Inspection on 05/05/06 for Vine, The

This inspection was carried out on 5th May 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 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 25/02/08

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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Ashlong House

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Edenvale

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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 Vine, The 58-60 Rosendale Road London SE21 8DP Lead Inspector Sonia McKay Unannounced Inspection 5th May 2006 08:30 Vine, The DS0000022768.V292496.R01.S.doc Version 5.1 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.V292496.R01.S.doc Version 5.1 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.V292496.R01.S.doc Version 5.1 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) 0208-670-9248 L`Arche Lambeth Mrs Lal Keenan 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.V292496.R01.S.doc Version 5.1 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. 29th November 2005 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 service users require varying degrees of support and assistance in their daily lives. The home is one of six 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 service users receive an information pack that contains the Statement of Purpose and Service Users Guide and a copy of the most recent CSCI 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.V292496.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The record of an unannounced inspection of the service informs this report. One inspector carried out the nine-hour inspection over one day. Three service users, the homes co-ordinator, the newly appointed home manager and two members of staff provided information. Written information was examined and there was a tour of the home. The registered provider also supplied the CSCI with information about the service by e-mail, written monthly reports and a community newsletter. What the service does well: What has improved since the last inspection? The ramp in the back garden has been extended so that service users who use wheelchairs have access to the lawn area of the back garden. There are more staff in the team and they do not work for too many hours. This means they are less tired and happier. Staff take better care when writing down the amount of money and valuables they are looking after for service users. A bedroom door lock has been replaced by one that staff can open in case a service user needs help in an emergency and lighting in the ground floor bathroom is brighter. Vine, The DS0000022768.V292496.R01.S.doc Version 5.1 Page 6 Staff have more information about what medicines service users take and what side effects they may have and there are now photographs of each service user with the medication so that staff can check that they are giving the medication to the right person. 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. Vine, The DS0000022768.V292496.R01.S.doc Version 5.1 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 Vine, The DS0000022768.V292496.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users have the information they need to make an informed choice about where to live. All new service users receive a comprehensive needs assessment before admission. Staff, who are trained to provide services for people with learning disabilities, spend significant time ensuring that admission to the home is personal and effective. Accessible contracts of occupancy are not all in place but are being developed. EVIDENCE: There is an informative ‘Statement of Purpose’ and a ‘Service Users’ Guide’ to the home. 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. 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 service user with ample opportunity to experience life in the home before making a decision to move in for a trial period. Vine, The DS0000022768.V292496.R01.S.doc Version 5.1 Page 9 Staff receive training in supporting service users with a learning disability and communication needs. They use signed communication and visual aids to enrich clear verbal communication with service users. Written contracts are not in place for each of the service users. The provider is currently reviewing the written contracts or statements of terms and conditions of occupancy with a view to including symbols and making them more accessible. (See requirement 1) Vine, The DS0000022768.V292496.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The changing needs and personal goals of each service user are reflected in their individual care plans. Service users are able to make decisions about their lives with assistance as needed. Emphasis is placed on service user consultation and participation. High-risk situations are assessed and action is taken to minimise any dangers to service users. EVIDENCE: Individual care plans are reviewed annually and every six months new goals are reviewed/set with the individual, home staff and staff from the workshops. The service user, along with family members (if the service user wishes) and home staff attend an annual review meeting. Staff work creatively with the service user before the review to enable them to understand and contribute as much as possible to the process in ways of their individual choosing (video, photographs, spoken word, objects, music and drawings). Vine, The DS0000022768.V292496.R01.S.doc Version 5.1 Page 11 The meeting is held in a place that is comfortable to the service user (either at home or in a formal meeting room). The meeting aims to review goals from previous planning meetings and explore how new goals can be supported. 