Inspection on 15/05/07 for Victoria Court

This inspection was carried out on 15th May 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Victoria Court 14/05/08

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 09/07/2008.

CARE HOME ADULTS 18-65 Victoria Court 39-41 Victoria Road Bridlington East Yorkshire YO15 2AT Lead Inspector Angela Sizer Unannounced Inspection 15th May 2007 10:00 Victoria Court DS0000019766.V340206.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.V340206.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.V340206.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.V340206.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th July 2006 Brief Description of the Service: Victoria Court was first registered with the local authority in 1988 and has been subsequently operated as a family concern. Victoria Court is a large detached double fronted property located in a residential area of Bridlington and is conveniently situated for all of the main community facilities including the public transport network. It is registered for nineteen adults who have a mental health problem and require primarily personal care such as support and guidance. Nursing care is not provided. Should such care be required then it will be provided by the community health care services. The service users (residents) accommodation is located on three floors. The care home does not have a passenger lift and is therefore only considered suitable for service users who are reasonably ambulant. Initially it had five single and seven double bedrooms, but currently the home is operating with eight single bedrooms and three double or shared rooms. The double rooms are only shared with the expressed agreement of the occupants. There are two lounges on the ground floor, one of which is a designated smokers lounge. There is a large secluded garden that provides the service users with reasonable privacy. The stated aim of the care home is, To provide a homely environment where the residents can feel comfortable and secure whilst receiving the support and guidance they need to achieve their goals. The accommodation fee is £305 a week. This, however, is negotiable prior to a service user’s admission into the home and is based on their assessed needs. Victoria Court DS0000019766.V340206.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced key inspection and took place one day and took a total of 8.5 hours. Prior to the visit surveys were posted out to; 19 residents and 11 were returned, none of relative surveys were returned, of the 8 staff surveys sent 6 were returned and none of the health and social care professionals surveys were returned, but a conversation took place with a health and social care professional about the care and support offered within the home. The pre-inspection questionnaire was looked at during the visit to the home. Several of the residents were spoken to throughout the day regarding the care they receive and what it is like to live in the home, some of their comments have been included in this report. Three residents’ care records were tracked during the site visit and 4 staff personnel files were looked at. Two of the staff were spoken to find out what it was like working in the home and what training, management and support was offered to them. A tour of the premises was undertaken and a number of records were looked at to assess whether maintenance is adequate. The previous requirements were discussed with the manager and it was identified that all of them remain unmet. She also explained that the registered provider is currently changing the use of one lounge into a single bedroom and is planning to reduce the number of beds from 19 to 14, currently the home has 8 single and 3 double rooms, but this has not been changed formally and an application will need to be made to the Registration Team at Sheffield. A discussion occurred regarding how the residents are supported to follow their religion of choice and practise their faith and how the home meets diverse needs of individuals. The manager was given feedback at the end of the first visit. The inspector would like to thank the residents, manager and staff for contributing to the content of this report. What the service does well: Victoria Court DS0000019766.V340206.R01.S.doc Version 5.2 Page 6 The home continues to offer support in a caring and informal way as stated in the last report. Victoria Court presents as being a friendly and informal environment in which the residents are free to ‘do their own thing’ and live a reasonably independent lifestyle. The staff have a close but professional relationship with the residents and see their primary role as providing social and emotional support for the residents. The home is more like a ‘hostel’ or ‘supported living unit’ rather than a ‘traditional’ care home. The staff endeavour to actively promote the residents’ independence and the majority of the service users go out unsupervised. The staff also encourage the residents to make decisions and choices for themselves. Several links have been developed within the local community and residents’ spoke about going to various groups and learning centres. Some comments included; “the staff help me when I need them to, they come with me to the doctors or to the shops when I am not feeling very confident”, “staff have come with me to the church or groups”. Staff displayed a good knowledge about the basic care needs of the residents and it was clear that they had developed positive relationships. Some comments included; “I am pleased with this home and the staff look after me very well”. Reviews are held on a regular basis and documentation was in place to confirm this. Key workers are involved in this process and care plans are looked at and updated on a monthly basis. Residents spoken to also confirmed that they have monthly meetings to discuss issues