several times a year, where their work and professional development can be discussed and records confirmed this. At the last site visit it was noted that one carer was not attending any mandatory training. This has now been addressed. The recruitment process for the most recently employed staff file was looked at. This person was recruited more than two years ago and the recruitment process to make sure this person was suitable to work in a care setting had not been followed properly. References and a police check were not obtained Victoria Court DS0000019766.V361334.R01.S.doc Version 5.2 Page 25 before the person started work there. A robust recruitment policy must be followed so that people living at Victoria Court are protected from someone being employed there, who may have been barred from this type of work because of a previous offence. A discussion however with the two managers showed that they were now aware of what checks need to be carried out before someone is deployed, to satisfy themselves that the individual is suitable to work in a care setting. Victoria Court DS0000019766.V361334.R01.S.doc Version 5.2 Page 26 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 People who use this service experience adequate quality outcomes in this area. There is a culture of respect and openness at the home, but more staff would enable people to become more involved, both in the running of the home, and in the local community. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The manager is very experienced and demonstrated that she had a good rapport with people and had good knowledge and understanding of the people living there. She has completed further training to help her with her role. She works closely with other members of staff so is able to supervise practise informally. People spoken with said that she was very approachable and they would be happy to talk with her if their key-worker was unavailable. Victoria Court DS0000019766.V361334.R01.S.doc Version 5.2 Page 27 The manager said that she has no rostered supernumerary time, but was generally able to find time to carry out management duties each week. This impacts on the available time for social interaction and activities organised by staff. She does not have access to a computer, or the Internet to support her in keeping up to date or identifying new care practices. The management have now introduced some systems for monitoring how the service runs and surveys are used to obtain people’s views about how the home operates and what changes they would like to see. The results of the last survey are displayed for people to look at, and some information is provided about how some of the suggestions will be implemented. These results though are given as percentages of the numbers of completed surveys so the figures are not easy to understand. The manager should make sure that the results are in a format that is easily understood. The manager also asks for feedback from health and social care professionals and those relatives who have contact with the home are also surveyed and responded to individually. The manager also ‘spot checks’ people’s service files and uses external auditors to check medication systems. This whole monitoring process needs developing more now, so that responses on different dates can be compared to make sure the home is changing according to what the people living there want. Resident’s meetings are held though minutes are only available for two in the last seven months. People spoken with said that informal meetings are held weekly, but the manager should make brief notes of these, and who attends, to show that all the people are able to influence how the home runs. Health and safety systems are in place to ensure the safety of the people living there and all staff now attend training, if requested by the manager. Staff are required to update their knowledge by reading about health and safety policies, but it would be good practice for the manager to have some way of checking their knowledge and understanding. Fire safety training was planned for soon after the site visit and the manager was able to confirm that all staff had attended this training. The accident records kept by the home were completed appropriately and the commission had been informed when one person had an accident, which required hospital attention. Safety certificates and annual checks like the gas; electrical systems and portable appliance testing had been completed appropriately in order to demonstrate that people’s health and safety was being protected. The registration certificate, which must be displayed in the hall, had the contact details for the registered provider crossed out. Any interested parties, including the people living there, must be able to write to the provider if they Victoria Court DS0000019766.V361334.R01.S.doc Version 5.2 Page 28 choose and following the inspection a letter was sent to the provider advising him of this. Victoria Court DS0000019766.V361334.R01.S.doc Version 5.2 Page 29 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 3 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 2 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 2 34 N/A 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 1 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 2 X 3 X X 3 X Version 5.2 Page 30 Victoria Court DS0000019766.V361334.R01.S.doc Are there any outstanding requirements from the last inspection? Yes 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 YA9 Regulation 12, 13, 14 Requirement Risk assessments do not always contain sufficient information to give clear direction to staff and therefore people’s needs may not be met in full and potentially risk may not be managed in a way that would ensure the safety of people living there. Previous timescale 15/08/07 not met People should have access to the kitchen to assist with food preparation and making drinks, if that is their choice, unless there is an assessment and documentation in place to state that they are at risk of coming to harm. All staff must be reminded to report any concerns or allegations to the right person without delay. This will help to make sure that the risk from further bad practice or abuse happening is minimised. People must have ready access to toilet paper and handwashing facilities in the toilet DS0000019766.V361334.R01.S.doc Timescale for action 14/07/08 2. YA9YA17 16 14/05/08 3. YA23 13 14/06/08 4. YA24 YA30 12, 16 14/05/08 Victoria Court Version 5.2 Page 31 5. YA30 16 6. YA33 18 7. YA34 19 rooms at all times, so that their dignity is always respected and they are protected from possible harm. The laundry-room needs to 14/07/08 have a floor that can be easily cleaned to reduce the risk of the spread of infection. There should be sufficient 14/07/08 numbers of staff on duty at all times to allow for people’s social needs to be met. There must be a thorough 14/05/08 recruitment process in place at the home. This includes: A fully completed application form with gaps in employment explored. A satisfactory CRB check. Two written references including one from the previous employer. This will contribute to people’s safety. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA5 Good Practice Recommendations A discussion could be held with each individual to inform them of their rights whilst living at the home. An updated contract could be given to each person. Staff at the home could discuss with individuals about how individual interests can be maintained and developed so that people receive person-centred support. There should be a planned schedule whereby people will be able to get a key to their private room. People should be made aware of the planned timescales so they can look forward to getting a key. DS0000019766.V361334.R01.S.doc Version 5.2 Page 32 YA13 YA16 Victoria Court 4. YA6 YA18 5. YA20 6. YA23 7. YA33 Records relating to supporting people in promoting their independence and managing their own healthcare should reflect people’s very specific needs so that support is very individualised. The manager should consider getting advice from the local doctor as to whether staff at the home can give ‘over the counter medicines’ for common ailments, so that people’ can receive speedier treatments from staff. To make sure that the right procedures are followed, the policies about safeguarding and whistleblowing should be expanded so that anyone referring to them would know who to report to, and when, should an incident occur. This will help to make sure that there is no delay in taking the right action to protect people. The manager should consider reviewing whether people’s health and safety is being put at risk by allowing staff to work two consecutive shifts, amounting to sixteen hours. Victoria Court DS0000019766.V361334.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Victoria Court DS0000019766.V361334.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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