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 service user has a ‘reference person’ in the home to act as a key worker. The key worker has special responsibility for assisting the service user with planning, maintaining personal records and day-to-day arrangements. Service users are involved in the assessment of new staff during their probationary period and increased involvement in staff appraisal is being developed. They are involved in setting the priorities for the Community as a whole and in the formal review of the day services. Service users are encouraged to participate in the day to 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 community council elections. Service users are also involved in the assessment of new staff during their probationary period. Service users are supported to make day-to-day decisions about 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. Fully independent advocates are in short supply in the borough. L’Arche uses a semi-independent advocacy system with assistants from other homes or workshops who know the service user well being assigned to each service user. L’Arche aims to obtain the services of fully independent advocates when major decisions need to be made Missing Persons procedures are in place and the home responds promptly to any unexplained absences. For example, one service user recently went missing from the home for a brief period, staff quickly began a search of the local area, but did not inform the police immediately. The police found the service user before he was reported missing and this had led to some difficulties. Missing persons procedures have been revised accordingly and the local behaviour support team have advised the staff of ways to address the issues of anxiety that trigger these events for the service user. Home security and the ways that staff can be alerted to someone leaving the home have also been reviewed and improved. 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.V292496.R01.S.doc Version 5.1 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 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. Service users 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. Service users are encouraged to be responsible in their daily lives. Meals are healthy and attractively presented and mealtimes are relaxed. EVIDENCE: L’Arche is a faith-based community and offers active support to each service user to develop their faith and spiritual lives. Service users who choose not to attend religious activities of any particular denomination are offered alternative activities. All service users are offered opportunities to engage in art, music and nature. Vine, The DS0000022768.V292496.R01.S.doc Version 5.1 Page 13 One service user attends a local authority daycentre and others attend the L’Arche workshops (weaving, stone work, gardening and candle making). One older service user attends the LArche retirement group. 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 service users, with the intention of building a shared community and consistent engagement between the staff and the service users. All service users are offered a minimum 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. Personal information held in individual care files contains detailed information about family and friends, their birthdays and family history. This enables staff to support service users to maintain and develop relationships. Staff support service users to maintain family relationships by telephone, letters and postcards and visits. One service user said that he was looking forward to visiting his parents at the weekend. LArche has an educational resource about sexuality and the home manager and homes co-ordinator demonstrate an understanding of the need to support service users around the issues of sex education and relationships if needed and to request assistance from professionals as required. Breakfast was being served as the inspection began. The service users and assistants eat together at a large dining table in the communal lounge. The mealtime was relaxed and only paced with a view to getting everybody to his or her activity or workshop on time. Service users and staff interacted well. Each service user has the breakfast menu of their choice, and the food prepared is fresh and appetising. Records of meals eaten show that a range of meals are served. Food stocks are stored appropriately and contain plenty of fresh fruit and vegetables. Each service user chooses and helps to prepare an evening meal to the best of their ability. Two of the service users said that they liked the meals. Responsibilities for completing household chores are decided during weekly house meetings and each service user is supported to take responsibility to the best of their abilities. Vine, The DS0000022768.V292496.R01.S.doc Version 5.1 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 at least once during a 12 month period. 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. Service users receive personal care in the way they prefer and require. Although there is evidence that service users have access to good reactive healthcare, preventative healthcare must be better planned. Medication is stored safely, but staff must be advised of the correct administration of some medications and medication stocks must be checked regularly to ensure correct administration. EVIDENCE: Service users are well dressed, in styles that reflect their personal choice and personality. One service user is assisted to dye her hair and is pleased with the results. Social services provide funding for an agency night wake staff to ensure that an older service user is safeguarded from falls during the night. 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. Staff spoke confidently about the daily exercise routines prescribed for two service users by physiotherapists. Vine, The DS0000022768.V292496.R01.S.doc Version 5.1 Page 15 There is regular monitoring of the psychological health of two of the service users and service users receive appropriate medical attention when they are noticeably unwell. However, some service users do not have health care plans in place to advise staff of how often service users should attend appointments or health screenings and some service users have not attended routine health checks for over twelve months (for example, dentist and chiropodist). There is a need to plan health care more effectively so that ill health is prevented. (See requirement 2). Recent reviews identify the need to develop ‘Health Action Plans’ with each service user. Local health teams have developed an accessible template. This is recommended to ensure that healthcare is pro-active and service users are made aware of their health care needs and plans. (See recommendation 2). Medication stock is stored securely in a lockable, wall-mounted steel cabinet. All service users require staff support to take their medication. Three staff have been trained to administer medication and a record is kept of the signatures they use on the medication administration records (MAR). The local pharmacist provides training and training is planned for newer staff. 