Inspection on 23/11/06 for Victoria House

This inspection was carried out on 23rd November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 18 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 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 Key Unannounced Inspection 23rd November 2006 10:00 DS0000066301.V321689.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.V321689.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.V321689.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.V321689.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st August 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.V321689.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 7 hours. The interim manager, staff and most of the residents were spoken to. 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. Relatives are concerned about the staff changes and in particular the absences of some of the management team. A meeting is going to be arranged for relatives after Christmas so that this can be discussed and relatives can get an update on what is happening. 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: Residents still need to have more activities both in the home and in the community so that they have an interesting and fulfilling lifestyle. There needs to be sufficient staff to support them in this. DS0000066301.V321689.R01.S.doc Version 5.2 Page 6 Medication still needs to be more carefully administered to ensure that residents get the right medication safely. More work is needed in the house to ensure that refurbishment is completed and that residents live in a comfortable and pleasant home and that is suitable for their needs. 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. DS0000066301.V321689.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.V321689.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2&5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The organisations assessment procedure is appropriate and would be used if any vacancies arose at the home. Residents now 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 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 been issued with contracts/terms and conditions as required by the previous inspection. These were in individual files and there was also confirmation that copies had been sent by recorded delivery to representatives to sign. Not all have been returned but this is being followed up. Therefore residents have detailed information about the service that they are entitled to. DS0000066301.V321689.R01.S.doc Version 5.2 Page 9 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ plans contain detailed information so that staff can meet their needs. Risk assessments have been reviewed and therefore contain up to date information about residents’ needs. EVIDENCE: All of the residents have plans which give details of how they need/like to be supported. Areas covered included health, self-care, communication, psychological needs, relationships and sexual needs, community presence and cultural needs. Since the last inspection all of the care plans have been updated and reviews have either taken place or have been arranged. A selection of care plans were examined during the visit and the information contained in them was detailed and relevant. They also indicate strengths and DS0000066301.V321689.R01.S.doc Version 5.2 Page 10 priorities and what individuals like and dislike. For example one residents’ care plan states that he needs to be more independent in terms of personal hygiene and dressing. It also indicates that he likes to dress in his countries traditional clothing for special occasions. Staff said that they have been more involved in the care plans and reviews. Residents’ plans contain detailed information so that staff can meet their needs. 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. Risk assessments have been reviewed and updated as required by the previous inspection. These include updated guidelines for managing challenging behaviour. Therefore 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. They are able to discuss and decide what they are going to do and be involved in decisions about their lives. DS0000066301.V321689.R01.S.doc Version 5.2 Page 11 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): 11, 12, 13, 14, 15, 16 & 17 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although the residents are encouraged to take part in activities and to be part of the local community this is still limited and is affected by 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. However there is a concern that the food budget is not really sufficient to continue to offer residents the choice and variety that they have been accustomed to. DS0000066301.V321689.R01.S.doc Version 5.2 Page 12 EVIDENCE: Residents are encouraged and supported to do as much as they can for themselves. For example staff said that one of the residents now takes his washing to the laundry. As previously stated the priorities for another residents are to make him more independent in terms of his personal hygiene and dressing. 