Inspection on 11/12/06 for Victoria House

This inspection was carried out on 11th December 2006.

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

The inspector found 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 19 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Victoria House 09/06/08

Victoria House 20/06/07

Victoria House 02/03/06

Victoria House 13/09/05

Victoria House 28/02/05

Victoria House 12/10/04

Victoria House 23/03/04

Similar services:

22 Sandown Road

The Highlands

Dilston College Of Further Education

West View House

Prince Bishop Court

Park View (15)

Craigmore House

1 Lanark Close

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

CARE HOME ADULTS 18-65 Victoria House 10 & 11 Victoria Terrace Bedlington Northumberland NE22 5QA Lead Inspector Alan Baxter Key Unannounced Inspection 11 , 14 and 20th December 2006 15:00 th th Victoria House DS0000000556.V322815.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 House DS0000000556.V322815.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 House DS0000000556.V322815.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Victoria House Address 10 & 11 Victoria Terrace Bedlington Northumberland NE22 5QA 01670 828396 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 F Haley Mrs R Haley Mrs R Haley Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Victoria House DS0000000556.V322815.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A maximum of 1 place can be used to accommodate a named service user who has a mental disorder (excluding learning disability or dementia). 2nd March 2006 Date of last inspection Brief Description of the Service: Victoria House was originally two terraced houses and work had been carried out to form one well-equipped house that can provide accommodation for up to six people. A conservatory has recently been built at the rear of the building. At the time of the inspection the Home accommodated six adults with learning disabilities. The accommodation was domestic in nature and was comfortably furnished and appointed. There is a small garden area/patio area to the rear of the property. Victoria House is situated within walking distance of Bedlington town centre and is therefore close to a range of local amenities. The fees charged are £456.43 per week. Information about the home, including inspection reports, is available on request. Victoria House DS0000000556.V322815.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced, and took place over three days in December 2006. One of the two registered providers, Mr Frank Haley, was present for most of the first day, and for the second and third days. The registered manager, Mrs Rose Haley, was unavailable. The care records of all six residents were examined. A wide range of other documents were also examined. These included menus, daily diaries, staff rosters, accident book, staff personnel files and training records. The inspectors spoke with staff on duty and with four of the six service users. The inspectors toured the building. What the service does well: Care records show that the manager and staff are knowledgeable about the service users, their strengths and needs. Service users are able to join in with some activities in the local community. Service users are given choice in some areas of their lives. Service users’ health needs are met at all times. Medicines are properly stored and given. Service users enjoy their food. Service users say that they are happy at the home. Staff recruitment policies are sound, and protect the safety of service users. Victoria House DS0000000556.V322815.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: No progress has been made with care plans. There is still a need for individual care plans for each identified need; for care plans to be regularly evaluated and updated; and for care plans to be the focus for the daily work of the care staff. This will help make sure that the service users’ needs are fully met. New staff must be given formal induction training to make sure they are competent in their work. Staff training must be given in all areas identified in training needs analyses. Staff supervision must be given regularly to all staff so that any issues can be discussed and improvements made. Staff must be involved in their annual appraisals. Service users must be given more choice as to their activities, especially in the evenings. Service users must be given more say in their daily routines and in the running of the home. All records must be kept up to date. Recording of medicines given must be improved, to protect service users and staff. Meetings for service users and staff to express their views must be started again. Quality assurance systems must be continuously updated. Victoria House DS0000000556.V322815.R01.S.doc Version 5.2 Page 7 Staff attitudes to service users, particularly when faced with challenging behaviours, must be looked at closely. Training must be arranged, where necessary, to make sure staff act and react appropriately. All accidents must be recorded in the accident book. The home must comply with its own statement of purpose. 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 House DS0000000556.V322815.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Victoria House DS0000000556.V322815.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 was inspected. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The individual aspirations and needs of all current service users are assessed. EVIDENCE: It was a requirement of the last inspection report that all assessment documents must be signed and dated by the person carrying out the assessment. This has been carried out. All residents’ files have generic assessments that had been carried out by Care Managers. Some residents have other assessments to support them in specialist areas such as Stoma care, physical disability and mental health. It was advised that current assessments and the associated care plans are kept on one file, to demonstrate that both elements are in place at any one time. Victoria House DS0000000556.V322815.R01.S.doc Version 5.2 Page 10 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): Standards 6,7 and 9 were inspected. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ care plans have not been developed as previously recommended. They are not being used as the main working document for each resident’s care, and do not fully reflect changing needs or personal goals. Residents are limited in the decisions they are able to make about their lives. Good quality risk assessments have been carried out for each resident. EVIDENCE: It was a recommendation of the last inspection report that, as each resident is coming up to the formal six monthly review of their care, their care plan is redrawn with each identified area of need being addressed with its own care Victoria House DS0000000556.V322815.R01.S.doc Version 5.2 Page 11 plan. This will allow for the evidence of evaluation and updating of care plans to be clear. This has not been carried out. Service user plans continue to need further development. They are currently written in narrative form. They would be more suitable in a format that highlights areas of care and support, has measurable outcomes and space for evaluation of the progress towards each goal. It was also apparent that the care plans are not in daily use by the staff who, instead, record all significant information in a daily diary. The front of the daily record book also contains brief ‘instructions for personal care’ of the service users, which again reinforces the view that the detailed ‘official’ care plans kept on service users’ files have little or no relevance to the actual care being given. It is particularly important to work to specific care plans where some service users display challenging behaviours, as is the case at Victoria House. Some of the daily recording suggests that some service users communicate through challenges to the service. No guidelines for addressing these challenges are in place, other than asking service users to go to their rooms for a period of reflection. There was no evidence that staff are observing and recording what happened before any challenges. This is necessary for staff to be able to analyse the build up to challenging behaviours, and to plan how to avoid or diffuse a similar situation in the future. There is a clear training need in this important area. The home already has a good quality ‘Management of Behaviour’ policy, which says the manager will promote the use of “a wide variety of non-aversive techniques which involve the least confrontational methods for managing challenging behaviours”. However, there was little evidence of such techniques being promoted or used in the home. The policy also states that the manager will “arrange training in a wide variety of anger and stress management, de-escalation, and diffusion techniques to ensure consistent and confident handling of situations by staff”. Again, there was a lack of evidence that such training has been given or is planned. Victoria House DS0000000556.V322815.R01.S.doc Version 5.2 Page 12 There was mixed evidence as to how well the staff group respect the right of service users to make their own decisions. On the positive side, care records showed a detailed knowledge of individual likes and dislikes, hobbies and interests. There was also some evidence in service user meetings of choices such as where to go on holiday and what to see at the theatre (although meals do not seem to be discussed). Most service users’ comments to inspectors were positive (“I have got choices”; “I chose the colour for my bedroom”; “Staff ask us what we would like to eat”). It was also apparent, however, that there is a degree of institutionalisation in the day-to-day routines for the service users (see standard 16, below). It was a requirement of the last inspection report that a clear written record must be kept of all examples of residents being given choices and being consulted on the running of the home. There was no recent evidence offered of this. Records of residents’ meetings showed that the last one took place on 31st July, nearly five months before this inspection. Prior to this date, residents’ meetings were reasonably regular, and included a routine of checking with residents whether or not they had any concerns or complaints. Although, in a survey of service users’ views, four said that they ‘always’ make decisions about what they do each day, and two said ‘usually’, there was little evidence in the daily diaries that the residents are given real choices about their lives. Risk assessment and risk management plans are very good. The plans promote choices, independence, rights and inclusion. Victoria House DS0000000556.V322815.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14,15,16 and 17 were inspected. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users are able to take part in age, peer and culturally appropriate activities during the day. Service users are part of the local community during the day, but (other than attendance at a weekly club) are not encouraged or supported to go out in the evenings. Leisure activities are rather limited and are not always age-appropriate. Families and friends are made welcome in the home. Service users’ rights are not being fully respected. A menu has just been introduced, giving service users better choice. Victoria House DS0000000556.V322815.R01.S.doc Version 5.2 Page 14 EVIDENCE: Service users are encouraged to continue their education and training. All service users attend college, several days each week, and are involved in a variety of courses, including social skills, literacy and numeracy, and drama. One person has a one-day a week work placement, but would really like a paid job, she said. There was documentary and verbal evidence that service users are integrated into their local community during the day. There are many references in the daily diary to service users popping down to the local shops or going to the library. There were occasional references to lunches out and to going swimming. Once a week, all service users attend the local Gateway club, which is a club for adults with a learning disability. However, other than this and occasional trips to the theatre, there seems to be no evening contact with the local community, due to the daily routines discussed in standard 7, above, and standard 16, below. There was almost no evidence that staff time with, and support for, service users outside the home - flexibly provided, including evenings and weekends – is a recognised part of staff duties (as is required in standard 13.4). It was a requirement of the last inspection report that in-house leisure activities must be made more varied. There was little evidence that this has been carried out. There is a record entitled ‘Client choice of how they spend their in-house leisure times’, and this gives a picture of wide-ranging hobbies and interests, and active staff involvement in activities such as baking, ‘pampering’, craft activities and the use of computers. The daily diaries show that service users are usually involved in some activity, if not at college. They also show, however, that service users are mostly involved, either individually or with each other, in activities such as television, board games, listening to music, or reading magazines. Other than occasional baking sessions, there was little evidence that staff are regularly involved in the service users’ activities, or that they take a positive lead in promoting quality social experiences. There are frequent references to service users “chilling “ in their bedrooms, or in various parts of the building. This appears to be (at least sometimes) a shorthand reference for service users doing nothing in particular and staff not being fully engaged with them. Victoria House DS0000000556.V322815.R01.S.doc Version 5.2 Page 15 In conversation with staff, it was stated that ‘the girls’ can do whatever they want. Again, there was no impression that staff see it as part of their role to take a lead on activities or other social stimulation. There was evidence that service users had been consulted about where they wished to go on holiday. This was to be a foreign holiday at first, but eventually became a choice between Blackpool and Haggerston Castle, with some going to each venue. Staff support service users to maintain family links and friendships. The daily diary shows that families and friends are made welcome in the home. This was confirmed by questionnaires returned by three relatives, who all said that they are made to feel welcome when they visit the home, and can see their relative in private. As noted in standard 7, above, there is evidence that service users’ rights are not always respected in their daily lives. The most striking evidence is the clear pattern of service users changing into their night clothes around 6.307pm every day (and as early as 5.40 pm on one occasion in October); all service users going to their bedrooms at about 9.10 pm; and an effective ‘lights out’ at 10.30 pm. These habits were said to be service users’ choice, but it seems quite remarkable that young adults should all choose such an age-inappropriate regime. One example seen in the daily diary showed that one service user was told to put her television off one night at 10.30pm as being “too late” for watching television; the following morning the same service user was asked to turn her television off at 8.35am as it was then “too early” for television. This does not seem to be in line with the home’s Statement of Purpose, which speaks of giving ‘choice and empowerment’, and ‘control and choice in their lives’. One part of this standard states that service users should be able to choose when to be alone or in company, and to be able to choose when they don’t want to join in an activity. However, the frequent use (and threat of the use) of isolation in the bedroom as a sanction for unacceptable behaviour, and the accompanying sanction of having to eat alone, for periods of several hours (and, on one occasion noted in the daily record book, for a period of over 24 hours), removes this important right. Such restrictions must only be used when agreed by all involved parties and formalised in the plan of care. The registered person was able to demonstrate that each service user’s food likes and dislikes have been canvassed. However, study of the (well-minuted) record of meals cooked showed that there was no cooked breakfast on offer; and there was a preponderance of ‘fast foods’ such as fish fingers (four Mondays in a row), pasties, hot dogs, meat balls and sausage-based dishes (‘toads’, etc.). Victoria House DS0000000556.V322815.R01.S.doc Version 5.2 Page 16 No menu is drawn up in advance. This is accepted as being appropriate for the client-group, given the small numbers and the family-type service being offered. However, there should, at least, be evidence of a study of the previous month’s menus, with regard to variety and nutritional content of their diet, with alterations made, as necessary. On the third day of the inspection, menus covering two weeks were submitted. These still do not offer a cooked breakfast on any day. Lunch offers a daily choice of two from a range including soup, sandwiches, jacket potato, and egg on toast, with a traditional Sunday lunch. The evening meal again offers a choice of two different dishes, with an improvement in the variety and some improvement in nutritional content. It was not clear if these menus are to be recurring menus. If so, then a four week cycle is recommended, to give more variety. Records must continue to be kept of what the service users’ choices were each day. Victoria House DS0000000556.V322815.