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 service user, 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 charts are pharmacy generated and have a colour photograph of each service user attached. 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 service users medication stored in a separate area. MAR charts show no gaps in the recording of daily administration. Examination of the pre-filled medication packs showed that medication had 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. The home manager does 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). (See recommendation 3) Vine, The DS0000022768.V292496.R01.S.doc Version 5.1 Page 16 The registered persons must seek advice from the GP in regard to the use of home remedies (over the counter) for each service user. (See requirement 3) The medication policy does not cover the following topics: • 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 (See recommendation 4) One of the service users is prescribed oxygen. An oxygen concentrator is stored in her bedroom. Although staff are advised of the maintenance and safe use of this equipment during their induction to the home, all of the staff who were originally trained by the supplier have now left. (See requirement 4) Staff administer medication to one service user using a spoon, whilst she eats her breakfast cereal, putting a small amount of milk and cereal into the spoon along with the tablets. If the service user is aware that the tablets are in the spoon and prefers to take them with the cereal to improve the taste or make them easier to swallow then this is not covert administration. If the service user is not aware that the tablets are in the spoon and would refuse to take them if they were clearly visible then this is covert administration. Staff must have clear direction about the reason for this type of administration and if it is assessed as being covert administration then this must be agreed by the GP and social worker. (See recommendation 5) Vine, The DS0000022768.V292496.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users views are listened to and acted upon and they are protected from abuse, neglect and self-harm. EVIDENCE: The home has a good complaints policy. There is text version and a more accessible version for service users 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, including the CSCI. Regular house meetings provide service users with an opportunity to raise concerns. A complaints book is available and there are no recorded complaints. The home manager and homes co-ordinator discussed ways in which complaints are made by service users and family members and acknowledged the importance of recording complaints and concerns in the complaints book to ensure that the complaint could be addressed effectively and progress within the timescales of the complaints procedure. 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. A staff member on duty had a thorough knowledge of signs of abuse, forms of abuse and action to take if she witnessed or suspected abuse, although some staff are not familiar with the local authority adult protection procedures. It is recommended that an up to Vine, The DS0000022768.V292496.R01.S.doc Version 5.1 Page 18 date copy of the Lambeth adult protection procedures be obtained for staff reference. (See recommendation 6) The provider has responded appropriately to adult protection concerns about one service user who has absconded from the home on occasion when very anxious and staff are working with social services and the behaviour support team to develop strategies to increase protection. All service users require staff support to manage their finances. A spot check of service user finances held in safe keeping by staff indicated that adequate systems are in place to protect service users from financial abuse. 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.V292496.R01.S.doc Version 5.1 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a comfortable and homely environment. Bedrooms and bathrooms meet their individual needs and are sufficient in number. Service users have the equipment they need to maximise their independence, although failure to arrange regular checks and servicing of wheelchairs has safety implications. 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. All bedrooms are single occupancy and suitable to the needs of the service users. 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 possessions. Radiator covers are in place to prevent contact burns Vine, The DS0000022768.V292496.R01.S.doc Version 5.1 Page 20 where needed and door locks are of a type that allow staff access in an emergency. One ground floor bedroom has a damaged carpet around the hand washbasin and wall decoration around the basin is also damaged. (See requirement 5) The number of toilets and bathing facilities are adequate and meet the individual mobility needs of the service users. 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. One first floor bathroom has damp patches on the ceiling. (See requirement 6) There is a clinical waste disposal contract and clinical waste is stored appropriately before collection. Two of the service users use wheelchairs. Although there is a note of a check made on one of the wheelchairs there is no record of professional checks and servicing of the wheelchairs and bathroom hoist. (See requirement 7) Fridge and freezer temperature checks are conducted daily and the results recorded and hot food temperatures are monitored. Vine, The DS0000022768.V292496.R01.S.doc Version 5.1 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 & 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff have clearly defined roles. A training programme that provides the specialist training required to meet the needs of the service users is in place although, as yet, this does not include a national vocational qualification in Care. Recruitment procedures are adequate. Staff must be supervised more often. 