within the home. Some comments included; “we talk about the food and anything else that is bothering us”. The home meets the physical and healthcare needs of the residents and medication is given in a safe way. The home has a complaints procedure and people who use the service are enabled to express their concerns. What has improved since the last inspection? Unfortunately none of the requirements and recommendations made during the previous inspection have been fully met. One requirement was partially met in that the broken floodlight to the front of the building has been removed. Although some areas have been subject to re-decoration, the home continues not to have a formal maintenance plan in place. Victoria Court DS0000019766.V340206.R01.S.doc Version 5.2 Page 7 What they could do better: Sometimes people come and live in the home without having a full assessment of need in place prior to moving in and therefore the home could be admitting people whose needs they cannot meet. People are not fully informed about the service and facilities offered as part of the fee charged. No evidence was seen confirming that the staff team have undertaken training or gained a good understanding about assisting a person who has Epilepsy or other complex needs. If training were undertaken in more specific areas people who use the service would receive support from a well-trained and skilled staff group who fully understood all needs. People who use the service have an individual care plan and risk assessment for each resident. These do not always contain sufficient information to give clear direction to staff and therefore residents’ needs may not be met in full. Potentially risk may not be managed in a way that would ensure the residents are safe. The files would also benefit from being re-organised as it was difficult to locate information. Although the home offers a good basic diet and the registered manager has obtained some further information about meeting specific dietary needs of a resident, it does not provide soya milk for the resident and they are expected to pay for this themselves. The home does have a procedure that covers the personal finances of the residents. The written records were looked at, but it was difficult to locate a full audit trail of money spent and savings that residents currently have. The environment is not always well maintained and some areas are in poor condition, this means that the safety of the environment is compromised. Some staff have not undertaken essential training, this means that residents may be put at risk and receive support from unqualified and unskilled staff members. A knowledgeable and qualified manager supports people who live in the home. The lack of a formal quality assurance monitoring system limits the manager’s ability to identify strengths and weaknesses in the service. The health and safety of people who use the service is not always maintained as the safety of the environment is compromised. Victoria Court DS0000019766.V340206.R01.S.doc Version 5.2 Page 8 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. Victoria Court DS0000019766.V340206.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.V340206.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): 2,3,4 & 5 People who use the service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People who use the service do not always have a full assessment of need in place prior to moving into the home and therefore the home could be admitting people whose needs they cannot meet. People are not fully informed about the service and facilities offered as part of the fee charged. EVIDENCE: Three residents files were looked at during the inspection visit, this was to make sure that the home finds out what residents’ needs are and to ensure that the home can meet their needs. The registered manager stated that the home usually receives an assessment of need from the placing Authority, but sometimes the placing authority does not forward these and then she would undertake her own assessment. Two of the three files did not contain a full community care assessment, even though a Social Services Department funded them. During the visit two staff members were spoken to and four staff files were looked at and although some of the staff group have undertaken basic training Victoria Court DS0000019766.V340206.R01.S.doc Version 5.2 Page 11 in relation to mental health issues and challenging behaviour, it was apparent that others have limited knowledge in this area. No evidence was seen confirming that the staff team have undertaken training or gained a good understanding about assisting a person with diverse needs. Because of the lack of evidence around assessment and care planning for diverse needs such as Epilepsy or more complex mental health and learning disabilities, the home was subsequently contacted on 15/05/07 and where asked to provide evidence that these needs were been addressed and a copy of an updated care plan and assessment was requested, at the point of the report going out in draft format this information had not been received. If training were undertaken in more specific areas people who use the service would receive support from a welltrained and skilled staff group who fully understood all needs. From speaking to several residents it was clear that they had had the opportunity to visit the home, spend time with other residents, enjoy a meal etc before making a decision to move to Victoria Court. Some comments included, “I came to have a look around and decide if I liked it”, “I am pleased with the home, the staff look after me very well”. Seven service users confirmed in the survey document that they had received sufficient information prior to being admitted into Victoria Court on which they could make a considered decision as to whether it was the right place for them. The manager stated that all residents receive a contract that details what a person living in the home can expect to receive in relation to care and services. Three of the residents’ files were looked at and none of them contained a contract or statement of terms and conditions. Also when several of the residents were spoken to none could remember receiving a contract or signing a copy. One person said, “I might have received one, but I don’t think I did”. Victoria Court DS0000019766.V340206.