Inspection on 25/02/08 for Vine, The

This inspection was carried out on 25th February 2008.

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

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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Vine, The 13/02/09

Vine, The 05/05/06

Vine, The 29/11/05

Vine, The 30/06/05

Vine, The 15/03/05

Vine, The 24/09/04

Vine, The 05/02/04

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Edenvale

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Chatsworth Care - Dawson House

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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 Vine, The 58-60 Rosendale Road London SE21 8DP Lead Inspector Sonia McKay Unannounced Inspection 25th February 2008 09:30 Vine, The DS0000022768.V353690.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 Vine, The DS0000022768.V353690.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. Vine, The DS0000022768.V353690.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Vine, The Address 58-60 Rosendale Road London SE21 8DP 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) 020 8670 9248 vine_60@yahoo.co.uk www.larche.org.uk L`Arche Lambeth Nicole Lynne Cramsie Care Home 7 Category(ies) of Learning disability (0), Learning disability over registration, with number 65 years of age (1) of places Vine, The DS0000022768.V353690.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named person over the age of 65 years of age. This condition will apply until the named person leaves the home. 5th May 2006 Date of last inspection Brief Description of the Service: The Vine is located in a residential road in West Norwood close to the organisations workshops, high street shopping and transport networks. Two houses are joined together to create one large home and back garden. The Vine is registered to accommodate seven adults with a learning disability. All of the residents require varying degrees of support and assistance in their daily lives. The home is one of five residential care homes in Lambeth and Southwark, which are part of the local L’Arche community. The aim of the community is to create an environment that welcomes people with learning disabilities. Fundamental principles of the community are that each person has a right to friendship, a spiritual life and to live in an environment that fosters personal growth. Prospective residents receive an information pack that contains the Statement of Purpose and Service Users Guide and a copy of the most recent Commission inspection report is available on request at the home. Current fees range between £435.22 and £519.20 per week and depend on the support needs of individuals placed. Vine, The DS0000022768.V353690.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience adequate quality outcomes. This unannounced key inspection was carried out in six hours by one inspector. The methods used to assess the quality of service being provided include: • • • • • • • • Discussion with the area manager Examination of the Annual Quality Assurance Audit document completed by the manager (this document is sometimes called an AQAA and it provides the Commission with information about the service) Discussion with one person currently living in the home A tour of the premises Visiting a community gathering attended by some of the residents living in this service Examining records of the care provided to two of the residents Examining records relating to staffing and training Examination of the way medicines are handled by staff in the home The Commission would like to thank all who kindly contributed their time, views and experiences to this inspection process. What the service does well: The aspirations and needs of prospective residents are fully assessed before they are offered a placement in the home. Systems are in place to obtain the views of residents about the running of the home and residents are encouraged and supported to raise any concerns that they have and these concerns are listened to and acted upon. The home is clean, homely and comfortable. Staff are trained to recognise abuse and what to do about it. Residents receive assistance with their personal care in the way they prefer and require. Residents receive support to maintain their physical health and to attend appointments. Vine, The DS0000022768.V353690.R01.S.doc Version 5.2 Page 6 Residents receive support with taking their medication if needs be or they are supported to administer their own medication if they are able. Residents have opportunities for personal development. They are able to take part in a wide range of leisure activities and therapeutic employment. Appropriate relationships with family and friends are encouraged and supported and people are encouraged to be responsible in their daily lives. People are supported to make their own decisions where possible and they are given appropriate support to make decisions if they need assistance. Residents are supported to take risks as part of developing an independent lifestyle. What has improved since the last inspection? What they could do better: Frequent changes in staffing and management of this home have impacted on the quality of the service being provided. Continued high staff turnover means that residents are routinely supported by new and unqualified staff. Managers must do more to ensure that the home is environmentally safe, for example, the fridge is too warm and could cause food poisoning and a hoist used by one resident is not checked professionally often enough. Steps are being taken to ensure that staff are equipped with the specialist training required to meet the needs of the residents although, as yet, this does not include a national vocational qualification in Care. Vine, The DS0000022768.V353690.R01.S.doc Version 5.2 Page 7 Information provided to people who are using the service must be revised to include more information about fees and what they are used for. Record keeping in regards to people who need help to manage their finances does not provide residents with adequate protection from financial abuse and must be improved to ensure that they are safe. Written plans for how each resident should be cared for and supported are in place but must be reviewed regularly to ensure that staff have up to date information on which to base their care and support. Staff must sign and date the care plans and where possible, also the resident. This will ensure that residents are fully involved in planning their care. 