Inspection on 17/04/08 for Victoria House

This inspection was carried out on 17th April 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Victoria House 06/06/07

Victoria House 23/11/06

Victoria House 21/08/06

Victoria House 27/01/06

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Victoria House 62/64 George Lane South Woodford London E18 1LW Lead Inspector Jackie Date Unannounced Inspection 17th April 2008 9:30 Victoria House DS0000066301.V361699.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 DS0000066301.V361699.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 DS0000066301.V361699.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Victoria House Address 62/64 George Lane South Woodford London E18 1LW 020 8530 3591 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) www.caremanagementgroup.com Care Management Group Ltd vacant post Care Home 6 Category(ies) of Learning disability (0) registration, with number of places Victoria House DS0000066301.V361699.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th December 2007 Brief Description of the Service: Victoria House is a six-bedded home for adults with learning disabilities and challenging behaviour. At the time of the visit five men were living in the home. It is in a residential area of South Woodford close to local shops and amenities and to local transport networks. People living in the home need varying degrees of support with everyday daily living tasks but all require a high level of supervision because of their challenging behaviour. Two of the five people can communicate verbally but the others have very limited communication. Some people access day services, others are supported in community based activities by the staff team. The building does not have any adaptations for people with physical disabilities and would not be accessible to wheelchair users. The scale of charges per week for each person range from £1,116 to £2,008 per week. The regional operations manager provided this information the day after the inspection. Information about the service provided is contained in the service users guide. Victoria House DS0000066301.V361699.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1star. This means the people who use this service experience adequate quality outcomes. This inspection was unannounced and started at 9:30 am. It took place over eight hours. This was a key inspection and all of the key inspection standards were tested. Staff were asked about the care that people using the service receive, and were also observed carrying out their duties. Where possible, people using the service were asked to give their views on the service and their experience of living in the home. All of the shared areas and one of the bedrooms were seen. Staff, care and other records were checked. In December 2007 a shorter random inspection was carried out. The reason for this inspection was to assess the progress made by the home since the last key inspection on 6th June 2007 and to monitor the actions taken by CMG to address the requirements made at the time of that visit. Relevant information from the random inspection is also included in this report Relatives, social workers and healthcare professionals were contacted and asked for their opinions of the service. At the time of writing this report feedback had been received from 3 relatives and the social worker/care manager of three people. Feedback forms were also received from 6 staff. In addition the inspector has attended relatives meetings and had the opportunity to speak to most of the relatives. Keyworkers supported the people using the service to complete feedback forms or completed them on their behalf. Services are now required to complete an AQAA (Annual Quality Assurance Assessment) and the completed form was received in April 2008. Information provided in this document also formed part of the overall inspection The inspector would like to thank the people living at Victoria House and staff for their input during the inspection. What the service does well: One family said that they are happy with the service provided and feel that the home is more settled now. Another family said, “the new manager seems promising”. A third family said, “just to confirm our satisfaction with the way our son is looked after”. Victoria House DS0000066301.V361699.R01.S.doc Version 5.2 Page 6 Staff continue to work hard to try to give people the care and support that they need and to provide a consistent service. This has meant that there are less instances of challenging behaviour. Staff on duty knew people well and were able to demonstrate a good awareness of their needs, likes and how to work with them. One person living at the home said that the staff were nice. What has improved since the last inspection? What they could do better: Two families are dissatisfied with the service provided and are seeking alternative placements for their sons. The service needs to better meet the needs of people that live there and to keep them safer than at present. The house needs some more repairs and new furniture and to be more homely and comfortable for people that live there. A relative said that the home would be better if it was more homely. Since the last key inspection there has been another new manager at the service and a relative said, “stability should be aimed for”. There have been several changes in management since CMG have taken over and none have stayed for long enough to see changes through or to build on developments in the service. The changes in management may well be outside the organisations control but it is a problem that needs to be addressed if the service is to flourish and the people living there are to get the service that they should. Victoria House DS0000066301.V361699.R01.S.doc Version 5.2 Page 7 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 DS0000066301.V361699.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 DS0000066301.V361699.