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 & 9 People who use the service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People who use the service have an individual care plan and risk assessment. These do not always contain sufficient information to give clear direction to staff and therefore residents’ needs may not be met in full. Potentially risk management may be impaired. EVIDENCE: Three residents’ files were looked at confirming that they had a care plan in place, these were basic in content and clearly identified the service users’ primary needs and the actions to be taken by the staff to meet those needs. Some contained detail about specific conditions or illnesses, but more detail about how and when staff should assist would be beneficial and would give a Victoria Court DS0000019766.V340206.R01.S.doc Version 5.2 Page 13 clearer picture about what is required. The home’s own care plans were in addition to any care plans provided by a placing authority. The care planning files which contained the daily notes, care plan and risk assessment were kept in the dining room. Most of the residents spoken to could confirm who their key worker was and that they had been consulted about what was recorded in their care plan. The manager explained that the care plans had been changed recently, but unfortunately there were different variations and it wasn’t clear about which one was the most current or up to date. At the site visit the inspector found it difficult to locate to locate information in files because of the level of organisation. Two staff members were spoken to about the care offered and the residents’ needs. Both staff members could describe what the needs of individual residents were and were clear about what support they required. They stated that this wasn’t always detailed in the care plans and it may be a problem for new staff who do not have sufficient knowledge about needs of individuals. Comments from staff included; “the care plans tell me what the person needs help with”, “I sit and talk to the residents who I am key worker for and we discuss what support they need”. Since the last inspection visit training has been offered to some staff members in relation to meeting needs arising from challenging behaviour, and mental health awareness. From observation and from speaking to the majority of residents it was apparent that overall the residents are enabled to make their own decisions about everyday life within the home. Everyone who lives in the home are free to come and go and the majority lead a fairly independent lifestyle. One resident said, “I go out whenever I want to, I have a bus pass and often take a trip to Scarborough”, “I go to the shops everyday”. Several residents manage their own finances and one person confirmed, “I look after my own finances”. Other residents who are less able and have communication problems do require more support from staff, this has been highlighted in previous inspection reports and a recommendation made that the staffing levels during the day be kept under review to ensure all residents’ needs are being addressed. Staff were observed interacting with residents in a caring and sensitive way throughout the visit. Reviews are held on a regular basis and documentation was in place to confirm this. Key workers are involved in this process and care plans are looked at and updated on a monthly basis. Residents spoken to also confirmed that they have monthly meetings to discuss issues within the home. Some comments included; “we talk about the food and anything else that is bothering us”. There was written evidence confirming that residents meetings take place on a regular basis and that this is an arena where the residents can express their wishes, views and opinions. One resident who during the last inspection visit had stated that he was not happy with the menu offered as he wished to receive a vegan diet. During this inspection visit the resident confirmed that a Victoria Court DS0000019766.V340206.R01.S.doc Version 5.2 Page 14 review had been organised and his social worker also attended resulting in an agreement about the menu being offered. The resident confirmed that he was currently satisfied with the food offered. Victoria Court DS0000019766.V340206.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16 & 17 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Overall people who use the service are enabled to live a lifestyle that promotes independence and choice. EVIDENCE: During the inspection several of the residents were spoken to about the range of activities and outings, it was confirmed that activities are offered on a regular basis. Some comments included; “the staff ask if we want to play board games or bingo, sometimes I do join in”, “I don’t like joining in activities I prefer to go out or stay in my room”. A discussion was held with the manager and she stated, “activities are offered on a daily basis, but the staff often arrange something and the residents choose not to join in”. Victoria Court DS0000019766.V340206.R01.S.doc Version 5.2 Page 16 It was also observed that some of the more able residents go out independently and during the visit several were observed to come and go as they pleased. One resident commented, “I go out everyday usually to the shops, as I like shopping”. Residents are supported to live an independent lifestyle and this was evident from speaking to individuals. Another