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. Vine, The DS0000022768.V353690.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Vine, The DS0000022768.V353690.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 4. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Information provided to people who are using the service must be revised to include more information about fees and what they are used for. The aspirations and needs of prospective residents are fully assessed before they are offered a placement and there is an opportunity for people to visit the home for a trial period before they move in. EVIDENCE: There is an informative ‘Statement of Purpose’ and a ‘Service Users Guide’. Emphasis is placed on making the guide accessible to service users with a learning disability and it contains many colour photographs, symbols and clear language. The information provided to people using the service must be revised in accordance with recent changes in the Care Homes Regulations of 2001 that came into force in September 2006. The ‘Service Users guide and associated individual contracts must provide greater detail relating to the standard package of services provided. The terms and conditions (including fee levels) that apply to key services (both personal Vine, The DS0000022768.V353690.R01.S.doc Version 5.2 Page 10 care and food) and the payment arrangements (resident contribution/local authority contribution) must be stipulated. The guide must also state whether the terms and conditions (including fees) would be different in circumstances where a person’s care is funded, in whole or in part, by someone other than the resident. (See requirement 1) New residents are admitted on the basis of a full assessment of needs. The manager obtains a copy of the care needs assessments carried out by health and social services as part of this process. Only long- term placements are offered and there is a lengthy placement process. This is tailored to meet the needs of the individual and usually involves at least two brief visits to the home and three longer visits, including overnight stays. This provides the prospective resident with ample opportunity to experience life in the home before making a decision to move in for a trial period. Records relating to the assessment and admission of two people admitted to the home since the last inspection indicate that their needs were properly assessed and they had opportunities to visit the home before making a decision to move in for a trial period. Each resident has a contract of service in place, as required in the previous inspection report. Vine, The DS0000022768.V353690.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Written plans for how each resident should be cared for and supported are in place but must be reviewed regularly to ensure that staff have up to date information on which to base their care and support. People are supported to make their own decisions where possible and they are given appropriate support to make decisions if they need assistance. Residents are supported to take risks as part of developing an independent lifestyle. EVIDENCE: Each resident has a series of files containing records about their care and support. The confidential information is stored securely in the staff office. Sets of records for two residents were examined during this inspection. The records examined show that residents meet with the support team on a regular basis to develop personal goals and to review how their care and support is going. There is one main review meeting each year. This meeting Vine, The DS0000022768.V353690.R01.S.doc Version 5.2 Page 12 enables the resident, along with friends and family of their choosing, to discuss issues with the staff team and placing authority social worker. Written plans for how residents are to be cared for are in place for staff to follow. The plans are generally well written, informative and pertinent. However, not all care plans are dated or signed and they are not routinely reviewed during the review meetings, which focus on goals. Care plans must be dated, signed (by the author and also the resident, if possible) and reviewed regularly and/or when care and support needs change. This must be done to ensure that staff have clear and current information about how each resident should be supported and cared for. (See requirement 2) New goals are reviewed/set with each resident, home staff and staff from the L’Arche workshops, which many L’Arche residents attend as a daytime activity. The home has links with the Lambeth community team for adults with a learning disability, who provide behaviour support, physiotherapy and speech and language therapy as the need arises. Each resident has a ‘reference person’ in the home to act as a key worker. The key worker has special responsibility for assisting the resident with planning, maintaining personal records and day-to-day arrangements. Residents are involved in the assessment of new staff during their probationary period and increased involvement in staff appraisal is being developed. Residents are involved in setting the priorities for the Community as a whole and in the formal review of the day services. Residents are encouraged to participate in the day-to-day running of the home and in community planning. They can take part in weekly house meetings, ‘talking group’ meetings with the director six times a year and L’Arche Community Council elections. Residents are supported to make day-to-day decisions such as what to wear, how to spend their leisure time, who to invite to dinner and what to cook. All need staff assistance to claim state benefits and manage their finances. L’Arche uses a semi-independent advocacy system with staff from other L’Arche homes or workshops who know the resident well joining a small group called a ‘circle of support’ for each resident. L’Arche aims to obtain the services of fully independent advocates when major decisions need to be made Whilst individual risk management strategies are developed for known highrisk situations, there is a need to develop a risk audit tool that assists staff to systematically consider risks posed to individuals during activities of daily living and community participation. (See recommendation 1) Vine, The DS0000022768.V353690.