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 others choose not to attend day services. One of the residents has started to attend a local college and he said that he was enjoying this. Residents do go out to local shops, the library and restaurants. Some of the residents are well known in local shops and restaurants. The manager is looking at the possibility of using the day service attached to another care home operated by CMG and will be meeting with them in the near future. Staff are trying to negotiate additional days for the person that attends day services on a part time basis. As required by the previous inspection the number staff on duty has increased with a fourth member of staff being on duty from 11 a.m. during the day. However feedback from staff was that there are often only three staff on duty especially at the weekend and this does limit activities. This is particularly because two of the residents dont like to go out very much and due to the challenging behaviour of one resident two staff must always be present when he is in the home or with him when he goes out. One resident likes to go to church on Sunday and there are not always sufficient staff to take him. Five of the six residents went to Clacton for a two-week holiday whilst work was being carried out in the house. The sixth resident did not want to go and stayed at another home for a couple of weeks with support from the staff team. Therefore although the situation with regards to activities for residents has started to improve there is still more work to be done. 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. In view of the improvements and changes that have been made the timescale for completion of this requirement has been extended. 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. DS0000066301.V321689.R01.S.doc Version 5.2 Page 13 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 said that they have been trying to introduce different foods into the menu and that they cook Caribbean food sometimes and residents had recently tried liver. Records are kept of what each person has to eat. Therefore residents are given meals that meet their needs and likes. However staff expressed concerns that the food budget was limited and did not allow for as much choice or “treats” as they would like. The organisation must review the food budget and either adjust this or provide evidence that it is adequate to meet residents needs and to cover catering costs. DS0000066301.V321689.R01.S.doc Version 5.2 Page 14 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 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. The administration and recording of medication is still not robust and needs to be improved to ensure that the residents are given prescribed medication as safely as possible and to minimise the risk of error. For this reason, the overall quality rating for this group of standards is judged as poor. 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 DS0000066301.V321689.R01.S.doc Version 5.2 Page 15 own towels and flannels to use as opposed to communal ones. Therefore residents receive appropriate personal care. The bedrooms and the bathroom now have curtains or blinds as required by the previous inspection and this affords the residents appropriate privacy. 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. Evidence was available that residents have had checks from the optician, dentist and when appropriate chiropodist. One of the residents does not cooperate with checks and when he refuses checks this is recorded. My health booklets have been introduced and these had details and information with regards to appointments and healthcare. Therefore residents’ healthcare needs are being met. One of the residents is prescribed rectal Valium to be administered in the event of a prolonged seizure. The previous inspection required that all staff must receive the appropriate training to administer rectal Valium so that they can safely meet this residents needs. Most of the staff team have received training and therefore the timescale for completion of this requirement has been extended to allow for the remaining staff to receive the training. As required by the previous inspection guidelines are 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 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. 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. There is a list of staff names and initials in the front of the medication folder for staff that can “handle medication” but as at the last inspection it is not clear which staff are deemed competent to administer medication and which staff are only competent to witness medication administration. In addition some of the staff included on the list are bank staff that do not come to the home any more. 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. If staff have been deemed competent to witness but not administer medication this must clearly be indicated. 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 still 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 DS0000066301.V321689.R01.S.doc Version 5.2 Page 16 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. In one case there had been some signatures against a medication but it had then been crossed out. It was stated that this was because this person now had liquid medication and not tablets. However some staff had signed the liquid 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. On the day the inspection the medication for the day had been placed in a carrier bag and then taken to the kitchen to be administered from there. The interim manager did say that this was against the organisations medication procedure and that she would be speaking to the staff concerned. If the administration of medicines is required away from the point of medicines storage, it is necessary to provide for the secure carriage of medicines for administration and immediate security in the case of the carer having to deal with an emergency. The administration of medication is not robust and the registered person must make appropriate arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The requirements are made to protect residents and ensure that they are given the correct medication safely. Some of the requirements were made at the time of the last inspection and must be addressed. Ongoing failure to meet requirements may result in the Commission considering enforcement action. There are now guidelines in place on the action to be taken in the event of a medication error occurring. 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. DS0000066301.V321689.