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): Standards 18,19 and 20 were inspected. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users do not always receive personal support in ways that maximise their dignity, independence and control over their lives. Service users’ healthcare needs are recognised and met. The recording of the administering of medicines is generally good, but it does not meet all the elements required. Victoria House DS0000000556.V322815.R01.S.doc Version 5.2 Page 18 EVIDENCE: Standard 18 requires staff to provide sensitive and flexible personal support and care, and to maximise service users’ privacy, dignity, independence and control over their lives. The home’s policy document ‘Basic Do’s and Don’ts for New Staff’ includes the admirable instruction that staff should “talk about each person with care and respect, representing them in a positive/competent light”. Regrettably, study of the daily recordings showed that service users are routinely represented as being naughty children, rather than adults with significant learning disabilities. Service users are routinely called ‘the girls’, although all are adults and some are much older than some of the staff who care for them. Service users should be consulted on how they should be referred to. When service users ‘behave’, they are frequently described as “little poppets” or “little angels”. However, expressions by service users of unhappiness or dissatisfaction, or incidents of challenging behaviour, are routinely and frequently described as “hissy fits” by staff of all levels of experience and qualification. Other entries include the practice of sending (or threatening to send) service users to their bedrooms for extended periods, as described in standard16, above; and many emotive entries that use inappropriate and unprofessional language to describe service user behaviour. Such entries demonstrate a lack of understanding and may call into question the value base of the home. They also infantalise service users in a way that is not in line with current good practice with in learning disability services; and they certainly highlight the pressing need for better staff training. There was evidence that service users’ physical health needs are properly assessed and met. Documentary evidence was on file regarding referrals of various service users to a range of medical specialists. Risk assessments were in place regarding one service user at risk of injury through falls connected with a medical condition, and evidence that several staff had been given appropriate training to meet the service user’s needs. Victoria House DS0000000556.V322815.R01.S.doc Version 5.2 Page 19 Study of the Medication Administration Record (MAR) showed that there were a number of omissions. Not all handwritten entries had been signed. The sections entitled “commenced/route/received/quantity/by” are not routinely completed. Amended entries, although initialled, are not being dated. No list was found of the full names of each member of staff involved in administering medicines, along with the initials they use to record in the MAR (this is required as an aid to drugs audits). There is an assessment of each service user’s ability to self-medicate. This is good practice. Victoria House DS0000000556.V322815.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): Standards 22 and 23 were inspected. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users feel that the staff listen to their views and act upon them. Most elements of a recent complaint about care practices were upheld. Due to a lack of staff training and appropriate care plans, service users are not being fully protected from abuse, neglect and self-harm. EVIDENCE: In a survey of service users’ views, all six said that they know who to speak to if they are not happy, and all six said they knew how to make a complaint. Five out of the six said that staff listen and act on what they say; one said ‘usually’. All three relatives who returned questionnaires said that they are aware of the home’s complaints procedure. None had used it. All three said that they are satisfied with the overall care provided. No complaints have been recorded since July 2005. Victoria House DS0000000556.V322815.R01.S.doc Version 5.2 Page 21 A former member of staff made a complaint to the Commission in November 2006 about the care practices in the home. This complaint was investigated as part of this inspection. Allegations that service users are not given choices or involved in the running of the home; that service users are treated like children; that service users are punished by being sent to their bedrooms for long periods and made to eat alone; that induction training is not given to new staff; that service users do not have running water in their bedrooms; and that no staff meetings or service user meetings take place, were all