Inspection on 06/06/07 for Victoria House

This inspection was carried out on 6th June 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 21 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 23/11/06

Victoria House 21/08/06

Victoria House 27/01/06

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Victoria House 62/64 George Lane South Woodford London E18 1LW Lead Inspector Jackie Date Key Unannounced Inspection 6 – 29th June 2007 09:45 th DS0000066301.V341856.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.V341856.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.V341856.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Victoria House Address 62/64 George Lane South Woodford London E18 1LW 020 8530 3591 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.caremanagementgroup.com Care Management Group Limited vacant post Care Home 6 Category(ies) of Learning disability (0) registration, with number of places DS0000066301.V341856.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd November 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 £1,400 to £1,968 per week. This information was provided by the manager at the time of the inspection. Information about the service provided is contained in the service users guide. DS0000066301.V341856.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and started at 9:45 am. It took place over 7 hours. This was a key inspection and all of the key inspection standards were tested. A specialist pharmacist inspection was carried out on 12th June and the report from this visit is included in the section relating to medication. Staff were asked about the care that residents receive, and were also observed carrying out their duties. Where possible residents were asked to give their views on the service and their experience of living in the home. All of the shared areas and bedrooms were seen. Staff, care and other records were checked. Relatives were contacted and asked for their opinions of the service. Feedback was received from three relatives. In addition the inspector attended 3 relatives meetings earlier this year and had the opportunity to speak to most of the relatives. Keyworkers supported the residents to complete feedback forms or completed them on the residents’ behalf. Services are now required to complete an AQAA (Annual Quality Assurance Assessment) and the completed form was received on 22nd June 2007. Information provided in this document also formed part of the overall inspection. This was a key inspection and all of the key inspection standards were tested. The inspector would like to thank the residents and staff for their input during the inspection. Five requirements have been made on more than one occasion. Failure to demonstrate compliance by the new target date will result in the Commission considering enforcement action to secure compliance. What the service does well: Staff continue to work hard to try to give residents the care and support that they need during a time when there have been a lot of changes. Although there are still staff vacancies a regular group of staff have been covering these and therefore residents have been receiving a service from staff that they know. Staff on duty knew the residents well and were able to demonstrate a good awareness of residents’ needs, likes and differing ways of communicating. DS0000066301.V341856.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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.V341856.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.V341856.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. People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. The organisation’s assessment procedure is appropriate and would be used 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. The residents have a contract between themselves and the provider. The contracts were available at the home and copies were seen in residents’ files. Therefore residents have details about the service that they are entitled to. DS0000066301.V341856.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): 6, 7 & 9. People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Residents’ plans focus on their individual needs and abilities and contain detailed information so that staff can meet their needs. Risk assessments are reviewed and updated when needed. They 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. 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 priorities and what individuals like and dislike. For example one resident’s care plan states that he enjoys a bath, helps with the hoovering and has a passion for spicy food. Care plans seen were up to date and gave clear information about individual residents and demonstrated that DS0000066301.V341856.R01.S.doc Version 5.2 Page 10 staff have knowledge about individuals. Care plans are reviewed monthly by staff and 6 monthly reviews are held to which the resident, their relatives and representatives are invited. Reviews have been arranged for all of the residents and these are scheduled between 12/6/07 and 21.7.07. Residents’ plans contain detailed and current 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 areas including client welfare, 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 are up to date. These include updated guidelines for managing challenging behaviour and minimising the effects of this. For example one resident has been the victim of several assaults by another resident. Risk assessments and guidelines have been updated to offer more protection to this person whilst the issues are being addressed. 