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 Quality in this outcome area good. This judgement has been made using available evidence including a visit to this 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. Appropriate action has been taken when possible adult protection concerns have been raised. 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. Some adult protection issues have arisen since the last inspection. These were taken seriously and the appropriate action was taken to safeguard residents. At the time of this inspection these issues have not all been concluded. 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 DS0000066301.V321689.R01.S.doc Version 5.2 Page 18 staff have received “Digman” training, which focuses on the dignified management of challenging and aggressive behaviour. Guidance is in place for working with a resident that continues to exhibit challenging and aggressive behaviour. Staff spoken to said that they felt that this person was getting used to the boundaries that were being set and that staff were dealing with the problems more consistently. This helps 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. The difficulties with accessing residents’ accounts have been sorted out as required by the previous inspection DS0000066301.V321689.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The residents live in a home that is suitable for their need in terms of its size and location. The overall environment has improved but work to the building has not been completed. This work needs to be finished to ensure that the residents are living in a homely and 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 most 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 DS0000066301.V321689.R01.S.doc Version 5.2 Page 20 adaptations due to their mobility needs and the home does not have any adaptations or specialist equipment. At the time of the last inspection the condition of the building was totally unacceptable and did not offer a comfortable, homely or safe environment to the residents. Since then a lot of work has been carried out on the house. There are new windows and doors, the building has been decorated throughout and new carpets fitted. New curtains have been purchased and some soft furnishings. There is new furniture in communal rooms and residents bedrooms. The garden has been paved. Therefore the standard of the accommodation has improved greatly. However a tour of the building found that there was still work that has not been carried out and finished. In addition it was disappointing to find that the same carpet had been fitted in the office, lounge, hall and bedrooms. Therefore the rooms had not really been personalised and residents had not been given a real choice about their rooms. Listed below are examples of some of the things found during the tour of the building. This list is not exhaustive but is included to highlight that further work is needed to ensure that the residents live in a homely, comfortable and safe environment. • A new TV in a cabinet has been purchased for the lounge. However the old TV is still on a high shelf above the new one • Radiator covers have not been painted. • The shower still does not work. There are some cracked tiles and they still need grouting. • Chipped and in some cases broken units have been left around the hand basins in residents’ bedrooms. • In one bedroom the dado rail finishes half way across the wall and there is a piece of wood fixed to the wall that does not appear to have a purpose and it has been left and painted over. The area around the curtain rail has not been finished during decorating. • In the downstairs toilet there is still a piece of wood fixed across the top of the cistern to prevent residents “damaging” this. This looks unsightly and is not in keeping with a domestic, homely environment. • All of the doors still have locks that need a key to open them from the outside. This includes the one at the top of the stairs and to the toilet. Therefore residents do not have free access to this. Some of the residents do know how to open these doors but not all. • There was not any toilet paper, towels or soap in the toilet. This is because one of the residents blocks the toilet. • In one bedroom there was a strong smell of urine. • The door to and from the garden cannot be opened from the outside. DS0000066301.V321689.R01.S.doc Version 5.2 Page 21 All of the above issues still need to be addressed and the work at the home needs to be completed to ensure that the residents live in a home that is homely, comfortable and maintained to a satisfactory standard. 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. All areas of the home must be kept in a good state of repair externally and internally. All areas of the home must be appropriately decorated. As so much work has been carried out already the timescale for the completion of the requirements on the environment have been extended to allow for the outstanding issues to be addressed. In addition all areas of the home must be kept free of offensive odours and all toilets must have toilet paper, soap and towels. This will assist in promoting a good standard of hygiene and lessen the risk of infection as well as being a basic standard for any toilet facility. Alterations must be made to the toilet door so that residents can access this area when they need. The home appeared to be clean and there were no other unpleasant odours. It was evident that the staff maintain a decent level of hygiene and cleanliness. DS0000066301.V321689.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. Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to the service. Staff are receiving 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 a good service to the residents. For this reason, the overall quality rating for this group of standards is judged as poor. Staff are properly recruited and the necessary checks carried out. This helps to protect residents and keep them safe. 