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): 2 & 5. People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. The organisation’s assessment procedure is appropriate and would be used for anyone wishing to move to the home, to ensure that their needs can be met. People using the service have contracts/statement of terms and conditions and therefore have detailed information about the service that they are entitled to. EVIDENCE: There have not been any new admissions to the home for about 7 years and therefore the current group of people have lived together for some time. There have not been any admissions since Care Management Group (CMG) took over the home. The organisation has an admissions procedure that includes gathering of information and assessments and this would be used for any new person wishing to move to Victoria House. People using the service have a contract between themselves and the provider. The contracts were available at the home and copies were seen in peoples’ files. Therefore people living at the home have details about the service that they are entitled to. Victoria House DS0000066301.V361699.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): 6, 7, & 9. People using the service experience adequate quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. People using the service do not have comprehensive care plans covering all of their needs and so their needs may not be fully met. Risks to people using the service are minimised as far as possible. EVIDENCE: The care plans seen followed on from recent risk assessments based on areas of concern. However they were not comprehensive and did not give an overall picture of each persons needs and how these are to be met. However the staff team are in the process of developing these and in the interim are maintaining an adequate service for each person. However not everyone’s needs are being fully met. The manager said that his intention was for each person to have a PCP (Person Centred Plan) and that these would be introduced within the next three Victoria House DS0000066301.V361699.R01.S.doc Version 5.2 Page 11 months. Each person living at the home must have a comprehensive care plan that identifies how their needs are to be met. Staff know people using the service quite well and are maintaining an adequate service at present. Recently the focus of the service has been on managing the challenging behaviour of one person and minimising risks to others. This person’s challenging behaviour has become less frequent as staff have introduced a consistent way of working with him. He talked about his behaviour and the fact that he had a chart with a reward system when his behaviour was appropriate. Daily recordings are made about what each person has done and support that they have been given. Incidents are also recorded. Therefore there is information about each individual, which can be used as part of the review process and to identify ongoing and changing needs. There are risk assessments in place. These identify risks for people using the service and staff and indicate ways in which the risks can be reduced to enable the people’s needs to be met as safely as possible. Risk assessments have been reviewed and are up to date. These include updated guidelines for managing challenging behaviour and minimising the effects of this. This helps to keep people safe. However there have been incidents when people living at the home have assaulted other people living there and these are being looked into by the relevant local authority in line with the safeguarding adults procedure. Overall the families of three of the people living there are satisfied with the service and feel that their son’s needs are being met. The other two families are not satisfied that their son’s needs are being met and in one case are not satisfied thatthat their son has been adequately safeguarded during the course of the past year. Both families have requested that their sons move and alternative placements are being sought. People living at the home have been registered with a local advocacy service and one person now has an advocate. Another person has a friend who offers support in making decisions and choices. Two people can and do express their views about what they want and what they like. They are able to discuss and decide what they are going to do and be involved in decisions about their lives. Victoria House DS0000066301.V361699.R01.S.doc Version 5.2 Page 12 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 using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. People are encouraged to take part in activities and to be part of the local community and this is being developed further to ensure that they have as fulfilling a lifestyle as possible. People are supported to keep in contact with their relatives and most relatives visit regularly. People are supported and encouraged to have a diet that is healthy and meets their need. This includes their cultural preferences. EVIDENCE: One person attends a local authority day service for five days and another for two days each week. People living at Victoria House have the opportunity of Victoria House DS0000066301.V361699.R01.S.doc Version 5.2 Page 13 using the day service attached to another care home operated by CMG (Lilliputs). One person has said that he does not wish to go to this service. People go out to local shops, to the cinema, the library and restaurants. Some of them are well known in local shops and restaurant. One person likes to go to church on Sunday and this does happen as often as possible. On the day of the visit two people went to the day service, another went swimming and a fourth went out for personal shopping. One person goes to a local farm to work and has applied to join a horse riding group and also a friendship group. Staff said that activities have been improving and that they are trying to develop activities such as artwork in the home. An activity book is kept and this records what people have been doing throughout the day. One person likes to listen to Nigerian music and staff facilitate this. Most people went on holiday last year and the manager said that they will be organising holidays in small groups later this year. At the time of the last key inspection there were some concerns about the availability of funds for activities. At that time the organisation confirmed that there was an activities budget and that the organisation would pay for staff