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 & 17. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents have opportunities for personal development. They are able to take part in a wide range of leisure activities and therapeutic employment. Appropriate relationships with family and friends are encouraged and supported and people are encouraged to be responsible in their daily lives. EVIDENCE: L’Arche is a faith-based community that offers active support to each resident to enable them to develop their faith and spiritual lives. Residents who choose not to attend religious activities of any particular denomination are offered alternative activities. All residents are offered opportunities to engage in art, music and nature activities, such as gardening. One resident attends a local authority daycentre, three residents attend the L’Arche gardening workshop, and one resident makes candles in the candle workshop. On the day of the inspection all were out engaging in their activities, Vine, The DS0000022768.V353690.R01.S.doc Version 5.2 Page 14 other than the resident who attends a local authority daycentre who had a medical appointment at home. The proximity of the other L’Arche homes provides a close community. L’Arche Lambeth has been operating for more than 25 years and has developed good relationships with local individuals and organisations. Staff live at the Vine with the residents, with the intention of building a shared community and consistent engagement. All residents are offered a minimum of two weeks holiday away from the home in each year, either alone (with staff support) or as part of a group with shared interests. Leisure activities include trips to a disco, the pub, cafes, dinner parties and daytrips. Trips in 2007 included America and Sweden. Personal information held in individual care files contains detailed information about family and friends, their birthdays and family history. This enables staff to support [people to maintain and develop relationships. Staff support residents to maintain family relationships by telephone, letters and postcards and visits. LArche has an educational resource about sexuality and the home’s coordinator, who facilitated the inspection, demonstrated an understanding of the need to support residents around the issues of sex education and relationships if needed. Residents and staff eat together at a large dining table in the communal lounge. Each resident has the breakfast menu of their choice. Records of meals eaten show that a range of meals are served. Food stocks were seen to be adequate and to contain supplies of fresh fruit and vegetables. Each resident chooses and helps to prepare an evening meal to the best of their ability. Responsibilities for completing household chores are decided during weekly house meetings and each resident is supported to take some form of household responsibility. Vine, The DS0000022768.V353690.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents receive assistance with their personal care in the way they prefer and require, although the written plans about these routines are not reviewed often enough. Residents receive support to maintain their physical health and to attend appointments, although records could be improved. Residents receive support with taking their medication if needs be or they are supported to administer their own medication if they are able. Again, record keeping and stock checking could be improved to make things safer. EVIDENCE: A staff team comprised of both men and women provides same gender support for bathing and personal care tasks. Preferred personal care routines are clearly described in individual support plans, detailing the level of support required with each task. These plans must be reviewed regularly, as not all plans are routinely reviewed during placement reviews. (See requirement 2) Vine, The DS0000022768.V353690.R01.S.doc Version 5.2 Page 16 During the previous inspection a requirement was made for the manager to improve the healthcare records and plans. Records relating to the healthcare of two of the residents were examined. The records show that each resident is supported to attend a variety of healthcare services in accordance with their individual healthcare needs. Good records are kept of the outcomes of the appointments and of any advice given. However, the records are becoming numerous and not so easy to track. It is recommended that a single record of healthcare be maintained alongside each persons health action plan. This will avoid confusion in a staff team that changes frequently. (See recommendation 2) ‘Health Action Plans’ are being developed with each resident, as recommended in the previous inspection report. These documents identify the healthcare and checks that are needed. Local health teams have developed an accessible template. This is recommended to ensure that healthcare is pro-active and residents are made aware of their health care needs and how they are to be met. There is evidence that staff contact doctors and emergency services for advice for residents as the need arises. Staff said that one resident has lost weight since moving into the home. This is being discussed with the GP. Staff do not routinely record peoples weight. This