Inspection on 21/08/06 for Victoria House

This inspection was carried out on 21st August 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 23 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Victoria House 17/04/08

Victoria House 06/06/07

Victoria House 23/11/06

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 Key Unannounced Inspection 21 & 22nd August 2006 12:05 st DS0000066301.V309028.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 DS0000066301.V309028.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. DS0000066301.V309028.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 8491 0465 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 Limited *** Post Vacant *** Care Home 6 Category(ies) of Learning disability (0) registration, with number of places DS0000066301.V309028.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th January 2006 Brief Description of the Service: Victoria House is a six-bedded home for adults with learning disabilities and challenging behaviour. It is in a residential area of South Woodford close to local shops and amenities and to local transport networks. Residents need varying degrees of support with everyday daily living tasks but all require a high level of supervision because of their challenging behaviour. Three of the six residents can communicate verbally but the others have very limited communication. Some residents 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 resident range from £1,200 to £2,000 per week. This information was provided in the pre inspection questionnaire. Information about the service provided is contained in the service users guide. DS0000066301.V309028.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit lasted for about 8 hours and took place from midday on the first day. The manager, staff and all of the residents were spoken to. On the second day of the visit the regional manager met the inspector at the home to discuss serious concerns that had been identified on the first day. All of the communal areas and most of the bedrooms were seen. Staff, care and other records were checked. Care staff were asked about the care that residents receive, and were also observed carrying out their duties. Due to the level of their disability some of the residents were not able to give any direct feedback about the care that they receive and relatives and other professionals were contacted and asked for their opinions of the service. Feedback was received from two relatives and one professional. This was a key inspection and all of the key inspection standards were tested. What the service does well: What has improved since the last inspection? What they could do better: There are 23 requirements in this report, some of which have been made on previous occasions. They cover residents’ needs, care planning and reviews, staffing levels, staff support, medication and health and safety. In addition four immediate health & safety requirements were issued at the time of the inspection. These have all been discussed with the manager and regional operations manager. DS0000066301.V309028.R01.S.doc Version 5.2 Page 6 The organisation has not adequately supported or actioned developments and improvements in the service and consequently residents are living in a poor environment that is not safe. Also the number of staff on duty has been cut and this means that there are not always enough staff to support residents to do things or to keep them safe. A meeting will be arranged with the organisation to discuss the seriousness of the issues raised and to seek assurances that these will be addressed in a timely fashion. Failure to address the concerns may mean that the Commission will consider enforcement action. 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. DS0000066301.V309028.R01.S.doc Version 5.2 Page 7 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 DS0000066301.V309028.R01.S.doc Version 5.2 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2&5 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. The organisations assessment procedure is appropriate and would be used if any vacancies arose at the home. Residents do not have fully costed contracts/statement of terms and conditions and therefore do not have detailed information about the service that they are entitled to. EVIDENCE: There have not been any new admissions to the home for about 6 years and therefore the current group of residents have all 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 if any vacancies arose. Residents have contracts/terms and conditions with the previous proprietor. Although there were some examples of blank contracts with the new organisation none of these had been completed. Therefore it was not possible to confirm that residents have detailed information about the service that they are entitled to. Residents must have fully costed contracts/statement of terms DS0000066301.V309028.R01.S.doc Version 5.2 Page 9 and conditions so that they have detailed information about the service that they are entitled to. DS0000066301.V309028.