resident stated that he attends a local community group called the Green Project, “I have a part-time job with work link and currently I am helping to maintain the grounds of a Church”. The home promotes and enables the residents to partake in events occurring in the community. During the visit staff were observed interacting with residents and this was carried out in a sensitive and caring manner. All staff spoke to the residents showing respect and called them by the name they prefer. Staff spoken to could describe clearly the principles of good care and how they should treat the residents, “help the residents as best as you can, to try and talk to the residents and encourage them to go out”. Visitors are welcomed into the home and this was confirmed by speaking to a social and healthcare professional who visits the home on a regular basis; “the staff always make me feel welcome, they are polite and courteous”. The residents also confirmed that they are enabled to have visitors when they choose to. There was evidence to suggest that day trips or outings are also offered to the residents, some comments included; “Last year we went to Scarborough and Sewerby and some other places, I really enjoy the trips out”. The manager confirmed that several outings are planned for this year and these will be discussed at the residents’ meetings and finalised as to where. Residents do not currently have a key to their own room, but they are lockable from the inside without the use of a key. There was no written evidence in place identifying if there was a particular risk why a resident could not hold his or her own key and it was ascertained during the visit that several of the residents wish to have their own key to maintain their privacy. All of the residents who were spoken to stated that the food offered was satisfactory and plentiful. The home does not employ a cook and the manager usually undertakes the preparation of meals within the home. All staff who prepare food have undertaken basic food and hygiene training. One resident stated, “the food is ok”, “staff tell us in the morning what we are having, but I usually like it”. The menu is not currently displayed, but there was evidence that the meals were regularly discussed at the service users’ meetings and it was clear that personal choice or preference was taken into account. During the previous inspection one resident had expressed dissatisfaction with the meals and had wanted to be on a vegan diet and not a vegetarian diet. A review of this resident’s dietary needs was held and from speaking to both the resident concerned and his social worker it was confirmed that the home has sought information and advice in relation to offering a vegan diet. The resident stated, “my diet has been an issue since before I arrived at this care Victoria Court DS0000019766.V340206.R01.S.doc Version 5.2 Page 17 home, I am receiving a vegan diet more or less now, but I am expected to buy my own Soya milk and it’s over £1 per pack”. Victoria Court DS0000019766.V340206.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 People who use the service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The medication procedure is followed and people who use the service receive their medication in a safe way. Not all residents are given the opportunity to administer their own medication. Personal care and healthcare support is offered to all residents. EVIDENCE: During the inspection visit several of the residents were spoken to with regard to their personal and healthcare support, all of them stating that they felt their needs were fully met. Some comments included; “I am pleased with this home, the staff look after me very well”, “I don’t know what I would do without the staff here, they have been very good to me”. The inspector was not shown written evidence to confirm that appointments were kept up to date. Subsequently the CSCI was informed that this information was partly recorded in a diary. From speaking to two staff members it was also clear that they had a good understanding of what individual needs were and who Victoria Court DS0000019766.V340206.R01.S.doc Version 5.2 Page 19 required support to attend GP’s etc. Also staff talked about “listening and talking to residents’ and helping them to be as independent as possible.” Staff were also observed interacting with several of the residents and this was undertaken in a caring and empathic way. Residents bedrooms were personalised with belongings and pictures. The home encourages residents to maintain their independence by integrating into the local community as much as possible. One person said, “I go out most days, I like to go for a walk and get some fresh air”. Others confirmed that they could get up and go to bed when they chose to. The home has a medication policy and procedure that is adhered to by staff. The medication records were looked at and were found to be in very good order. All of the staff who administer medication receive training in relation to the safe handling of drugs and this was evidenced by speaking to the staff and also from written documentation. One staff member said, “I first of all did some in-house training regarding medication and then I went on the course offered by York University”. The medication is stored in a locked portable box within a locked cupboard; the manager explained that none of the residents are currently in receipt of any controlled drugs. She went onto to say that if any controlled drugs were prescribed then she would obtain a controlled drugs cabinet and have this fixed to a wall inside the cupboard and also purchase a controlled drugs register. The home does not have a specific homely remedies policy, but again the manager stated, “we don’t issue any homely remedies at the moment”. The manager was advised to discuss and agree this with the community pharmacist to seek further advice and direction. One resident was partially self-administering medication, but there was no written documentation to confirm that risk had been assessed. The resident was ordering the medication, but due to concerns raised by the management it had been decided that the resident should retain the medication in a locked drawer in their bedroom, but would have to take medication in line of sight of staff to ensure none was missed. However there was no written record to enable staff to record that the medication had been taken. The home does not routinely assess whether the residents can self-medicate. Victoria Court DS0000019766.V340206.