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 interim manager. EVIDENCE: DS0000066301.V321689.R01.S.doc Version 5.2 Page 23 As required by the previous inspection the number staff on duty has increased with a fourth member of staff being on duty from 11 a.m. during the day. The interim manager said that she had discussed staffing levels with the staff and had believed them to be satisfactory. However feedback from staff during the visit was that there are often only three staff on duty especially at the weekend and this does limit activities. This is particularly because two of the residents dont like to go out very much and due to the challenging behaviour of one resident two staff must always be present when he is in the home or with him when he goes out. One resident likes to go to church on Sunday and there are not always sufficient staff to take him. 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 although better are still not sufficient to meet residents’ needs appropriately or safely. The staffing levels prior to the last inspection had been four staff per daytime shift including weekends and staff felt that was what was required. The requirement from the previous inspection with regard to staffing levels remains unmet but as improvements have been made the timescale for implementation has been extended to enable the organisation to review the situation again and make further adjustments. 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 two of the senior staff are on sick leave. 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. The two remaining seniors are covering most shifts between them to ensure that there is an experienced shift leader. The interim manager said that they were due to interview for support workers posts. Shortly after the inspection it was confirmed that one of the seniors would not be returning to work and therefore this post will be advertised as soon as possible. The requirement that sufficient appropriately experienced staff must be available to cover shifts at the home and to provide continuity of care, as far as is reasonable therefore remains unmet. But as action is being taken the timescale for completion will be extended to allow for the recruitment to be completed. This should mean that residents are supported by staff that they know and that know 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. DS0000066301.V321689.R01.S.doc Version 5.2 Page 24 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. Some staff are still waiting for training that is required to meet a residents’ health need but other staff have received this training. 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 provided with most of the training and skills that they need to meet the needs of the residents. The interim manager has started supervision for all of the staff and has also held staff meetings. This will give staff collectively an opportunity to discuss concerns, the care of residents and the development of the service. Staff spoken to said that they feel supported by the interim manager and that they have the opportunity to be more involved in the running of the home. DS0000066301.V321689.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): 37,39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has not been consistently managed. However the interim manager has started to address requirements from the previous inspection and the staff team are being provided with support and guidance. Although the registered provider monitors the service to check the quality of the service provided to residents the report from the visits are not available at the home and therefore staff are not always aware of or clear about the action that they need to take to address deficiencies. The residents are living in a safe environment. EVIDENCE: DS0000066301.V321689.R01.S.doc Version 5.2 Page 26 At the time of the last inspection a new manager had been in post for approximately 2 months. Unfortunately at the time of this visit the manager had been absent from the home for sometime and has since then resigned his post. Some interim management arrangements have been put in place and a registered manager from another service has been covering the home for three days per week. Although this person had not been working at the home for very long it was evident that she had started to address issues and that staff were feeling more supported and they said, “things were starting to pick up”. Staff also said that they were looking forward to some stability in the management of the home and an opportunity to develop the service. A new manager has been appointed and it is hoped that he will be able to start working at the home in the New Year. The service manager said that the intention was that there would be a handover period between the interim manager and the new manager. This should not only offer support and a better induction to the new manager but also give some support, stability and consistency to staff and residents. Most of the 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. Fire drills are held monthly. There has been a fire drilling involving two of the night staff but not all of them as required by the previous inspection. All staff that work nights must be involved in fire drills so that they are clear about the required action to be taken in the event of a fire at night. As this process has started the timescale for completion has been extended to allow for further drills to be held. A fire procedure has been 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. This was also a requirement of the previous inspection. An immediate requirement notice was issued at the time of the last inspection and the specified work was