upheld. The allegation that there is a lack of activities in the home was partially upheld. Allegations that service users are prevented from using the computers, television and keyboard during the day; that service users are not given or allowed to buy toiletries; that staff members partners stay overnight at the home; that a new member of staff was not given a contract or job description; and that service users are unreasonably restricted from eating sweets, chocolate and hot drinks, were not upheld. In a survey of service users’ views, five said that staff ‘always’ treat them well; one said ‘usually’. New staff are always checked against the ‘POVAfirst’ list and a Criminal Record Bureau check is made to find out whether they have been previously dismissed for abusive behaviour or have a criminal record. No evidence was seen that staff have been given Protection of Vulnerable Adults (POVA) training. It was a requirement of the last inspection report that the home’s policy and procedure on protecting its residents from abuse must be revised to make sure that all allegations of abuse are passed immediately to Social Services, and any internal investigation takes place only when agreed in a strategy meeting. This has been carried out. It was also a requirement that the home’s ‘whistle blowing’ policy must be revised to include reference to ‘bad practice’, as well as illegal practices by staff. This has been carried out. Victoria House DS0000000556.V322815.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): Standards 24,26 and 30 were inspected. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides service users with a comfortable, homely and safe environment. Service users have comfortable, individualised bedrooms, but must be given a permanent water supply to wash hand basins at all times. The home is clean and hygienic. Victoria House DS0000000556.V322815.R01.S.doc Version 5.2 Page 23 EVIDENCE: The inspection of the home’s premises confirmed that they are suitable for its stated purpose, and are accessible, safe and generally well maintained. A paper towel dispenser is needed in the conservatory w.c., the cistern of which is due to be repaired. The first floor shower is due to be fitted with a more easily accessible shower tray in April, after which it will be available for use by service users. There is a small step at the front of the building. This was difficult to see in the dark when the home was evacuated during a fire alarm. There is no external light. The door bell has a piercing tone that is not in keeping with the domestic setting. Mr Haley plans to replace this. Service users’ bedrooms are pleasantly decorated and furnished. Each bedroom was nicely personalised with things that are important to each service user. People have a range of electrical equipment for their private use. There is lots of storage space and room for toiletries. Each person said their bedroom was warm and their beds comfortable. One person’s bed did not have a valance sheet on it and this detracted from the overall homeliness of the room. Two personal towels are fraying around the edges. All bedrooms have a wash hand basin but, although connected to the water supply, no water came out when the taps were turned. Mr Haley said that this was because a problem experienced with the home’s combi-boiler had lead to him turning off a valve under each hand basin. Service users had been without running water for some two months. Mr Haley was asked to adjust these valves immediately, which he did. The home was seen to be in a clean and hygienic condition throughout. Victoria House DS0000000556.V322815.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): Standards 32,34, 35 and 36 were inspected. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff members either hold a competency qualification, or are working towards one. However, staff do not always demonstrate the necessary values of sensitivity and respect. The home’s recruitment policy and procedures protect the service users. Staff are not receiving all the training they need. Staff are not receiving formal supervision. EVIDENCE: Mr and Mrs Haley both hold the Registered Manager Award (RMA) and National Vocational Qualification (NVQ) level four in care. Including Mr Haley, 50 of the care staff hold at least NVQ level two in care. This meets the minimum percentage currently required. Those staff not holding an NVQ qualification were due to start studying for this in January 2007. Victoria House DS0000000556.V322815.R01.S.doc Version 5.2 Page 25 However, the issues discussed in standards 7,16,18 and 22, above, raise questions as to whether the staff team do, in fact, have the skills and experience necessary to meet service users’ needs. Specifically, this standard says that staff must have knowledge of the disabilities and specific conditions of service users; must have the specialist skills to meet service users’ individual needs, including skills in communication and in dealing with anticipated behaviours; and must have understanding of physical and verbal aggression and self-harm as a way of communicating needs, preferences and frustrations. Such skills and knowledge have not been demonstrated in the course of this inspection. The recruitment records of three staff were examined. All were wellmaintained and followed the home’s policy and procedure. Job application forms were fully completed and included full work histories (important for picking up any suspicious gaps in previous employment); a declaration about any previous convictions; proof of identity; two written references and evidence of a police check having been carried out. The job application form has