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People who use the service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home has a complaints procedure that enables residents to express their concerns/complaints. People who use the service are not always safeguarded as a minority of staff have not undertaken safeguarding adults training. There is no a clear audit trail for residents monies. EVIDENCE: The home has a complaints procedure; there have been no complaints since the last inspection visit. From speaking to several of the residents during the visit it was clear that if they had a problem or complaint that they would speak to the manager. Some comments included; “I would speak to the manager and I have done in the past”, “any complaints have been sorted out by the staff or manager”. There is a multi-agency safeguarding adults policy and procedure and from speaking to two staff members they could describe what the different types of abuse are, but they were unclear about the actual procedure and stated they would talk to the manager. There was written evidence confirming that most of the staff group had undertaken the safeguarding vulnerable adults training. Victoria Court DS0000019766.V340206.R01.S.doc Version 5.2 Page 21 The home does have a procedure that covers the personal finances of the residents. The written records were looked at, but it was difficult to locate a full audit trail of money spent and savings that residents currently have. The registered manager explained that she doesn’t have anything to do with the financial procedures and it is registered provider who undertakes this task when she visits the home each week. People who live in the home do not have access to their own monies, unless the Quality Assurance Manager is present. Victoria Court DS0000019766.V340206.R01.S.doc Version 5.2 Page 22 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): 24,25,27 & 30 People who use the service experience poor outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The environment is not always well maintained and some areas are in poor condition, this means that the safety of the environment is compromised. EVIDENCE: A tour of the premises was undertaken and overall the general environment is poor. Some areas require improvement and some carpets will require replacement in the near future. There were some individual bedrooms that were homely and personalised and from speaking to several residents it was clear that they were happy living at the home. The manager gave an update regarding the progress made since the last inspection, the registered provider has purchased a garden patio set and the front of the building has been repointed. The spotlights to the front of the building have been removed. The quiet lounge has had a new carpet fitted and it has also been re-decorated. Victoria Court DS0000019766.V340206.R01.S.doc Version 5.2 Page 23 The smoking lounge and several of the residents’ bedrooms were in poor condition, requiring redecoration and some of the chairs were worn and stained. Also some furniture in the bedrooms was old and broken and requires disposingal. In bedroom 11 the carpet was badly worn in places and posed a trip hazard. One of the bathrooms on the first floor required redecoration and the carpet was stained. A toilet on the first floor was poorly decorated and although there was a wash hand basin, there was no soap or drying facilities in there. In bedroom 6 the headboard was dirty and stained. The main hallway carpet is worn badly on the step that enters into the dining room and this poses a trip hazard. Several residents were spoken to in their bedrooms and their views gained about the environment; “I like living here and I like my room”, “I have got everything I need, but I would like a telly”. During a conversation with the manager it was stated that portable appliance testing is undertaken and the registered provider pays for two items in the residents’ bedrooms, but over two items the residents’ are charged £2.50 per item. The statement of purpose and statement of terms and conditions must detail that this is an additional charge. Not all of the staff have undertaken training in relation to infection control. The home employs a domestic for five mornings per week. Victoria Court DS0000019766.V340206.R01.S.doc Version 5.2 Page 24 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): 32,33,34,35 & 36 People who use the service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Some staff who have not undertaken essential training, this means that residents may be put at risk and receive support from unqualified and unskilled staff members. EVIDENCE: The manager informed the Inspector that the home employs 8 care staff, 2 of which have gained NVQ 2 or above, another staff member has attained their assessor’s award and a further 4 are working towards achieving NVQ 2. From speaking to the manager and looking at records it was highlighted that two staff members who undertake care duties are ‘refusing’ to undertake any training and as this is an essential part of the role. The management has failed to address this appropriately. Four staff files were inspected confirming that two out of the four had undertaken induction and foundation training that