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to the service. Residents’ plans contain detailed information about their likes, dislikes and needs. However residents’ plans and risk assessments have not been reviewed since 2004 and therefore do not necessarily contain up to date information about their needs. This may place residents and staff at risk. EVIDENCE: DS0000066301.V309028.R01.S.doc Version 5.2 Page 11 All of the residents have plans which give details of how they need/like to be supported. The last three inspection reports have made a requirement that care plans must be reviewed with the resident and significant others at least every six months and updated to reflect changing needs. At the time of the last inspection in January 2006 Care Management Group (CMG) had recently taken over the service and the deputy manager said that they would be introducing the care planning process that is used by the new organisation and that all residents would have a review before this happened. The timescale for meeting this requirement was therefore extended to allow for the new systems to be introduced, reviews to be held and the new care plans to be developed. However five of the six residents have not had reviews and their care plans have not been updated since 2004 and therefore information contained in them is not always up-to-date. The other resident has had a review but there was not any information about the review and a new care plan had not been written. The assessments package and information prepared for the review was very detailed and demonstrated that this persons keyworker knew him very well and was aware of his needs and wishes. Areas covered included health, self-care, communication, psychological needs, relationships and sexual needs, community presence and cultural needs. Since the last inspection there have been changes in the staff team and bank staff are used to cover shifts. Therefore it is especially important that up to date information is available to enable residents’ needs to be met. The ongoing failure to meet this requirement has an impact on the safety and welfare of residents and the Commission may consider enforcement action to secure compliance. Daily recordings are made about what each person has done and support that they have been given. These recordings are broken down into various area including health, social, activities behaviour and an overall comment. In addition night staff make recordings. 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 the residents’ and staff and indicate ways in which the risks can be reduced to enable the residents’ needs to be met as safely as possible. Most of the risk assessments have not been reviewed either and were therefore not necessarily up to date. Although for two of the residents more recent guidelines had been introduced to manage their challenging behaviour. One of these was very comprehensive and gave detailed guidance on strategies to manage the aggressive behaviour and to offer some protection to staff and other residents. Risk assessments must be up to date and reviewed regularly to ensure that staff have up-to-date information about risks to residents and how to minimise them. This will help to keep residents safe. The residents have been registered with a local advocacy service and have been put on a waiting list for an advocate. Three of the residents can and do express their views about what they want and what they like. For example DS0000066301.V309028.R01.S.doc Version 5.2 Page 12 one resident has clearly stated that he does not want to go to a day service or to church. They are able to discuss and decide what they are going to do and be involved in decisions about their lives. DS0000066301.V309028.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 & 17 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to the service. Although the residents are encouraged to take part in activities and to be part of the local community this has been restricted due to cuts in staffing levels. Residents are supported to keep in contact with their relatives and relatives are welcomed at the home. Residents are given meals that meet their needs and individual preferences. EVIDENCE: Residents are encouraged and supported to do as much as they can for themselves. For example the information about one resident states that he likes to pick his own clothes, and can order his own food when out in a restaurant. One of the residents attends a day service for five days and another for two days each week. Some of the other residents do not have day services and DS0000066301.V309028.R01.S.doc Version 5.2 Page 14 others choose not to attend day services. One of the residents has got an interview at a local college and it is hoped that he will be able to start going there regularly from September. Residents do go out to local shops, the library and restaurants. Some of the residents are well known in local shops and restaurants. During the first visit one of the residents had been to the shops to buy a new personal CD player and another went to the library. On the second day of the visit one of the residents was going out for lunch. This was something he said he enjoys doing every week and he chooses where to go. However since the last inspection the number staff on duty during the day has been decreased and this has meant that residents are not able to go out as much or do as many activities as there are insufficient staff to support them and to support those remaining in the home. Feedback from staff was that “residents are not doing a lot of activities due to staffing and they rarely go out in the evenings although some of them do like to go to the pub”. None of the residents have had a holiday so far this year. It was planned that two of the residents would be going to Spain in September but this has had to be changed recently due to the staffing situation and it is now anticipated that they will be going to Clacton for a week. Both of the residents had been looking forward to a holiday in Spain and they had been looking forward to going abroad for some time. Therefore although the staff team are trying to arrange things with the residents and to take them out as much as possible residents do not get enough opportunities for appropriate activities and this must be addressed by