lunches, staff expenses and activities. On the day of the visit the manager received confirmation that this budget would be increased to facilitate more activities. Some people can and do use the keys to their rooms. During the visit people were observed to spend time in the lounge, dining area, garden or in their rooms. It was evident that they chose when and where to spend their time. All of the people using the service have contact with their families, some of their relatives visit the home regularly and some people visit their families at home. They also have a lot of contact with staff and people using the service at a nearby home run by the same organisation. Relatives meetings have not taken place recently although the manager has been in contact with relatives. One relative said, “since the new manager has taken over he appears to be working towards a better line of communication”. Other relatives do not live locally and they said that they communicate via a telephone call and a long letter each month. Some people are able to say what they want to eat and are able to contribute to the menu planning. Staff use their knowledge of others likes and dislikes when planning the menu and are working to introduce’ healthy eating’. One person likes African food and this is included on the menu. Some of the people are not able to ask for a drink or something to eat but staff spoken to knew how to interpret their non-verbal communication. For example one person will bang his foot on the floor if he wants something. Another will go and stand at the kitchen if he is hungry or wants a drink. People are given meals that meet their needs and likes and this includes their cultural preferences. At the last key inspection staff expressed concerns that the food budget was tight. On this occasion one member of staff said that funding can limit what food you buy. The manager is aware of the concerns and said that he is introducing some budget planning in this area and will be monitoring the situation over the Victoria House DS0000066301.V361699.R01.S.doc Version 5.2 Page 14 course of the next few months. However on this occasion inspection of the kitchen found that there were good stocks of fresh, frozen, tinned and packet items. Victoria House DS0000066301.V361699.R01.S.doc Version 5.2 Page 15 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 using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. People using the service receive personal care that meets their individual needs and preferences and the staff team support them to get the healthcare that they need. Medication is appropriately administered and this helps to ensure that people using the service receive their correct prescribed medication as safely as possible and that the risk of errors are minimised as far as possible. EVIDENCE: People using the service require differing amounts of support with their personal care and some require a lot of support and are dependent on staff to meet their personal care needs. Two people are fairly independent and require reminders, prompts and minimal supervision. Staff know how each person needs and prefers to be supported and this information was detailed in previous care plans. However as stated previously the manager and staff team are in the process of developing new care plans based on identified needs and concerns and not all of the people using the service had a detailed plan. Victoria House DS0000066301.V361699.R01.S.doc Version 5.2 Page 16 However from discussions with staff it was evident that they have got to know the people living there and that they are providing them with appropriate personal care. All of the people using the service go to the local doctor and specialist help is received from the community learning disabilities team. Health Action plans have been introduced and there was evidence that staff followed up health concerns raised by a relative. At present two people are receiving input from the psychologist. Staff support people to all of their medical appointments. Evidence was available that people have had checks from the optician, dentist and when appropriate chiropodist. ‘My health’ booklets have been introduced and these had details and information with regards to appointments and healthcare. Some of the people are not able to verbally indicate what they want, need or feel. However staff spoken to were aware of the behaviours that would indicate there was a problem. For example one person cries when in pain and another just sits in one place. Staff then try to establish what the problem is. The healthcare needs of people using the service are therefore being adequately met. None of the people living in the home are able to self medicate and medication is administered by staff. This is usually the senior member of staff on duty. Staff cannot administer medication until they have been deemed competent. Copies of medication assessments were seen in some of the relevant staff files. The manager is planning to organise medication training for all staff with a view to increasing the number of staff that are able to administer medication. Medication is securely stored in a locked cabinet in the office and most medication is in a monitored dosage system. There is also a lockable medicines case that is used when medicines are administered away from the point of medicines storage. Medicines can therefore be secured in the case of the carer having to deal with an emergency. Therefore medication is securely stored at all times. In line with good practice the medication file has information about the medication that people take, how it is taken and possible side effects. Staff are also in the process of getting new photographs of people that take medication. The file also contained a list of staff that are able to administer medication and a sample of their initials. Medication administration records are kept and are up-to-date. All of the people taking medication have had medication reviews. This is good practice. Examination of the MAR (Medication Administration Record) found that these had been appropriately completed. Guidelines/protocols are in place for the administration of PRN (when required) medication to assist staff as to when