recently been updated and is now better suited to its purpose. There was mixed evidence of staff training and development. Some established staff had training certificates covering mandatory training such as first aid, food hygiene, fire safety and load management/manual handling; and also some service-user-specific training such as epilepsy awareness and Learning Disability Award Framework (training specific to working with persons with a learning disability). The personnel file of a former member of staff who had recently left the home, confirmed that no formal induction or foundation training had been given in the required six weeks/six months period after starting work at the home. This was in contravention of the home’s ‘lone working’ policy, which states that new staff must have knowledge of the home’s moving and handling, food hygiene, infection control, health and safety etc. before working alone in the home. This person had a training needs assessment (although this was undated and unsigned) that had identified a wide range of training needs, but no training had been given (or even arranged, in most of the areas identified). The training needs assessment for the whole team has not been updated since January 2006. There was no evidence of the required equal opportunities training. Victoria House DS0000000556.V322815.R01.S.doc Version 5.2 Page 26 Staff supervision records showed that there had been a good pattern of supervision being carried out until December 2005, but that there was no evidence of supervision having taken place in the twelve months since. There was some evidence of staff annual appraisal having taken place. The content of the appraisals seen was good, detailed and thoughtful. However, there was no record of any input from the persons being appraised, nor had they signed their agreement of these appraisals. Victoria House DS0000000556.V322815.R01.S.doc Version 5.2 Page 27 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): Standards 37,39,42 were inspected. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users benefit from well-intentioned management, but there are significant gaps between the home’s statement of purpose and some of the actual care practices. The home was not able to demonstrate continuous self-monitoring of quality. The health, safety and welfare of service users are generally being promoted and protected, but there are some significant omissions, such as the nonrecording of accidents in the home. Victoria House DS0000000556.V322815.R01.S.doc Version 5.2 Page 28 EVIDENCE: The Registered Manager, Mrs Rose Haley, is qualified and experienced to run the home and to meet its stated purpose, aims and objectives. Unfortunately, the home is achieving few of the aims and objectives set down in its ‘Statement of Purpose’, and many of its own policies, such as the ‘Basic Do’s and Don’ts for New Staff’, described in standard 18, above, are not being adhered to. Mrs Haley was not able to be present on any of the days of this inspection, and it is understood that, for health reasons, she will not be in day-to-day control of the home for a three-month period from January 2007. In February 2006, Mrs Haley undertook an “Evaluation of the Service provided at Victoria House”. This was based on comments from service users, families and involved professionals. It was a quite comprehensive and detailed document. However, it failed to identify a single area where improvements were necessary or desirable. The quality assurance questionnaire for relatives and professionals contains sections with multiple-questions, to which there is currently only a single ‘yes/no’ response possible. This must be amended. No staff meetings or service user meetings have been held in recent months, nor has there been any staff supervision, nor any evidence of any other quality assurance systems being used. Accidents described in the daily diaries were not recorded in the accident book. Also, unexplained bruises seen on one service user were not recorded in the accident book. Established staff have been given training in fire safety, moving techniques, first aid, food hygiene and (some) in infection control. New staff have not been given such training, even where a training needs analysis has identified such a need. Significant findings of risk assessments are recorded. A number of items of food were found to be beyond their ‘use-by’ date. These were removed and full audit was due to be carried out the next day. Some sauces were found in cupboards that should be stored in a fridge. Food must be stored according to Food Hygiene guidelines. REQ Victoria House DS0000000556.V322815.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 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 2 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 x 2 X 2 X X 2 X Victoria House DS0000000556.V322815.R01.S.doc Version 5.2 Page 30 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. Standard Regulation 1. YA6 15(2) Requirement Each resident’s care plan must be redrawn, with each identified area of need being addressed with its own care plan. The format must highlight areas of care and support, have measurable outcomes and space for evaluation of the progress towards each goal. Residents’ care plans must be working documents, available to staff and residents at all times, and used as the main focus for recording progress. Residents who present challenging behaviour must have a detailed individual behavioural care plan, focussing on positive behaviour, ability and willingness, agreed with the care manager and based on current best practice. Positive guidelines for responding to challenging behaviours must be