should be regularly as part of monitoring overall health. (See requirement 3) Medication stock is stored securely in a lockable, wall-mounted steel cabinet. All residents require a degree of staff support to manage or take their medication. One resident is administered medication covertly during breakfast. This covert administration has been agreed by the residents GP who has provided written instruction of how this is to be done. Another resident is a diabetic, staff support him to calculate the correct dose of insulin and he administers this himself. This is supported by a detailed care plan and risk assessment. Staff are trained to administer medication during their induction training. A record is kept of the signatures they use on the medication administration records (MAR). The organisation has a medication policy and there are procedures in place detailing how medication is obtained and handled at the Vine. There is a written medication profile for each resident, detailing the names of the medication they are prescribed, what condition it is prescribed for, when it must be taken and what side effects there may be. MAR (Medication Administration Records) charts are pharmacy generated and there is a colour photograph of each resident in the record. Vine, The DS0000022768.V353690.R01.S.doc Version 5.2 Page 17 Detailed records are kept of all medication received into the home and of any medication disposed of or returned to the pharmacy. The pharmacist supplies the majority of daily medications in pre-filled measured dose blister packs. The medication cabinet is well organised, with each residents medication stored in a separate area. MAR charts show no gaps in the recording of daily administration although some staff have used a pencil to record the administration. This is not a permanent record. (See requirement 4) Examination of the pre-filled medication packs show that medication has been administered as prescribed. However, as some medication is not suitable to be supplied in these packs, it is supplied to the home in brand containers or bottles. During the previous inspection it was noted that the home manager did not conduct justified medication stock checks to ascertain whether the balance of medication available is correct (The medication supplied minus the medication administered or disposed of should be equal to the balance of medication available). Records show that these checks were conducted as recommended but ceased when the registered manager left. These checks must be reintroduced to ensure that there is a way of monitoring how well staff are administering the medications. (See recommendation 3) During the previous inspection a requirement was made for the registered manager to seek advice from the GP in regard to the use of home remedies (over the counter) for each resident. There is now a letter in place from the GP listing the medications that residents can use on this basis. As recommended in the previous inspection report, the medication policy has been revised to cover areas such as: • The supply of medication when away from the home (for example, while at work, a day centre or on holiday) • Over the counter medication • Handling of medication errors • Use of oxygen Vine, The DS0000022768.V353690.R01.S.doc Version 5.2 Page 18 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 is adequate This judgement has been made using available evidence including a visit to this service. Residents are encouraged and supported to raise any concerns that they have and these concerns are listened to and acted upon. Staff are trained to recognise abuse and what to do about it, although record keeping in regards to people who need help to manage their finances does not provide residents with adequate protection from financial abuse and must be improved to ensure that they are safe. EVIDENCE: The home has a good complaints policy. There is text version and a more accessible version for residents who may not be able to understand a text only document. A complaints poster is displayed on the notice board in a communal area and has colour photographs of people who can assist with a complaint. Regular house meetings (weekly) provide residents with an opportunity to raise concerns. A complaints book is available and there is one recorded complaint since the last inspection visit. A resident complained about the contents of a packed lunch prepared by a member of staff. The record indicates that appropriate action was taken to ensure that the member of staff understood what is required. A record of visitors is available and is being used appropriately. Abuse awareness training is part of the L’Arche induction and formation training undertaken by all new staff and a copy of the local authority Vine, The DS0000022768.V353690.R01.S.doc Version 5.2 Page 19 (Lambeth) adult protection procedures have been obtained for staff reference, as recommended in the previous inspection report. All residents require staff support to manage their finances. A spot check of finances held in safe keeping by staff indicate that recent staff changes have caused confusion in the recordings of how money is being spent. Residents earn a small wage for the work they do in the L’Arche workshops. This income has not been entered onto the record. The registered provider had picked up this irregularity and it is currently under investigation with input from finance. To ensure that residents are protected from financial abuse staff must record all financial transactions, both income and expenditure. (See requirement 5) Each financial transaction is recorded and receipts for items purchased are retained. The record of transactions requires that two staff sign for each expenditure and the home manager and a member of the head office finance team periodically check the financial records. Vine, The DS0000022768.V353690.