and how to administer this medication. It is recommended that these guidelines are made more detailed, for example to indicate the time lapse between doses and how much can be administered in any 24 hour period. This will ensure that staff are clear about the administration of this medication and it will also lessen the risk of error. Victoria House DS0000066301.V361699.R01.S.doc Version 5.2 Page 17 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 using the service experience adequate quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. There is a complaints procedure, available in a user-friendly format that is followed in the event of any complaints being made. However complaints and concerns have not always been addressed in a timely fashion. Staff have received safeguarding adults training to ensure that they are clear about what constitutes abuse and what to do if abuse is seen or suspected. Appropriate action has been taken when safeguarding issues have occurred. However people are still not robustly safeguarded and this needs to be strengthened. EVIDENCE: Victoria House DS0000066301.V361699.R01.S.doc Version 5.2 Page 18 There is a complaints procedure and a pictorial complaints procedure to help people understand how to complain. Two people can say if they were are not happy about anything but due to the degree of their disability the other three people living in the home would not. One person now has the support of an independent advocate. There is a complaints log and this contained details of complaints made and the action taken to address these. When asked if the service has responded appropriately to concerns raised about care one relative said “CMG fall down very much in this area. They should respond and act quicker”. This was in relation to the fact that her son was the victim of several assaults by a person that lived in the home up until late last year. Another relative said that the situation with that person should have been sorted out a lot earlier. The key inspection in June 2007 stated, “The challenging and aggressive behaviour of one of the residents is having a detrimental affect on other residents and this needs to be addressed so that residents are not the subject of assaults and feel safe in their own home”. It was in fact almost another 6 months before this person moved from the home. The organisation has a protection of vulnerable adults procedure. Safeguarding adults issues continue to arise and the recent issues have been in relation to the aggressive behaviour of one person living in the home assaulting other people living there. The staff team have been working in a consistent manner with this person and he is receiving input from a psychologist. The staff team have received safeguarding vulnerable adults training and are aware of safeguarding issues. In the past staff have received “Digman” training, which focuses on the dignified management of challenging and aggressive behaviour. Recently four staff completed a 3 day accredited challenging behaviour course. The third day of this course covers the use of restraint. On occasions since the random inspection in December 2007 it has been necessary to restrain one of the people living at the home. Appropriate records have been kept of this and the necessary people have been notified. Recently the need for this has lessened. However as previously stated different placements are being sought for two people living at the home. In one case part of the reason for the move has been an ongoing failure to adequately safeguard the person. People living at the home must be safeguarded from physical assault and should feel and be safe in their own home. A random selection of peoples’ finances was checked and cash amounts held agreed with records. Receipts were on file. Peoples’ monies are securely stored and checks are made at each handover. Problems with appointeeship have now been sorted out and CMG now hold the appointeeship for 4 people and these all go to the bank to withdraw cash. Staff support them to do this. The family of another person manage his finances. At the time of the last key inspection it was found that people had been paying for activities and also paying staff expenses, including meals, when they were supporting people in activities. In addition at least one person had purchased Victoria House DS0000066301.V361699.R01.S.doc Version 5.2 Page 19 bedroom furniture. This has now been addressed and people have been reimbursed. However during this visit it was noted that one person had purchased tea and another some bedding and it is apparent that staff are not clear about who purchases what and it is recommended that CMG clarify this and issue new guidance to ensure that peoples’ monies are being more robustly safeguarded. Victoria House DS0000066301.V361699.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 & 30. People using the service experience adequate quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. People using the service live in a home that is suitable for their need in terms of its size and location. However the house is quite bare, still in need of some repair and refurbishment and is not a comfortable and homely environment for people to live in. The quality of the environment is not always addressed promptly and this can affect the quality of the service that people receive. EVIDENCE: The house is in South Woodford and is near to the local shops, bus routes and a train station. There is a lounge, dining room, a conservatory that leads to the garden, kitchen, office and laundry and one bedroom on the ground floor. Most bedrooms are upstairs. All of the bedrooms are singles but do not have en suite facilities. There is a toilet and shower upstairs and downstairs there is a bathroom with a toilet and shower. There is also a separate toilet on the ground floor. None of the current people using the service requires any Victoria House DS0000066301.V361699.R01.S.doc Version 5.2 Page 21 adaptations due to their mobility needs and the home does not have any adaptations or specialist equipment. People using the service were observed to spend time in all of the communal areas, including the garden. Improvements have been made to the garden