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.V341856.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. People using the service experience adequate quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Although the residents are encouraged to take part in activities and to be part of the local community this needs to be developed further and is affected by limited funding. 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 still a concern that the food budget is not really sufficient. EVIDENCE: Residents are encouraged and supported to do as much as they can for themselves. For example staff said that one of the residents will help to tidy his room and put his ironed clothes away. Another does his own cereal and DS0000066301.V341856.R01.S.doc Version 5.2 Page 12 makes his coffee. Staff spoken to said that residents are doing a lot more now, both for themselves and in terms of activities. One of the residents attends a local authority day service for five days and another for two days each week. Residents now have the opportunity of using the day service attached to another care home operated by CMG (Lilliputs). Two of the residents have quite clearly said that they do not wish to go to this service. A third said that he enjoys going to Lilliputs and likes swimming, baking, going to the cinema and going shopping. Staff said that they are not yet sure if another resident likes going to Lilliputs as he is unable to express his opinion. They are monitoring this closely. Staff did say that this resident does enjoy the ride to Lilliputs. This day service is not local to Victoria House and residents are taken there in the home’s vehicle. However there are not many drivers and therefore if a driver is not available residents cannot always go. This was the case on the day of the inspection when the manager was delayed due to traffic congestion and there was not another driver available. Residents were unable to go to the day service. Appropriate transport arrangements must be in place so that residents can attend their activities regularly. Residents do go out to local shops, to the cinema, the library and restaurants. Some of the residents are well known in local shops and restaurant. One resident likes to go to church on Sunday and this does happen as often as possible. The staff were in the process of organising holidays for those residents that wish this. Three residents are going to Devon together and a fourth resident said that he is going to Spain. He was really looking forward to this. Information in the AQAA (Annual Quality Assurance Assessment) states lack of funds for improved activities as being a barrier to improvement. The inspector was informed that there is not a budget to pay for activities. Also residents’ financial records indicate that residents have paid for staff expenses for activities and this included meals and refreshments for staff. Staff spoken to also said that there was not any money for activities. Further information and requirements relating to residents’ finance can be found in the section relating to concerns, complaints and protection. This was discussed with the Regional Operations manager and she said that there was an activities budget and that the organisation would pay for staff lunches, staff expenses and activities. Adequate funding must be in place to support activities for residents and to pay for staff expenses so that they can facilitate these activities. The requirements with regard to activities relate to both standards 12 & 14. 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 DS0000066301.V341856.R01.S.doc Version 5.2 Page 13 same organisation. Relatives meetings are now being held regularly and therefore relatives have been given the opportunity to discuss issues and concerns and to find out what is happening at the home. 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. For example one persons care plan said that he likes ice cream, tea, beer and coffee and that he dislikes fruit, biscuits and juice. One of the residents has diabetes and he is supported to eat appropriately. Some of the residents are not able to ask for a drink or something to eat but staff spoken to knew how to interpret their non-verbal communication. For example one resident will bang his foot on the floor if he wants something. Another will go and stand at the kitchen if he is hungry or wants a drink. Staff said that they have been trying to introduce different foods into the menu and that they cook Caribbean food sometimes. Therefore residents are given meals that meet their needs and likes. However staff again expressed concerns that the food budget was tight. Examination of the kitchen found that there was very little stock of food in the cupboards, fridge or freezer. The inspector was told that this was because they needed to do a ‘big shop’. Information in the AQAA (Annual Quality Assurance Assessment) ‘What could we do better’ section states “ increase food budget”. The previous inspection required that 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. Some increases were made to the food budget and the Regional Operations manager said that she had recently agreed £150.00 for the home to stock up the freezer. However in light of the information provided to the inspector and observations of food stocks on the day of the visit this requirement has not been adequately addressed. DS0000066301.V341856.