the organisation. Residents must be supported and enabled to take part in appropriate activities both in the home and in the community so that they have fulfilling lifestyles. This requirement relates to standards 12 & 14. Please also see the section on staffing for more information about and a requirement with regard to staffing. Some of the residents can and do use the keys to their rooms. During the visits residents were observed to spend time in the lounge, dining area, or in their rooms. It was evident that they chose when and where to spend their time. All of the residents have contact with their families, some of their relatives visit the home regularly and some residents visit their families at home. Residents also have a lot of contact with staff and residents at a nearby home run by the same organisation. Some of the residents 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. One of the residents has diabetes and he is supported to eat appropriately. Staff were observed to take time to explain what drinks he could have. At lunchtimes during the visits residents had different things to eat according to their likes all wishes. Records are kept of what each person has to eat. Therefore residents are given meals that meet the needs and likes. DS0000066301.V309028.R01.S.doc Version 5.2 Page 15 DS0000066301.V309028.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 & 21 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to the service. Residents receive personal care that meets their individual needs and preferences and the staff team support them to get the healthcare that they need. However systems are not in place to ensure that residents’ health care needs are safely met. The administration and recording of medication needs to be improved to ensure that the residents are given prescribed medication as safely as possible and to minimise the risk of error. EVIDENCE: The residents 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. Details of the help that they need and how they prefer to be supported are in their individual plans. For example “he can run the bath himself and likes the water to be tepid”. Each resident has different coloured towels and flannels so that these are easily identifiable and residents get their own towels and flannels to use as opposed to communal ones. Therefore residents receive appropriate personal care. However in some of the bedrooms and the bathroom there are not any curtains or blinds and this does DS0000066301.V309028.R01.S.doc Version 5.2 Page 17 not afford the residents appropriate privacy. Curtains had been taken down when the new windows were fitted and had not been replaced. All windows must have suitable blinds or curtains to ensure that residents have privacy when in their bedrooms or in the bathroom. All of the residents go to the local doctor and specialist help is received from the community learning disabilities team. Staff take residents to all of their medical appointments. One of the residents has diabetes and staff have taken him to see the specialist diabetes nurse. During the visit this resident went to the doctors to discuss the problems that he had been having with his health. He was a bit anxious about this and staff gave him reassurance before the visit. After the visit a member of staff discussed what the doctor had said with him and explained it further. This information was also written down for him to read. After this he indicated to staff that he understood and was happy about it. Staff were also concerned that another resident had been losing weight and that morning had taken him for some blood tests. Evidence was available that residents have had checks from the optician, dentist and when appropriate chiropodist. However different recording systems are being introduced and it was difficult to find some of this information and in some cases recordings were made in more than one place or information was in different files. Accessible, up to date and accurate records relating to residents healthcare must be kept. One of the residents is prescribed rectal Valium to be administered in the event of a prolonged seizure. There have been staff changes at the home and at present most of the staff have not receive training to administer this. The manager said that scheduled training had been cancelled and that in the interim he would expect staff to telephone for an ambulance if needed. However there were no guidelines or instructions about this and these must be developed to ensure that this resident is not placed at risk. Additionally all staff must receive the appropriate training to administer rectal Valium so that they can safely meet this residents needs. Although the staff team are active in ensuring that residents’ healthcare needs are being met and are supporting them to get the health care that they need the organisation has not provided the necessary training or guidance for them to safely meet all of the residents needs. None of the residents are able to self medicate and medication is administered by two staff who both sign the record sheet. One of these is usually the senior member of staff on duty. Staff cannot administer medication until they have been deemed competent. They are required to complete a series of questions, which are marked by the manager. The pharmacist provides this question booklet and staff get a certificate when they have completed this satisfactorily. However there is a list of staff names and initials in front of the medication folder but not all of the staff have been deemed competent. The manager said the only staff deemed competent administer medication but this is not clear in the folder. The list of staff names authorised