to make it safer and easier for people to use. There is a also a garden swing which is very popular with one person in particular. From touring the building it was evident that some decoration and improvements have been made since the last key inspection but more work is needed to make the building comfortable and homely and also to ensure that furniture and fittings are of a good standard and in a good state of repair. For example, there is not any furniture in the conservatory, the flooring in the dining room is damaged in places, and the bathroom flooring has gaps around bath and walls. When asked how the home can improve one relative said, “ by providing a homely atmosphere”. The new manager and the staff team have identified improvements that are needed and quotes have been obtained for some items. However some of the areas have been outstanding for some time. This is an ongoing problem at the home and the organisation needs to be more proactive in this area. A system must be in place to ensure that the quality of the environment is of a satisfactory standard and that maintenance and refurbishment is ongoing. These needs to take into account the fact that some of the people living at the home do at times exhibit destructive behaviour and cause damage to the fabric of the home. Whenever possible people living in the home are involved in choosing colours and furniture and items for their own rooms. Two people said that they had chosen their bedroom furniture and the colours for their rooms. For a third person a larger bed has been purchased, as he is very tall. Staff have a daily schedule for cleaning and at the time of the visit the home appeared to be clean and there were no unpleasant odours. Victoria House DS0000066301.V361699.R01.S.doc Version 5.2 Page 22 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 using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Staff have the opportunity individually and collectively to discuss their own development or any problems and developments within the service and feel supported by the manager. Staff are receiving the necessary training to give them the skills to meet peoples’ current needs and provide an appropriate service for them. Staffing levels are sufficient to allow for this. People using the service are supported and protected by the organisations recruitment practice. EVIDENCE: Four staff (including one senior) are on duty during the daytime and at night there are two waking night staff. There is only one vacancy and that is a deputy manager and this post is being advertised. Staff said, “we do have enough staff to meet the needs of our service users on shift. Whenever there Victoria House DS0000066301.V361699.R01.S.doc Version 5.2 Page 23 is an extra activity to be done we always get an extra member of staff”. From observations during the inspection, examination of the rota and discussions with staff it was evident that there were sufficient staff on duty to meet people’s needs. Unfortunately, for reasons beyond CMG control, the majority of the staff team have changed since the last key inspection in June 2007. It has therefore been a very unsettling time for people living in the home and a very difficult time for the staff team. However staff have now settled in, completed training and got to know the people living at Victoria House. This has meant that the situation at the home is settling down and this is reflected in the fact that, overall, incidents continue to decrease. Feedback from a member of staff was “there is more teamwork and team spirit which has increased the efficiency of the service to service users”. The organisation operates an appropriate recruitment procedure. Jobs are advertised, application forms completed and interviews held. Staff records are held centrally at the organisations head office in line with an agreement made with the Commission. However copies of the necessary information was available in the file held at the home and three files were examined during the inspection. The files contained copies of the application form, short-listing criteria and interview score sheet. There was also evidence that the necessary checks had been carried out. A member of staff said, “My employer carried out my CRB before I started work and I didn’t start until the full checks were done.” Therefore the recruitment procedure offers safeguards to people using the service. From discussions with staff and looking at records it was apparent that the organisation had been providing a lot of training to staff. Staff said, “staff are normally asked to do any training sessions not done previously. It is organised by Head Office and training is carried out very well. Any new updates are passed on to staff by the manager”. The manager has set up a training matrix that shows the training that staff have undertaken and also any future training needed or planned. All staff have had an induction to CMG and other training has included protection of vulnerable adults, first aid, report writing, medication, keyworking and food hygiene. Another staff said, “staff are getting the training needed to improve their knowledge and understanding when working with the service users”. Therefore the staff team are being provided with the training and skills that they need to meet the needs of the people using the service. The new manager has started supervision for all of the staff and has also held staff meetings. This gives staff collectively and individually an opportunity to discuss concerns, the care of people using the service and the development of the service. The senior staff have had supervision training and will be carrying out formal staff supervision in the near future. Staff spoken to said that they Victoria House DS0000066301.V361699.R01.S.doc Version 5.2 Page 24 feel supported by the manager and that they have the opportunity to be more involved in the running of the home. The feedback form for one of the people using the service said, “the staff in Victoria House are kind and friendly”. Victoria House DS0000066301.V361699.R01.S.doc Version 5.2 Page 25 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 & 42. People using the service experience adequate quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. The new manager has started to implement changes for the benefit of people using the service. However the organisation need to demonstrate that they are able to sustain improvements in the service and to restore relatives and other stakeholder’s confidence. The registered provider monitors the service to check the quality of the service provided to people living there. People using the service are living in a safe environment. Victoria House DS0000066301.V361699.R01.S.doc Version 5.2 Page 26 EVIDENCE: There has been a new manager in post for approximately three month. He has a NVQ qualification and has obtained the RMA (Registered Managers Award) and has also been a registered manager for services for people with learning disabilities. He was aware of areas that need to be developed and improved and has started to work towards this. The manager has the necessary skills and experience to manage this service. Feedback from staff was that the manager was hands on and supportive and has been getting to know staff and people using the service. They also said that he asks staff and people using the service for their opinions and that the service is developing ‘for the better’. Feedback from relatives was “the new manager seems promising” and “since the new manager has taken over he seems to be working towards a better line of communication”. One person using the service said, “I like Tony” (Tony is the manager). However, at this stage, the new manager has not been in post long enough to evidence that changes for the better are being sustained and consolidated. The manager has not yet made an application to be registered with the Commission. He said that he has got the application form but has not yet submitted this. An application for registration with the Commission must be submitted so that the process for the registration of the manager can start and that a registered manager will be responsible for the service. Since the last key inspection in June 2008 the then new manager has left, as has the then new regional operations manager and the senior operations manager. Unfortunately there has not been any ongoing stability in the management of the service since CMG took over responsibility for the service in 2005. Whilst each individual has had the experience and knowledge to support the development of the service none have remained in post for a long enough period to bed in and see through changes and developments. One outcome of this is that some relatives have lost confidence in the organisation. One relative said, “stability should be aimed for” and “I continue to be dissatisfied with CMG and am doing my utmost to ensure that my son is moved to a more suitable environment”. The social worker for another person confirmed that his family also want their son to move. All of the necessary health and safety checks are carried out regularly by the staff team. For example fire call points are tested weekly, as are hot water temperatures. Fridge and freezer temperatures are tested daily and the service received a good food hygiene assessment from the Local Authority. Appropriate servicing is carried out on the fire system and fire equipment and a safe environment is maintained. To improve the safety and security of the service the garden fences have been made higher and alarms have been fitted to exit doors. Victoria House DS0000066301.V361699.R01.S.doc Version 5.2 Page 27 The quality of the service provided to people using the service is monitored by the manager and by the organisation. Monthly monitoring visits are carried out to assess how effectively the home is operating to meet its stated aims and objectives, and reports are written. These indicate the action to be taken when deficiencies are identified. Copies of these reports were available in the home. Representatives from the Quality Assurance department of CMG carry out four of these visits and the regional operations manager carries out the remainder. Victoria House DS0000066301.V361699.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 3 3 X 4 X 5 3 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 3 26 3 27 2 28 2 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 3 3 X X 3 X Victoria House DS0000066301.V361699.R01.S.doc Version 5.2 Page 29 NO 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 YA6 Regulation 15 Requirement Timescale for action 31/08/08 2. YA23 13 3. YA24 23 Each person using the service must have a comprehensive care plan that details their needs and how these are to be met. Systems and support must be in 31/08/08 place to ensure that people living in the home are robustly safeguarded and feel that they are safe in their own home. A system must be in place to 31/12/08 ensure that the quality of the environment is of a satisfactory standard and that maintenance and refurbishment is ongoing. These needs to take into account the fact that some of the people living at the home do at times exhibit destructive behaviour and cause damage to the fabric of the home. This will ensure that people live in a comfortable home that is in a good state of repair. An application must be submitted to the Commission for the manager’s registration. 30/06/08 4. YA37 8 Victoria House DS0000066301.V361699.R01.S.doc Version 5.2 Page 30 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 YA20 Good Practice Recommendations It is recommended that guidelines for PRN (when required) medication are made more detailed, for example to indicate the time lapse between doses and how much can be administered in any 24 hour period. This will ensure that staff are clear about the administration of this medication and it will also lessen the risk of error. It is recommended that the registered provider clarify what is appropriate expenditure from peoples’ finances and issue new guidance to ensure that peoples’ monies are being more robustly safeguarded. 2. YA23 Victoria House DS0000066301.V361699.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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 House DS0000066301.V361699.R01.S.doc Version 5.2 Page 32 - 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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