carried out on the emergency lighting and the garden to allow for a safe exit in the event of an evacuation. During the course of the visit the LFEPA (London Fire & Emergency Planning Authority) visited to carry out an inspection. They highlighted the need for some signs and for an extinguisher to be fitted to the wall. They also said that some of the doors did not close properly and therefore would not provide an adequate seal in the event of a fire. The fire officer said that they would visit the following week to check compliance. This was discussed with the representative of the organisation and the handyman visited the home that afternoon to remedy the problem. The necessary gas safety checks have been carried out and a satisfactory landlords gas safety certificate has been obtained to confirm that the gas services are safe. DS0000066301.V321689.R01.S.doc Version 5.2 Page 27 A representative of the organisation has been carrying out monthly monitoring visits as required by the previous inspection but reports from these visits could not be found at the home. Therefore it could not be confirmed that staff were aware of the action that needed to be taken to address any issues identified during the monitoring visit. For example a member of staff said that the issue of the doors not shutting properly had been identified at the monitoring visit a few days previously. However it appeared that not everyone was aware of this and no action had been taken. The person responsible for the monitoring visits must ensure that the staff team are aware of any required action and also that a copy of the written monitoring report is made available to the home as soon as possible. Issues identified can then be addressed as needed within an appropriate time frame. In addition a copy of the monthly monitoring report must be sent to the Commission each month. Representatives of the organisation are aware of this as it was discussed at meetings with senior managers and agreed that this would happen. DS0000066301.V321689.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 3 ENVIRONMENT Standard No Score 24 2 25 3 26 2 27 2 28 2 29 3 30 2 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 3 12 1 13 3 14 1 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 X 3 X 2 X X 2 X DS0000066301.V321689.R01.S.doc Version 5.2 Page 29 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA14 Regulation 16 Requirement Residents must be supported and enabled to take part in appropriate activities both in the home and in the community. (Previous target of 31/10/06 not met). The organisation must review the food budget and either adjust this or provide evidence that it is adequate to meet residents needs and to cover catering costs. All staff must receive the appropriate training to administer rectal Valium. (Previous target of 31/09/06 not met). Any handwritten amendments or additions to Medication Administration Records (MAR) sheets must be signed and dated by the person making the entry. (Previous targets of 31/03/06 and 31/08/06 not met). The list of staff names authorised to give medicines, which includes a record of their signed initials and signatures must be kept available for DS0000066301.V321689.R01.S.doc Timescale for action 31/03/07 2 YA17 16 28/02/07 3. YA19 13 31/03/07 4. YA20 13 31/01/07 5. YA20 13 31/01/07 Version 5.2 Page 30 6. YA20 13 7. YA20 13 8. YA20 13 9. YA24 23 10 11. YA27 YA28 23 16 12 13 14. YA30 YA30 YA33 13 13 18 reference with the MAR (Medication Administration Record) charts. (Previous target of 31/08/06 not met). Any staff witnessing the administration of medication must have received the necessary training to do this and have been deemed competent to do so. (Previous target of 31/08/06 not met). Medication Administration Records (MAR) must clearly indicate the correct medication that is to be given to the resident. (Previous target of 31/08/06 not met). If the administration of medicines is required away from the point of medicines storage, it is necessary to provide for the secure carriage of medicines for administration and immediate security in the case of the carer having to deal with an emergency. All areas of the home must be kept in a good state of repair externally and internally. (Previous timescale of 31/10/06 not met.) Alterations must be made to the toilet door so that residents can access this area when they need. All areas of the home must be appropriately decorated. (Previous timescale of 31/10/06 not met). All areas of the home must be kept free of offensive odours. All toilets must have toilet paper, soap and towels. Staffing levels must be sufficient to meet residents’ needs appropriately and safely at all times. (Previous timescale of 15/09/06 not met). DS0000066301.V321689.R01.S.doc 31/01/07 31/01/07 31/01/07 31/03/07 31/03/07 31/03/07 31/12/06 31/12/06 28/02/07 Version 5.2 Page 31 15. YA33 18 16. YA39 26 17. 18. YA39 YA42 26 23 Sufficient appropriately experienced staff must be available to cover shifts at the home and to provide continuity of care, as far as is reasonable. (Previous timescale of 30/09/06 not met). The person responsible for the monitoring visits must ensure that the staff team are aware of any required action and also that a copy of the written monitoring report is made available to the home as soon as possible. A copy of the monthly monitoring report must be sent to the Commission each month. Fire drills must be held that involve all staff that work nights. (Previous timescale of 15/09/06 not met). 28/02/07 31/01/07 31/01/07 31/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000066301.V321689.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 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 DS0000066301.V321689.R01.S.doc Version 5.2 Page 33 - 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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