to give medicines, which includes DS0000066301.V309028.R01.S.doc Version 5.2 Page 18 a record of their signed initials and signatures must be kept available for reference with the MAR (Medication Administration Record) charts. If staff have been deemed competent to witness but not administer medication this must clearly be indicated. In addition new staff are witnessing the administration of medication and signing to say they have done this. However there is no evidence that they understand what the issues are and exactly what they are responsible for. Any staff witnessing the administration of medication must have received the necessary training to do this and have been deemed competent to do so. Medication is stored in a locked cupboard on the wall in the main office. Examination of the MAR (Medication Administration Record) found that there were several handwritten entries. For accountability any handwritten amendments or additions to Medication Administration Records (MAR) sheets must be signed and dated by the person making the entry. This requirement was made at the time of the last inspection and must be addressed. On some of the MAR charts items were listed as not supplied. In some cases this was because there was sufficient stock at the home but in other cases it was because the resident no longer had that medication. The MAR chart must clearly indicate the correct medication that is to be given to the resident. The charts should be checked when received from the pharmacist and any required amendments made and signed. The pharmacy should be informed of changes so that the next chart can be corrected. The requirements are made to protect residents and ensure that they are given the correct medication safely. There are not any detailed guidelines in place on the action to be taken in the event of a medication error occurring and these are needed to ensure that staff are quite clear on the action that must be taken. Specific advice on this was given to the manager at the time of the visit. This will ensure that medication is administered as safely as possible and any problems that might arise are appropriately dealt with. The district nurse visits to administer medication for the resident with diabetes and therefore the requirement from the previous inspection the staff receive training in the correct preparation of the prescribed dose and administration of a subcutaneous injection is no longer appropriate. Previous inspections have required that there is a policy/procedure with regard to ageing/illness or death of a resident and this is included in the policies and procedures that have been introduced by CMG (Care Management Group). DS0000066301.V309028.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. There is a complaints procedure, available in a user-friendly format that would be followed in the event of any complaints being made. Most staff have now received adult protection training to ensure that they are clear about what constitutes abuse and what to do if abuse is seen or suspected. This gives residents a greater protection from abuse. However, although residents’ finances are being safeguarded in the home they are not being appropriately or adequately managed by the organisation. EVIDENCE: There is a complaints procedure and a pictorial complaints procedure to help residents understand how to complain. Three of the residents would be able to say if they were not happy about anything but due to the degree of their disability the other three residents would not. As stated previously in the report attempts have been made to get advocacy support for the residents but they are still on a waiting list. There had not been any recorded complaints since the last inspection. The organisation has a protection of vulnerable adults procedure and the manager was aware of the action that needs to be taken in the event of an allegation or suspicion of abuse. Some of the staff team have received protection of vulnerable adults training and others will be receiving this in due course. Due to the behaviour of some of the residents staff are in the process of doing “Digman” training, which focuses on the dignified management of DS0000066301.V309028.R01.S.doc Version 5.2 Page 20 challenging and aggressive behaviour. As stated previously in the report some detailed guidance is in place for working with one of the residents that continues to exhibit challenging and aggressive behaviour. These help to protect both staff and residents. A random selection of residents’ finances was checked and cash amounts held agreed with records. Receipts were on file. Residents’ monies are securely stored and checks are made at each handover. Therefore systems are in place in the home to protect residents from financial abuse. However CMG have been responsible for this home since November 2005, almost 9 months, and three of the residents are still not receiving their allowances due to problems with appointeeships. The manager said that the relatives of these residents had written to the organisation to express their dissatisfaction with this. Basic items are still been purchased for residents but they “owe” the money to the service. Staff spoken to felt that this was placing restrictions on some residents purchasing things that they might need or that would make their life more comfortable. This is not acceptable and residents’ finances are not being appropriately managed by the organisation and this must be addressed. The responsible individual must ensure that appropriate arrangements are in place for all residents to receive any monies that they are entitled to. DS0000066301.V309028.