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. People using the service experience adequate quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Residents receive personal care that meets their individual needs and preferences. Residents’ healthcare needs are being adequately met but more needs to be done to ensure that they receive good quality proactive health care. 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. Standard 20: (inspected by a CSCI pharmacist inspector) There were a number of issues raised at the inspection involving medication in addition to the two outstanding requirements from the previous inspection. However, after discussing the issues with the home’s recently appointed manager, I feel that with his experience he is able to competently handle the issues. DS0000066301.V341856.R01.S.doc Version 5.2 Page 15 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. The plans also confirm how residents are supported to be as independent as possible. For example one member of staff said that two of the residents are more independent. They need to be encouraged to bath regularly and only require minimal supervision. For example staff knock on the door to check if the person is okay. Another resident can wipe himself if you give him a towel. Another resident will lead staff to the bathroom when he needs personal care. 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. 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. As previously stated some of the residents are not able to verbally indicate what they want, need or feel. However staff spoken to were aware of the behaviours that would indicate there was a problem. For example one of the residents cries when in pain and another just sits in one place. Staff then try to establish what the problem is. However two of the relatives spoken to said that they had been concerned that health issues had not been dealt with as fully as they would have expected. In one case a relative said that although their son had received some treatment it was not until they insisted that this was not adequate that he was taken to a chiropodist and the problem was resolved fairly quickly after that. Another relative said that they thought their son was limping and when staff were asked about this they shrugged their shoulders. The relative said that they expected more than this and that in the past the support around health issues had been very good. Therefore although residents’ healthcare needs are being adequately met more needs to be done to ensure that they receive good quality proactive health care. An announced inspection was conducted on 12.06.2007 by a CSCI pharmacist inspector (PI) following a referral from the home’s regulatory inspector. The referral indicated that there had been 5 requirements involving medication from the previous inspection, of which 2 (numbers 10 & 17) were still outstanding. The home’s new manager had been in post for about 3 months and recent incidents suggested that the control of medication was not robust DS0000066301.V341856.R01.S.doc Version 5.2 Page 16 with particular concern about the use of homely remedies and the administration of medication prescribed on a when required basis. There were a number of issues raised at the inspection involving medication in addition to the two outstanding requirements from the previous inspection. However, after discussing the issues with the home’s recently appointed manager, the pharmacist inspector was of the view that I feel that, with the his experience, the manager is able to competently handle the issues. On inspection it was found that medication prescribed on a when required basis now had forms in place with the medicine administration record (MAR) charts providing a protocol for administration, however, more information was required to adequately guide care staff. The home’s policy & procedure on the treatment of minor ailments with homely remedies meets the required standard and the only preparation currently kept is paracetamol. Advice was given with respect to checking with a service user’s GP or pharmacist before using homely remedies outside the home’s documented policy. The tables at the end of this report refer to these and other issues arising from the inspection. Requirements 10 to 21 and recommendations 1 to 4 have been made as a result of the pharmacist inspector’s findings. The title of the Royal Pharmaceutical Society’s guidelines, providing further information on the issues raised by the pharmacist inspector, is given at the end of the table of recommendations. References within these guidelines that have relevance to the issues raised have been included, where applicable, in the tables with the details of the requirements & recommendations. DS0000066301.V341856.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. People using the service experience adequate quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. There is a complaints procedure, available in a user-friendly format that would be followed in the event of any complaints being made. Complaints and concerns are being addressed but are not being recorded as complaints. Staff have 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. However the systems in place relating to residents finances do not offer them adequate safeguards from financial abuse. DS0000066301.V341856.R01.S.doc Version 5.2 Page 18 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. However relatives have raised a number of issues that the manager and organisation have been working through and many have been resolved. None of these issues have been recorded as complaints and therefore the complaints log is not an accurate reflection of concerns raised. It is important that all complaints/concerns are recorded and that the action taken to resolve these is noted. This can then inform service development and quality assurance and ensure that any concerns, issues or complaints are not overlooked and are appropriately dealt with. Also that the organisation can demonstrate more robustly that people expressing concerns are being listened to. 