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, 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 home is clean, homely and comfortable but more must be done to ensure environmental safety. EVIDENCE: The large home is suitable for its purpose, comfortably furnished, clean and homely. Communal areas are large and include a lounge/dining room, a smaller lounge with patio doors that open on to a conservatory and the rear garden. There is ramped access to the rear garden lawn, which is useful for one resident who uses a wheelchair. All bedrooms are single occupancy and a ground floor bedroom has en-suite access to a bathroom with a hoist, to enable one resident, with a mobility need, to bathe. Four bedrooms are located on the ground floor and three bedrooms are located on the first floor. Each room is personalised with photographs and treasured Vine, The DS0000022768.V353690.R01.S.doc Version 5.2 Page 21 possessions. Radiator covers are in place to prevent contact burns where needed and door locks are of a type that allow staff access in an emergency. One ground floor bedroom previously noted to have a damaged carpet and wall décor around a hand washbasin has been improved, as required in the previous inspection report. The number of toilets and bathing facilities are adequate and meet the individual needs of the residents. There are two bathrooms on the first floor, one for men and one for women. Two toilets and one bathroom are available close to the communal areas on the ground floor and there are two more bathrooms and one toilet on the first floor. Damp patches on the ceiling of a first floor bathroom have been treated and the ceiling redecorated, as required in the previous inspection report. There is a clinical waste disposal contract and clinical waste is stored appropriately before collection. During the previous inspection it was noted that mobility aids such as wheelchairs and hoists were not regularly checked or serviced. A requirement was issued. During this inspection it is noted that a bathroom hoist was professionally checked at the beginning of 2007. The test certificate indicates that some work was required to the hoist. This work has not been completed. It is also noted that there are a series of monthly health and safety checks that do not include wheelchairs or other mobility equipment. It is recommended that these checks be added so that they are routinely checked for faults. (See requirement 6 & recommendation 4) Fridge and freezer temperature checks are conducted daily and the results recorded and hot food temperatures are monitored. Fridge temperatures have repeatedly been high for a number of weeks and no action has been taken. This is unsafe and could lead to food poisoning. (Requirement 7) Vine, The DS0000022768.V353690.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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Continued high staff turnover means that residents are routinely supported by new and unqualified staff. Steps are being taken to ensure that staff are equipped with the specialist training required to meet the needs of the residents although, as yet, this does not include a national vocational qualification in Care. Recruitment procedures are adequate. EVIDENCE: House assistants within the L’Arche community are provided with board and lodgings. Staff at the Vine live on the premises and take turns to do duty. L’Arche is a Christian community of people with and without learning disabilities who have chosen to live and work together according to a clear set of values. Staff are required to be part of all aspects of care and support and a committed community lifestyle. Records are kept of all staff duty rosters. Between two, three and four members of staff are on duty in the home during the daytime depending on Vine, The DS0000022768.V353690.R01.S.doc Version 5.2 Page 23 the activities and needs of the residents. Two members of staff are on duty, but asleep, during the night. There are also a team of day activities co-ordinators based in an office at the L’Arche head office. These staff arrange activities for residents who do not wish to take part in workshop activities. Recruitment records are held at the L’Arche head office. A recruitment coordinator has made progress in auditing staff recruitment records and has revised the LArche recruitment procedures. As staff live on premises, and are often recruited from overseas, the organisation has not been able to guarantee that the required POVA first check (an initial check against the list of people who are prohibited from working with vulnerable adults) be completed prior to the member of staff commencing work in the home. The registered provider has revised the recruitment and supervision procedures to ensure that risks to residents are minimised. Overseas police checks are obtained before the member of staff commences employment and a POVA first check is applied for on arrival in the UK. Until a satisfactory check is returned the member of staff does not work alone or provide any personal care. Recruitment records checked during the inspection included POVA first and enhanced criminal records checks for each member of staff. A framework of policies and procedures provides staff with guidance. There is also ongoing staff support from the homes co-ordinator and other longstanding community staff. None of the staff have an NVQ. As assistants usually only stay for between one and three years they do not normally have an NVQ (National Vocational Qualification in Care). The director of L’Arche has conceded that it will be hard for the organisation to meet this standard, unless they can recruit more local people. (See requirement 8) L’Arche provides all new assistants with induction training in the first six weeks. ‘Foundation training’ is undertaken in the first year, this is a combination of ‘in-house training’ and training provided by the local specialist learning disability team. A training co-ordinator has developed a training needs assessment for staff working at the Vine and records of training undertaken by individual staff are available. An appropriate range of training, specific to the needs of the