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 & 30 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to the service. The residents live in a home that is suitable for their need in terms of its size and location. However the overall environment is in very poor condition and promised refurbishment and improvements have not been carried out. Therefore the residents are not living in a homely or comfortable environment. 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, conservatory, kitchen, office and laundry area on the ground floor and the bedrooms are upstairs. All of the residents have single bedrooms. 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 residents requires any adaptations due to their mobility needs and the home does not have any adaptations or specialist equipment. The last inspection in January 2006 found that the condition of the building had deteriorated since the previous inspection and the requirement that all areas of the home must be appropriately decorated and should be homely and comfortable had not been met. However DS0000066301.V309028.R01.S.doc Version 5.2 Page 22 CMG stated that funds had been allocated for a lot of work to be carried out at the home. This was to include a new roof, windows and doors and redecoration and refurbishment throughout. The garden was to be decked and a barbecue built. At the time of that visit quotes were being obtained for the work. Therefore the timescale for completion of this work was extended to the end of June 2006 to allow for the work to be carried out. At the time of this visit the new roof, new windows and exterior doors had been fitted. In addition new kitchen units had been fitted but none of the other work had been carried out. Work had been started on the garden but not completed. It would appear that the estimates had been lost and therefore none of the work had been agreed. The manager said that he was in the process of trying to get some new estimates. An inspection of the building found that the environment had deteriorated even further and overall the building was in a very poor condition. Listed below are examples of some of the things found during a tour of the building. This list is not exhaustive but is included to highlight the poor environment that the residents are living in. • Office-wallpaper is coming off & flooring needs replacing. • Hall- skirting is missing in places, needs redecorating and the flooring needs replacing, there are some holes in the plaster, some of the flooring is loose and some of the radiator covers are broken. • Lounge-there is no wallpaper on the wall underneath the bay window, phone wires hanging loose, no lampshade, the settee is broken. • Kitchen-some of the walls do not have any plaster, is has not been fully tiled, the old flooring has been left down and this does not meet the new units. • Dining room- very bare, skirting coming away from the wall, missing plaster. • Downstairs bathroom shower room- no blind or curtain, broken radiator cover, skirting rotten, flooring not sealed. • Upstairs shower room -flooring is not properly sealed and shower cannot be used, as there is no shower hose or attachment. • Bedrooms- in the bedrooms there was torn wallpaper, broken furniture, stained ceilings no lampshades and in some cases no curtains. • Upstairs fire exit door-the frame around this is rotten. • Garden- extremely uneven, no proper path, water backs up in the drain and floods outside the conservatory and kitchen. • Exterior lighting- lighting at the top of the fire exit not working, light for the garden not working. The condition of the building was totally unacceptable and does not offer a comfortable, homely or safe environment to the residents. See also the section on health and safety requirements with regards to this and the details of the immediate requirement notices served at the time of the visit. The poor state of the building was discussed with the manager and the regional manager at the time of the visit. Failure to provide a suitable and safe environment for the residents may result in the Commission considering enforcement action. A meeting will be held with senior representatives of the DS0000066301.V309028.R01.S.doc Version 5.2 Page 23 organisation to further discuss the concerns. Individual requirements have not been made for the work that needs to be carried out but overall requirements that cover all of the work that needs to be done. The home appeared to be clean and there were not any unpleasant odours. It was evident that the staff are trying to maintain decent level of hygiene and cleanliness in difficult conditions. DS0000066301.V309028.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to the service. Staff are receiving most of the necessary training to give them the skills to meet residents’ current needs and provide an appropriate service for them. Staffing levels are not adequate to provide an appropriate or safe service to the residents. New staff are properly recruited and the necessary checks carried out. This helps to protect residents and keep them safe. Staff do not have the opportunity individually or collectively to discuss their own development or any problems and developments within the service and therefore feel unsupported. EVIDENCE: Staffing levels have been cut and there are now three staff on the daytime shifts instead of four. Night-time staffing levels have remained the same with two waking night staff on duty. This cut was due to budgetary constraints and the needs of the residents were not reviewed before this decision was taken. All of the residents need a lot of support and supervision. In one case due to DS0000066301.V309028.R01.S.doc Version 5.2 Page 25 one residents challenging and aggressive behaviour he