meets the Skills for Care specification. Two staff members were spoken to confirming that they had a good awareness of the basic care needs of the Victoria Court DS0000019766.V340206.R01.S.doc Version 5.2 Page 25 residents. Staff stated that training is offered; “I have done some training for dealing with challenging behaviour and vulnerable adults”. During the inspection visit the manager confirmed that the staffing levels had not been reviewed as recommended in the previous inspection report. She remains of the opinion that the current staffing levels are sufficient in meeting all of the needs of residents. Several residents and two staff members also felt that the staffing levels were satisfactory. One staff member said, “there are usually two of us on during the day, but most of the residents go out alone and are fairly independent”. The manager covers care duties on a daily basis and also undertakes the preparation of the main meal of the day, as the home does not employ specific catering staff, therefore one carer would be supporting the residents at busy periods. Management should review the daytime staffing levels on a regular basis to ensure that the needs of all residents in particular social activities. Verbal feedback was gained from a health and social care professional stating that the staff are “always polite and friendly”, “the home provides emotional support that is very enabling and the staff are sensitive with the residents”. There was evidence confirming that the recruitment procedure is adhered to and that criminal records checks and references are sought prior to staff commencing employment. The home has a training plan and keeps records on individual staff files. The training offered to staff meets the Skills for Care specification and evidence was seen confirming this, but unfortunately not all staff have undertaken the training and the manager stated that two staff members, a night carer and a domestic who also undertakes care duties have stated they will not do the training, therefore residents are receiving support from untrained staff. There was written documentation confirming that supervision is offered to staff, but again the staff members who refuse to undertake training have also refused to attend for supervision. Staff who do not receive support and supervision on a regular basis are putting residents at risk by not being appropriately trained and monitored. The manager said, “it is very difficult when staff members work nights and will not come in during the day for supervision or training”. This is an issue that management must address. Victoria Court DS0000019766.V340206.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): 37,38,39,41 & 42 People who use the service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. A knowledgeable and qualified manager supports people who live in the home. However some issues in relation to training and supervision have not been addressed. The current lack of a formal quality assurance monitoring system limits the manager’s ability to identify strengths and weaknesses in the service. The health, safety and welfare of people who use the service is not always promoted, as essential training and supervision of staff does not always occur and the environment is not always maintained to a safe standard. EVIDENCE: Victoria Court DS0000019766.V340206.R01.S.doc Version 5.2 Page 27 The registered manager had successfully completed the Registered Manager’s Award and a National Vocational Qualification at level 4 in care. The manager had considerable experience in working with the service users and demonstrated a sound understanding of the needs and of the elements of care, such as independence and choice that go to provide them with a good quality of life. Since the last inspection the manager has undertaken refresher training in first aid and food hygiene. She did not have access to a computer and was therefore unable to access the Commission for Social Care Inspection’s (C.S.C.I.) website or use the POVA first procedure and has limited responsibility in relation to making budgetary decisions, the Registered Provider takes care of all financial aspects of the home including residents’ personal allowances. The manager has developed positive relationships with the residents in the home and it was apparent from observing her interacting with several of the residents during the visit. The manager spoke to residents with respect and was polite and courteous. She stated; “residents must be treated with dignity and respect and enabled to make choices about their lives”, also stating that, “staff are here to enable residents and ensure that they are safe”. The manager also displayed a good awareness of equality and diversity issues and confirmed that training is currently being looked into for staff. The manager said, “each person is different and we recognise their individuality and support this as much as possible”, “one resident follows the Quaker religion and staff assisted the resident to attend meetings in the area until that person was confident enough to attend alone”. This was confirmed by speaking to the resident concerned and some comments from residents included; “the staff came with me to my first meetings, I just needed some moral support”, “the staff are very helpful and come with me to see my doctor if I am not feeling confident enough to go”. The Quality Assurance system is being developed and there was no written evidence to look at that would confirm that service users and other stakeholders are systematically approached for their views. It was noted that two accidents had taken place where service users had required medical assistance or had sustained an injury but a report had not been provided for the C.S.C.I. Induction and foundation training is offered to staff and on-going training as and when required. Records confirmed that training