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 fully concluded. The staff team have received protection of vulnerable adults training and are aware of adult protection issues. Due to the behaviour of some of the residents staff have received “Digman” training, which focuses on the dignified management of challenging and aggressive behaviour. However there have not been any recorded incidents of restraint since the last inspection. Guidance is in place for working with a resident who continues to exhibit challenging and aggressive behaviour. Feedback from some relatives, staff and residents was that not all residents feel safe in the home. One resident in particular has been the subject of physical attacks from another resident. As a result of this his mother and social worker met with the manager to express strong concerns. Since then more stringent measures have been put in place to protect residents. Unfortunately this has meant that residents are being even more closely supervised by staff. Staff spoken to said that some residents are frustrated by this and do need to feel free and not have staff around all the time. However in the interim this is the only way that they can keep residents safe until a more permanent solution is found. 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. Three of the residents go to the bank to withdraw cash. Staff support them to do this. The family of another resident manage his finances. However CMG have been responsible for this home since November 2005, almost 19 months, and two of the DS0000066301.V341856.R01.S.doc Version 5.2 Page 19 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 CMG to express their dissatisfaction with this. One relative said that he believed that the manager had tried very hard to get the situation resolved but had been unsuccessful. Basic items are still being 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. However the Regional Operation manager said that this should not be an issue, as CMG will provide funding to these individuals until the situation is resolved. She also said that the organisation have been trying to resolve the problem but that the bank will not let CMG take over appointeeship. As far as the organisation are aware the previous owner and a previous member of staff are still signatories on these two residents accounts but CMG have been unable to confirm this and are not in a position to monitor these accounts. Therefore there are not adequate safeguards for residents with regards to their finances. During the checking of residents’ finance it was found that residents have been paying for activities and also paying staff expenses, including meals, when they are supporting residents in activities. In addition at least one of the residents had purchased bedroom furniture. Again the Regional Operation manager said that this should not be the case. She said that she would look into the matter. Residents’ finances need to be audited and residents must be reimbursed for any inappropriate expenditure. The above issues in relation to residents’ finances have not been identified during the course of the organisations own monitoring of the service and this also needs to be addressed to ensure that residents are being safeguarded from financial abuse. DS0000066301.V341856.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 & 30. People using the service experience adequate quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. The residents live in a home that is suitable for their need in terms of its size and location. The overall environment continues to improve but outstanding 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 adaptations due to their mobility needs and the home does not have any adaptations or specialist equipment. DS0000066301.V341856.R01.S.doc Version 5.2 Page 21 Ongoing improvements are being made to the home and attempts are being made to make the building more homely and welcoming. For example there are more pictures and photographs on the walls. Toilet locks have been changed so that residents can access these freely. Toilets had toilet paper, soap and towels. The flooring has been changed in one of the bedrooms and the hand basin has been removed. There is no longer a smell of urine in this room. One of the residents is very tall and a larger bed has been purchased for him. Some of the bedrooms have got new furniture and one resident confirmed that he had chosen his furniture. However a tour of the building found that there was still work that has not been carried out and finished. 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. • 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. • The skirting behind the bath in the downstairs bathroom is rotten and needs replacing. 