needs two staff to take him out and if he is in the house two staff must be there. Another resident also requires two staff to take him out. Therefore with only three staff on duty residents’ opportunities to go out or to participate in activities has been restricted. In addition to supporting residents the staff also have responsibilities for cooking, cleaning, shopping and taking and collecting one resident from the day service each day. Therefore staffing levels are not sufficient to meet residents’ needs appropriately or safely. Staff spoken to expressed their concerns about the reduction in staffing levels and its effect on the residents. This was discussed with the manager and regional manager at the time of the inspection and they were informed that minimum staffing must return to its previous levels. Staffing levels should only change as a result of a review and change in residents needs. The shift pattern has changed recently. The daytime shifts are now 8 a.m. to 3 p.m., 2 p.m. to 9 p.m. This shift pattern is in line with good practice and should mean that staff no longer routinely work long days. However there are a number of staff vacancies and the reality is that although bank staff are used the staff team are frequently working double shifts, working on their days off or extending their shifts. In addition to this there is an expectation that on call staff will cover shifts if there is a problem. Even though they may have been working that day or due to work again the next day. The manager does not have the authority to get agency staff to cover shifts. This combined with the cut in staffing levels has resulted in staff feeling tired and pressured to cover shifts to maintain the service to the residents. Sufficient appropriately experienced staff must be available to cover shifts at the home and to provide continuity of care, as far as is reasonable. This should mean that residents are supported by staff that they now and that now them and also that staff do not work excessive hours. 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 for the newest member of staff. There was also evidence that staff employed at the home prior to CMG taking over had new CRB (Criminal Records Bureau) checks and that any missing information and details had been requested and was being gathered. From discussions with staff and looking records it was apparent that the organisation had been providing a lot of training to staff. All staff have had an induction to CMG and other training has included protection of vulnerable adults, first aid, and report writing. One member of staff said that the training was very good. However standard 19 gives details of training that is required to meet residents’ health needs. Staff that were working at the home prior to CMG taking over have NVQ level 2 and in some cases NVQ level 3. New staff will be able to undertake NVQ training. Therefore the staff team are being DS0000066301.V309028.R01.S.doc Version 5.2 Page 26 provided with most of the training and skills that they need to meet the needs of the residents. Staff have not been receiving supervision and regular staff meetings have not been held. Staff spoken to said that they feel unsupported both by the manager and the organisation. Staff must receive regular, recorded supervision at least six times per year, to give an opportunity for monitoring of work and professional guidance. Also for staff to discuss concerns individually. Regular staff meetings must take place (a minimum of six per year) and be recorded and actioned. This will give staff collectively an opportunity to discuss concerns, the care of residents and the development of the service. DS0000066301.V309028.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to the service. The organisation has not robustly supported the manager and staff team to develop and improve the service. Although the registered provider monitors the service to check the quality of the service provided to residents this has not resulted in deficiencies in the service been adequately addressed. The residents are not living in a safe environment. EVIDENCE: At the time of the last inspection the management arrangements for the home were not robust. A manager has now been appointed and has begun the process to enable him to apply for registration with the Commission. This manager has only been in post for approximately 2 months. The regional operations manager for the home is also new and has been in post for slightly longer. In July the regional operations manager produced an action plan for DS0000066301.V309028.R01.S.doc Version 5.2 Page 28 improvement for the home. However, as stated previously, the staff team do not feel that they are supported by the manager or by the organisation or that the improvement of the service is a priority. There is a tremendous amount of work to be done not only to bring the environment up to an appropriate standard but to develop the service as well. The staff team and residents should be involved in this and supported through changes. A representative of the organisation has been carrying out monthly monitoring visits as required by the previous inspection but requirements from these reports have not been fully actioned. Most of the health and safety checks are carried a 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. Fire drills are held monthly. However the does not appear to have been a fire drill involving the night staff and in addition the fire procedure does not cover the action that should be taken in the event of a fire during the night. A fire procedure must be developed to ensure that staff are aware of the correct action to be taken in the event of a fire at night