in relation to fire, health and safety, infection control, food hygiene, safeguarding adults and moving and handling are all offered, but not all staff had undertaken the training and therefore the residents receive support from a staff group that could be better trained. Victoria Court DS0000019766.V340206.R01.S.doc Version 5.2 Page 28 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 2 4 3 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 2 26 X 27 2 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 1 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 4 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 2 1 X 2 2 X Victoria Court DS0000019766.V340206.R01.S.doc Version 5.2 Page 29 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 YA2 Regulation 14,17 Requirement Timescale for action 15/08/07 2 YA3 14,18 People who use the service must have a full assessment of need undertaken by a suitably qualified person prior to moving into the home as this would ensure that all of their needs can be met. 15/08/07 Where people have special or complex needs that are not the same as their primary need, staff must be competent to address those needs. The management of the home must be able to demonstrate that they have ensured that all staff are competent to meet all care needs. People who live in the home must receive a contract including a statement of terms and conditions. A written record must be maintained of this. This will demonstrate that the home has worked to make sure that residents understand the basis on which they live in the home. Risk assessments do not always contain sufficient information to give clear direction to staff and DS0000019766.V340206.R01.S.doc 3 YA5 5a 15/08/07 4 YA9 12,13,14 15/08/07 Victoria Court Version 5.2 Page 30 5 YA16 12 6 YA20 13 7 YA23 17 Schedule 4 8 YA24 23 9 YA24 17, 23 therefore residents’ needs may not be met in full and potentially risk may not be managed in a way that would ensure the residents are safe. People who live in the home must be offered the option of a key to their room as this would promote independence and privacy. People who live in the home must be given the option to selfmedicate, unless a written risk assessment has been undertaken and agreed with a medical professional that this would not be appropriate as it may pose a risk to the resident. Any financial records relating to the residents must be held within the home to ensure that a full audit trail of money spent and savings that residents currently have is available for inspection. People must be able to access their personal monies at any reasonable time. Any additional charges payable by residents’ (portable appliance testing) must be detailed in the statement of purpose and statement of terms and conditions to ensure that they are fully aware of all extra costs. A programme of redecoration must be developed with timescales as appropriate. 15/08/07 15/08/07 15/08/07 15/08/07 15/08/07 10 YA24 23 11 YA35 17,18 (Previous timescale 31/08/06 – not met) Several areas in the environment 15/08/07 require attention and renewal; people who use the service do not live in a well-maintained and safe home. Please refer to the section in relation to the environment for details. All staff undertaking care duties 15/08/07 DS0000019766.V340206.R01.S.doc Version 5.2 Page 31 Victoria Court 12 YA36 17,18 13 YA37 18 14 YA39 8 must complete the mandatory training courses that meets the Skills for Care specification as this would ensure that residents are supported by a well-trained and effective staff group. All staff must receive formal supervision at least 6 x year and this must be offered during their working day. Therefore ensuring that practice is monitored and developed through this procedure. The management must address the issue of staff refusing to attend training and supervision, as this poses a risk of unsafe care being provided to the residents. A formal Quality Assurance monitoring system must be developed based on a systematic cycle of planning-action-review, thereby reflecting the aims and outcomes for the service users. (Previous timescale 31/10/06 not met) The home must give notification to the CSCI of all deaths, illnesses or other events that adversely affect the people who live in the service, to ensure that safety of the residents is maintained. 15/08/07 15/08/07 15/08/07 15 YA42 17,37 15/08/07 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 YA26 Good Practice Recommendations Consideration should continue to be given to providing the service users with single bedrooms to further promote DS0000019766.V340206.R01.S.doc Version 5.2 Page 32 Victoria Court their independence. 2 YA32 The staff should be encouraged to undertake an appropriate National Vocational Qualification at level 2 or above. The day staffing level should be kept under review, as an integral part of the Quality Assurance process, to ensure that it remains appropriate to meet all of the service users’ assessed needs in particular their social needs To consider providing the registered manager with access to the Internet and email so that they may undertake ‘POVA First’ checks on-line and have direct access to information provided by the Commission for Social Care Inspection as this would ensure that the manager keeps her knowledge up to date and would promote good practice. The home does maintain records in relation to the care offered to people who use the service, but files were disorganised and it was difficult to locate information and evidence. It is recommended that the files are reorganised to ensure that all who use them can locate information easily. 3 YA33 4 YA37 5 YA41 Victoria Court DS0000019766.V340206.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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.V340206.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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