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 an overall requirement that covers 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. As so much work has been carried out already the timescale for the completion of the requirement on the environment has been extended to allow for the outstanding issues to be addressed. However this requirement has been made on two previous occasions and must be addressed within this timescale. The home appeared to be clean and there were no unpleasant odours. Five of the staff team have attended infection control training. Different coloured mops and buckets are used to clean different areas of the home in line with good hygiene practice. It was evident that the staff maintain a decent level of hygiene and cleanliness. Standard 30: (partly inspected by a CSCI pharmacist inspector) DS0000066301.V341856.R01.S.doc Version 5.2 Page 22 An announced inspection was conducted on 12.06.2007 by a CSCI pharmacist inspector (PI) following a referral from the home’s regulatory inspector. The home’s procedure for treating blood spillages did not meet the standard required by the Department of Heath and the required disinfectant granules were not available in the home. The title of the Department of Health’s procedure referred to is given as reference 2 at the end of the table of recommendations and provides further information on this issue. DS0000066301.V341856.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32. 33, 34, 35 & 36. People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Staff have the opportunity individually and collectively to discuss their own development or any problems and developments within the service and feel supported by the manager. Residents are supported and protected by the organisations recruitment practice, including the recruitment relief staff. Staffing levels are sufficient, and staff receive the necessary training, supervision and support, in order to meet residents’ current needs and provide an appropriate service for them. EVIDENCE: As required by the previous inspection staffing levels have been reviewed and the number staff on duty has increased to 4 staff on duty during the daytime and two waking night staff. Staff spoken to said that the staffing was brilliant compared to last year. Although there are still some staff vacancies these are DS0000066301.V341856.R01.S.doc Version 5.2 Page 24 being covered by regular relief staff and by permanent staff members. This has meant that residents are receiving a service from a more consistent staff team that know them They also said that staffing levels are better and the bank staff are very regular and more like permanent staff. This has meant that residents have been able to do more both in the home and in the community. Staff said that with the exception of one resident the others seem much happier with a steady staff team. Although some staff are working long days they are not working as many as at the time of the previous inspection. In addition there is also a relief senior that covers shifts and this has meant that senior staff have not had to cover as many shifts. It is anticipated that the staffing situation will be resolved in the near future. Staffing levels are now sufficient to meet residents’ needs. 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. In addition there was information on file to confirm that the necessary checks had been carried out on relief staff. Therefore the recruitment procedure offers safeguards to residents. From discussions with staff and looking at 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, report writing, administration of rectal valium, medication, keyworking and food hygiene. One member of staff said that the training was very good but unfortunately it was often at CMG head office in Wimbledon, which meant a lot of travelling. Therefore the staff team are being provided with the training and skills that they need to meet the needs of the residents. The new manager has started supervision for all of the staff and has also held staff meetings. A member of relief staff confirmed that they attended staff meetings and that they had received some supervision. This gives staff collectively and individually 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 manager and that they have the opportunity to be more involved in the running of the home. DS0000066301.V341856.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42. People using the service experience adequate quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. The new manager has started to address requirements and issues about the home and residents are benefiting from this. However there is still a lot of work to be done so that the residents can receive a good quality service that meets their needs. The registered provider monitors the service to check the quality of the service provided to residents. The residents are living in a safe environment. DS0000066301.V341856.R01.S.doc Version 5.2 Page 26 EVIDENCE: There has been a new manager in post for approximately three month. The manager has the necessary skills and experience to manage this service. Feedback from staff was that the manager was hands on and supportive and has been getting to know staff and residents. They also said that he has made a lot of good changes, that “things are much better” and staff are working as a team. Staff felt that as a result of this and the more stable staffing the residents were much happier and also were doing a lot more. Feedback from relatives was that the manager is trying and things do seem to be improving. One relative said that the home seems to be going in the right direction but that she still has strong concerns. As a result of this she is going to pursue the possibility of her son moving to another home. Another relative said that the manager was trying but that she did not feel comfortable yet. The manager has started to address the issues and concerns in the service but it is evident that there is still a lot of work to be done to not only regain the confidence of