when all the residents are in bed and less staff are on duty. A fire drill must be held that involves staff that work nights so that they are clear about the required action to be taken in the event of a fire at night. There is an exterior fire escape from the first floor into the garden. The light at the top of this fire exit was not working, nor was the light in the garden. At the bottom of the fire escape the ground was extremely uneven and there was no proper path to the assembly area. The Inspector was then informed that some of the emergency lights were not working. Therefore if there were to be a fire during the night the means of escape would not be lit and would therefore place staff and residents at risk, as would the condition of the garden. It was of great concern that no action had been taken to address any of these issues and as a result of this an immediate requirement notice was issued. This required that all the emergency lighting and the garden light be repaired or replaced within 24 hours. Also that repairs/improvements be made to the garden within three days to allow for a safe exit in the event of an evacuation. The landlords gas safety certificate should have been renewed in January 2006 and this has not been done. Therefore the necessary gas safety checks have not been carried out and this could place staff and residents at risk. A satisfactory landlords gas safety certificate must be obtained a copy forwarded to the Commission. DS0000066301.V309028.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 1 25 3 26 1 27 1 28 1 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 1 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 X LIFESTYLES Standard No Score 11 2 12 1 13 3 14 1 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 1 3 3 X 3 X X 1 X DS0000066301.V309028.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. 1. Standard YA5 Regulation 4,5 Requirement The organisation must provide each resident with a fully costed contract/statement of terms and conditions as detailed in standard 5.2. Care plans must be reviewed with the resident and significant others at least every six months and updated to reflect changing needs. (Previous timescales of 31/03/05, 31/07/05 & 31/03/06 not met). Risk assessments must be up to date and reviewed regularly Residents must be supported and enabled to take part in appropriate activities both in the home and in the community. All windows must have suitable blinds or curtains to ensure that residents have privacy when in their bedrooms or in the bathroom. Accessible, up to date and accurate records relating to residents healthcare must be kept. All staff must receive the appropriate training to DS0000066301.V309028.R01.S.doc Timescale for action 31/10/06 2. YA6 15 31/10/06 3 4. YA9 YA14 13 16 30/09/06 31/10/06 5 YA18 12 31/08/06 6. YA19 17 30/09/06 7. YA19 13 30/09/06 Version 5.2 Page 31 administer rectal Valium 8. YA19 13 Guidelines must be in place for the action to be taken in the event that a trained member of staff is not available to administer rectal Valium when a resident requires this. The list of staff names authorised to give medicines, which includes a record of their signed initials and signatures must be kept available for reference with the MAR (Medication Administration Record) charts. Any staff witnessing the administration of medication must have received the necessary training to do this and have been deemed competent to do so. Medication Administration Records (MAR) must clearly indicate the correct medication that is to be given to the resident. Any handwritten amendments or additions to Medication Administration Records (MAR) sheets must be signed and dated by the person making the entry. (Previous target of 31/03/06 not met). Detailed guidelines must be in place on the action to be taken in the event of a medication error occurring. The responsible individual must ensure that appropriate arrangements are in place for all residents to receive any monies that they are entitled to. All areas of the home must be kept in a good state of repair externally and internally. (Previous timescale of DS0000066301.V309028.R01.S.doc 31/08/06 9. YA20 13 31/08/06 10. YA20 13 31/08/06 11. YA20 13 31/08/06 12. YA20 13 31/08/06 13. YA20 13 31/08/06 14. YA23 13 30/09/06 15. YA24 23 31/10/06 Version 5.2 Page 32 30/06/06 not met.) 16. YA28 16 All areas of the home must be appropriately decorated. (Previous timescale of 31/03/05, 31/10/05 & 30/06/06 not met.) Staffing levels must be sufficient to meet residents’ needs appropriately and safely at all times. Regular staff meetings must take place (a minimum of six per year) and be recorded and actioned. Sufficient appropriately experienced staff must be available to cover shifts at the home and to provide continuity of care, as far as is reasonable. All staff must receive regular recorded supervision at least six times a year with a senior/manager in addition to regular contact on day-to-day practice. (Previous timescale of 30/04/06 not met.) A fire drill must be held that involves staff that work nights. A night time fire procedure must be developed. A satisfactory landlords gas safety certificate must be obtained and a copy forwarded to the Commission. 31/10/06 17 YA33 18 15/09/06 18. YA33 18 30/09/06 19. YA33 18 30/09/06 20. YA36 18 30/09/06 21. 22. 23. YA42 YA42 YA42 23 23 13 15/09/06 15/09/06 15/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000066301.V309028.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: 0845 015 0120 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 DS0000066301.V309028.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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