Vine, The DS0000022768.V353690.R01.S.doc Version 5.2 Page 24 residents, is available. Although, as most staff are new to the service they are at an early stage of development. A framework of policies and procedures provides staff with guidance. There is also ongoing staff support from the homes co-ordinator and other longstanding community staff. L’Arche provides all new assistants with induction training in the first six weeks. ‘Foundation training’ is undertaken in the first year, this is a combination of ‘in-house training’ and training provided by the local specialist learning disability team. There is an in-house induction plan for staff working at the Vine but records of individual staff induction are not available. (See recommendation 5) During the last inspection a requirement was made, as staff had not been formally supervised often enough. Supervision records were not available during this inspection although staff said that they felt adequately supervised and knew who to talk to if they have a problem or query, but that written notes have not always been taken during meetings. This is not adequate. (See requirement 9) Vine, The DS0000022768.V353690.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. Frequent changes in staffing and management of this home have impacted on the quality of the service being provided. Systems are in place to obtain the views of residents about the running of the home. Health and safety must be improved. EVIDENCE: The registered home manager left the service in January 2008. A longstanding member of the community staff is acting up as an interim measure until the new manager starts in April 2008. LArche has a management-training programme in place that includes training in staff supervision. Vine, The DS0000022768.V353690.R01.S.doc Version 5.2 Page 26 During the last inspection it was noted that the L’Arche community has an annual development plan for quality assurance in place although the home had not been visited on a monthly basis by a representative of the responsible individual as required by Regulation 26 of The Care Homes Regulations 2001. A requirement was issued. During this inspection it is noted that although the frequency of these inspections has increased, copies of the reports detailing the outcomes have been supplied to the home manager. Areas of record keeping and of failure to ensure environmental safety (the fridge temperatures and failure to check and maintain a hoist properly) indicate unsatisfactory management of health and safety in the home and must be improved. Fire evacuation drills have been conducted with increased frequency, as required in the previous inspection report. A requirement made in this regard is therefore met. Vine, The DS0000022768.V353690.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 2 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 3 29 2 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 2 X X 2 X Vine, The DS0000022768.V353690.R01.S.doc Version 5.2 Page 28 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 YA1 Regulation 5 Requirement The registered person must revised the service users guide in accordance with changes in legislation that require more information about fees and what they cover to be included. The registered person must ensure that written care plans are signed (by the author and resident if possible), dated and reviewed regularly and/or when care needs change. The registered person must maintain a record of the weight of each resident. The registered person must ensure that a permanent record is kept of the administration of any medication to any resident (pencil must not be used to record the administration) The registered person must ensure that a detailed record is kept of all financial transactions made on behalf of any resident (both income and expenditure). The registered persons must ensure that wheelchairs and mobility aids (including the bathroom hoist) are regularly DS0000022768.V353690.R01.S.doc Timescale for action 12/07/08 2. YA6 15 23/05/08 3. 4. YA19 YA20 12.1 17.1(a) 23/05/08 30/04/08 5. YA23 17.2 30/04/08 6. YA29 12(1) 13(4) 30/04/08 Vine, The Version 5.2 Page 29 checked and serviced. The timescale of 28/07/06 for action to be taken to meet this previous requirement is not met. Evidence that action has been taken to meet this requirement must be supplied to the Commission by 7. YA42 23.2 13.3 The registered person must 30/04/08 ensure that the refrigerator is operating properly and keeping food items at the required temperature. The registered persons must 30/06/08 ensure that plans are in place to ensure that care staff hold a care NVQ 2 or 3, or are working to obtain one by an agreed date; or can demonstrate that through past work experience and training staff meet that standard. Previous timescales of 03/02/06 and 31/08/06 are not met. A proposal for how this requirement is to be met must be supplied to the Commission by The registered person must ensure that staff are appropriately supervised. 8. YA32 18(1)(a) 9. YA36 18(2) 30/04/08 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 Vine, The DS0000022768.V353690.R01.S.doc Version 5.2 Page 30 1. 2. 3. 4. 5. YA9 YA19 YA20 YA29 YA35 The registered person should develop an overall risk assessment audit tool. The registered person should maintain a single record of healthcare for each resident. The registered person should implement a system for justified medication stock checks. The registered person should add wheelchairs, hoists and any other aids and adaptations to the list of things that staff routinely check. The registered person should maintain a record of each member of staffs induction training within the home. This should include formal induction training and in-house induction including fire safety and fire evacuation procedures. Vine, The DS0000022768.V353690.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 Vine, The DS0000022768.V353690.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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