relatives but to provide a good quality service to the residents. All of the necessary health and safety checks are carried out regularly by the staff team. For example fire call points are tested weekly, as are hot water temperatures. At the time of the visit it was noted that there had been a recurring problem with the water temperature in the bathroom. This was discussed with the manager and the thermostatic valve was replaced. The manager has confirmed that the temperature is now constant and within the safe guidelines. Fridge and freezer temperatures are tested daily. The manager has had a fire drill and night staff were included in this as required by the previous inspection. The portable appliance testing was overdue but this was arranged and the manager confirmed that this was carried out shortly after the visit. Therefore a safe environment is maintained. The quality of the service provided to the residents is monitored by the manager and by the organisation. The service manager carries out monthly monitoring visits to assess how effectively the home is operating to meet its stated aims and objectives, and reports are written. These indicate the action to be taken when deficiencies are identified. Copies of these reports were available in the home. DS0000066301.V341856.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 2 27 2 28 3 29 3 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000066301.V341856.R01.S.doc 3 3 X 3 X LIFESTYLES Standard No Score 11 3 12 2 13 2 14 2 15 3 16 3 17 2 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 3 3 3 X X 3 X Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes 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 targets of 31/10/06 & 31/03/07 not met). Appropriate transport arrangements must be in place so that residents can attend their activities regularly. Adequate funding must be in place to support activities for residents and to pay for staff expenses so that they can facilitate these activities. 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. (Previous target of 28/02/07 not met). A record must be kept of all issues raised or complaints made by residents, their relatives or representatives. Along with details of any action taken and the outcome. This can then be part of the quality DS0000066301.V341856.R01.S.doc Timescale for action 31/10/07 2 YA14 16 31/08/07 3 YA14 16 31/08/07 4 YA17 16 31/08/07 5 YA22 22 31/08/07 Version 5.2 Page 29 6 YA23 13 7 8 YA23 YA23 13 13 9 YA24 23 10 YA20 13(2) 11 YA20 13(2) assurance monitoring of the service and can indicate areas for development and improvement. Residents’ finances need to be audited and residents must be reimbursed for any inappropriate expenditure. Robust systems must be in place to safeguard residents from financial abuse. The responsible individual must ensure that appropriate arrangements are in place for all residents to receive and to have access to 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 timescales of 31/10/06 31/03/07 & not met.) In order to provide the complete medication profile for all service users (SU) all the medicines prescribed for each SU are required to be recorded on their current medicine administration record (MAR) chart. This includes medicines administered by health-professionals from outside the home, Controlled Drugs, medicines for external use, prescribed dietary supplements, any medicines not administered during the 4-week duration of the MAR chart, e.g. vitamin B12 injection with doses at 3-monthly intervals. Where necessary reference can be made to other records kept, e.g. medicines administered by a district nurse. Reference 1) 3.0, 3.2.2, 3.2.3 (Previous target of 31/01/07 not met). All medicines prescribed for the DS0000066301.V341856.R01.S.doc 31/08/07 31/08/07 31/08/07 31/12/07 12/06/07 12/06/07 Page 30 Version 5.2 12 YA20 13(2) 13 YA20 13(2) 14 YA20 13(2) 15 YA20 13(2) home’s service users must be available for administration. If there is delay in supply then action is to be taken immediately to inform the prescriber. Reference 1) 4.0 To be technically correct, when a service user has not been known to have an allergy this should be recorded as “none known” on their medicine administration records rather than the term “unknown”. Reference 1) 3.0 The use of compliance devices e.g. Medidos, Dosett, in the home to provide for the administration of medicines to service users taking medicines away from the home, when attending outside appointments or on short periods of unplanned leave, requires a written policy and procedure. The transfer of some medicines from the manufacturer’s packaging may be contraindicated. If in doubt contact your pharmacist for advice. Reference 1) 4.9 A written policy/procedure is required for the handling of cytotoxic medicines. A draft policy/procedure was given to the home’s manager during the inspection. There were currently no medicines within this category in the home. Reference 1) 5.1 The documented policy/procedure for the disposal or return of medicines to the pharmacist requires change to indicate the current procedure used and ensuring staff awareness. Reference: (1) 2.0, 3.3. DS0000066301.V341856.R01.S.doc 12/06/07 12/09/07 12/09/07 12/09/07 Version 5.2 Page 31 16 YA20 13(2) To ensure compliance with the 12/09/07 medicines licensing requirements and to maintain the efficacy of medicines requiring cold storage the following arrangements are required during storage: • a maximum/minimum thermometer to monitor the fridge temperatures when storing such medicines. Details of the type of thermometer required were given to the