introduced for staff. Appropriate training in the positive management of challenging behaviours must be given to staff. A clear written record must be kept of all examples of residents being given choices and being consulted on the running of the home. DS0000000556.V322815.R01.S.doc Version 5.2 Timescale for action 31/03/07 2. YA6 15(1) 31/03/07 3. YA7 12(2) 31/01/07 Victoria House Page 31 4. YA13 16(2) Staff must support service users to become part of the local community during the evenings as well as during the day, and use the normal range of leisure opportunities. Sufficient staff must be made available to allow this. In-house leisure activities must be made more structured and varied, with staff taking a more active role in promoting quality activities such as baking and ‘pampering’. This requirement is outstanding from 31/03/06. Daily routines and house rules must promote independence, individual choice and freedom of movement, subject to restriction only where agreed as part of the care plan. Practices such as changing into nightwear in the early evening; having one set time for all service users to go their bedrooms, with a set time for ‘lights out’; and the frequent use of isolation for prolonged periods in bedrooms as a sanction must be rethought and changed. Staff must provide sensitive and flexible personal support and care to maximise service users’ privacy, dignity, independence and control over their lives. 31/01/07 5. YA14 16(2) 31/01/07 6. YA16 12(4) 31/03/07 7. YA18 12(5) 31/01/07 8. YA20 13(2) All recordings must follow the home’s own policy that staff should “talk about each person with care and respect, representing them in a positive/competent light”. The Medication Administration Record 31/01/07 (MAR) must be improved by making sure that all handwritten entries are signed; by completing the sections entitled “commenced/route/received/quantity/by”; by dating amended entries; and by drawing up a list of the full names of each member of staff involved in administering medicines, along with the initials they use DS0000000556.V322815.R01.S.doc Version 5.2 Page 32 Victoria House 9. YA23 13(6) 23(2) 10. YA24 to record in the MAR, to be kept in the front of the MAR as an aid to auditing. All staff must be given regular training in the Protection of Vulnerable Adults (POVA). A paper towel dispenser is needed in the conservatory w.c., the cistern of which needs repair. The first floor shower is to be fitted with a more easily accessible shower tray, to enable service users to use it safely. An external light must be fitted by the front door to illuminate the small step at the front of the building. Running water must be made available to service users’ wash hand basins at all times. Staff must demonstrate that they have knowledge of the disabilities and specific conditions of service users; have the specialist skills to meet service users’ individual needs, including skills in communication and in dealing with anticipated behaviours; and have understanding of physical and verbal aggression and self-harm as a way of communicating needs, preferences and frustrations. New staff must be given formal induction training within six weeks of starting employment; and foundation training within six months. Individual and group training needs analyses must be kept up to date and all training needs identified must be met within a reasonable time. 31/03/07 31/03/07 11. YA26 12. YA32 16(2) 18(1) 31/12/06 31/03/07 13. YA35 18(1) 31/12/06 14. YA35 18(1) 30/04/07 15. YA36 18(2) Equal opportunities training must be given to all staff. All staff must be given formal, recorded 31/12/06 supervision at least six times each year. All staff must have input into their annual appraisal. This must be recorded on the appraisal form, which should be signed by both parties. Victoria House DS0000000556.V322815.R01.S.doc Version 5.2 Page 33 16. YA37 24(1) 17. YA37 18(1) 18. YA39 24(1) The Registered Manager must ensure that, at all times, the home is run in such a way that it complies with its statement of purpose. The Commission must be informed in writing of who will be in day-to-day control in the absence of the registered manager, and how her shifts will be covered in her absence. The home’s “Evaluation of the Service provided at Victoria House”, based on comments from service users, families and involved professionals, must be continually updated. The quality assurance questionnaire for relatives and professionals must be revised, as this contains sections with multiple-questions, to which there is currently only a single ‘yes/no’ response possible. Regular staff meetings must be held. Regular service user meetings must be held. All accidents must be recorded in the accident book. New staff must be given training in fire safety, moving techniques, first aid, food hygiene and in infection control. A full audit of the ‘use-by’ dates of all food in the home must be carried out. Food must be stored according to Food Hygiene guidelines. 31/12/06 31/01/07 31/01/07 19. YA42 13(4) 31/12/06 Victoria House DS0000000556.V322815.R01.S.doc Version 5.2 Page 34 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 YA2 YA17 YA18 Good Practice Recommendations Current assessments and the associated care plans should be kept on one file, to demonstrate that both elements are in place at any one time. A four week cycle of menus is recommended, to maximise choice and variety. Service users should be consulted on how they should be referred to. Victoria House DS0000000556.V322815.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR 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. 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