home’s manager during the inspection. • fridge temperature records to include the daily monitoring of the maximum, minimum and current temperature readings. After taking the temperature readings it is necessary to reset the thermometer to avoid the carry-over of the maximum/minimum settings to the next day. An example of a suitable temperature record chart was given to the home’s manager during the inspection. • Either a designated lockable fridge or a designated lockable container marked “medicines only” for enclosing medicines stored in the domestic fridge. • a policy/procedure detailing the requirements for medicines requiring cold storage. A draft policy/procedure was given to the home’s manager during the inspection. DS0000066301.V341856.R01.S.doc Version 5.2 Page 32 Reference 1) 2.0, 5.2 17 YA20 13(2) Entries made by staff on residents medicines administration record (MAR) charts require their signature or signed initials and the date of the entry. If appropriate include brief details or reference to another document containing details e.g. district nurse records. This provides accountability for the entry and continuity of the audit trail. Reference 1) 3.2.2 (Previous target of 31/01/07 not met). The home’s policy/procedure for medicines taken out of the home by its residents requires the inclusion of documentation to account for medicines leaving or being returned to the home and the use of medicines compliance devices Reference 1) 2.0, 4.9, 6.2.5, 6.2.6 When medicines are prescribed with directions for administration on a when required basis or with nonspecific directions, e.g. to be taken as directed, documented guidance is required to be available with the medicines administration record (MAR) chart to ensure medicines are correctly administered. This includes such directions as when to administer, frequency, maximum repeated dosing, time interval between doses, etc. Reference 1) 4.4 The registered person must ensure that NHS prescription forms for service users exempt from the payment of prescription charges have the exemption declaration on the back of the forms completed and DS0000066301.V341856.R01.S.doc 12/06/07 18 YA20 13(2) 12/09/07 19 YA20 13(2) 12/06/07 20 YA20 13(2) 12/06/07 Version 5.2 Page 33 21 YA30 13(3) signed before submission to the pharmacy for dispensing. Reference 1) 4.7 In order to avoid the risk of 12/06/07 cross-contamination of bloodborne infections e.g. Hepatitis, HIV, it is required to provide a policy/procedure to include the use of granules containing sodium dichloroisocyanurate (Presept or equivalent) and to have the granules available in the home to deal effectively with any blood spillage. This is described in the Department of Health guidance given during the inspection. Advice was provided for the storage arrangements in order to provide for efficient usage in the case of such a spillage. References 1) 5.1 & 2) Appendix 4 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA20 Good Practice Recommendations The home is recommended to provide guidance for the administration of medicines to service users (SU) having difficulty in swallowing medicines or require administration via the percutaneous endoscopic gastrostomy (PEG) route or other feeding tube. A copy of a protocol addressing the issue of administering medicines to service users with swallowing difficulties was given to the home’s manager during the inspection. Reference 1) 6.2.2, 6.2.3 To avoid the risk of staff acting on outdated information it is recommended to remove the March 2004 edition of the British National Formulary (BNF) leaving the more recent March 2006 edition available for reference. A new edition is published every 6 months and copies may be obtained direct from: RPS Publishing, C/O Turpin Distribution, Stratton Business DS0000066301.V341856.R01.S.doc Version 5.2 Page 34 2. YA20 3. YA20 4. YA20 Park, Pegasus Drive, Biggleswade, Bedfordshire SG18 8TQ, Tel: 01767 604971, Fax: 01767 601640, Website: www.pharmpress.com Email: custserv@turpin-distribution.com It is recommended that the home have a formal agreement with a pharmacist for advice, administered and financed through the local primary care trust. Reference 1) 10.0 It is recommended to review, update and collate the home’s medicines policies & procedures taking into account the information provided in the CSCI Professional Advice documents and that of the Royal Pharmaceutical Society including: • Medicine administration records (MAR) in care homes and domiciliary care. CSCI • The administration of medicines in care homes. CSCI • Training care workers to safely administer medicines in care homes. CSCI • The safe management of controlled drugs in care homes. CSCI • The Administration and Control of Medicines in Care Homes and Children’s Services. The Royal Pharmaceutical Society of Great Britain. To provide a useful working document it is recommended that the sections from the two medicines policies/procedures be brought together into a single document with improved indices to provide for ease and speed of reference and to be made available at the point of medicines usage. References: 1) The Administration and Control of Medicines in Care Homes and Children’s Services. Royal Pharmaceutical Society of Great Britain. June 2003. 2) Guidelines on the Control of Infection in [Care} Homes. Department of Health. 1996 DS0000066301.V341856.R01.S.doc Version 5.2 Page 35 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.V341856.R01.S.doc Version 5.2 Page 36 - 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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