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. A new duty pattern has been introduced to ensure that staff have adequate time off. There are currently five members of staff (excluding the home manager) and plans to recruit a two additional members of staff are underway. Vine, The DS0000022768.V292496.R01.S.doc Version 5.1 Page 22 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 the activities and needs of the service users. Two members of staff are on duty, but asleep, during the night. A small team of agency staff provide night waking cover for one service user who is at risk of falling when getting out of bed unaided. 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 service users 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 and is also closely supervised. 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. As assistants usually only stay for between one and three years they do not normally have an NVQ qualification. The director of L’Arche has conceded that it will be hard for the organisation to meet this standard. One member of staff is currently undertaking a vocational qualification in care (NVQ level 3). (See requirement 7) 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 7) 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 service users, is available. Vine, The DS0000022768.V292496.R01.S.doc Version 5.1 Page 23 Mandatory training includes first aid, health and safety (including epilepsy and fire safety), food hygiene, manual handling, Sign-along and medication administration. Staff have not been formally supervised often enough. (See requirement 9) Vine, The DS0000022768.V292496.R01.S.doc Version 5.1 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The recent resignation of the registered manager and appointment of a new manager has been disruptive and a number of key areas, such as supervision of the staff team and fire evacuation drills have slipped as a result. The provider has failed to monitor the services provided often enough and some areas of health and safety must be improved. EVIDENCE: The registered home manager has recently resigned and a new home manager has been in post since February 2006. The home manager has yet to register with the CSCI but has submitted an application. The new home manager is currently completing a vocational qualification in Care (NVQ level 3) and intends to complete the NVQ level 4 and Registered Managers Award. She has experience of working with adults with a learning disability and has attended a range of short training courses in appropriate Vine, The DS0000022768.V292496.R01.S.doc Version 5.1 Page 25 topics. LArche has a management training programme in place that includes training in staff supervision. The L’Arche community has an annual development plan for quality assurance in place although the home has 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. Only four visits have been conducted in the last six months. (See requirement 10) Regular house and community meetings are held to ensure that the views of the service users impact on the running of the community and planning home life. Policies and procedures are reviewed regularly and a number have been reviewed or developed in 2005/6, including physical restraint, challengingbehaviour, risk assessment, internal incident reporting, internal financial controls, confidentiality, medication, visitors, transport and recruitment. L’Arche has demonstrated that policy and procedure are reviewed in light of changing circumstances. Staff conduct regular in-house environmental checks. The annual safety check of gas appliances was conducted 14/11/05. A mains electrical circuitry test certificate available in the home has recently expired. The registered provider confirmed that the mains circuitry was retested in the last year. Small electrical appliances are safety tested by one of the house assistants. The last test was carried out in April 2006. Fire authorities inspected the premises and confirmed that precautions are adequate on 11/01/05. Environmental and fire risk assessments are conducted. Environmental health inspectors inspected the food handling arrangements in February 2006 and found them satisfactory. Fire evacuation drills have not been conducted with the required frequency. Only two drills have been conducted in the last twelve months. (See requirement 11) Vine, The DS0000022768.V292496.R01.S.doc Version 5.1 Page 26 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 3 2 3 3 3 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 2 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 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 3 3 X 2 X Vine, The DS0000022768.V292496.R01.S.doc Version 5.1 Page 27 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA5 Regulation 5(3) 12(5)(a) 12(1) 17(1) Sch3(k)(m) Requirement Timescale for action 31/08/06 2. YA19 3 YA20 13(2) 4. YA20 18(1)(c ) The registered persons must ensure that service contracts are in place for each service user. 28/07/06 The registered persons must ensure that the healthcare needs of service users are assessed and recognised and that procedures are in place to address them (heath care plans). There must also be a record of any treatment or specialist health care. Previous timescale of 03/02/06 not met. The registered persons must 28/07/06 seek advice from the GP in regard to the use of home remedies (over the counter medication) for each service user. The registered persons must 28/07/06 ensure that all staff involved in the administration of medication are provided with appropriate training on medication (this must include training on the maintenance and use of an oxygen concentrator in use at DS0000022768.V292496.R01.S.doc Version 5.1 Vine, The Page 28 5. YA24 23 6. YA24 23 7. YA29 12(1) 13(4) 8. YA32 18(1)(a) 9. 10. YA36 YA39 18(2) 26 the home by one of the service users). The registered person must repair or replace damaged carpet and decor around a hand wash-basin in one first floor bedroom. The registered person must take action to prevent damp in one first floor bathroom and repair ceiling paintwork damaged by black mould. The registered persons must ensure that wheelchairs and mobility aids (including the bathroom hoist) are regularly checked and serviced. The registered persons must 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 timescale of 03/02/06 not met. The registered person must ensure that staff are appropriately supervised. The registered person must ensure that monthly monitoring visits are conducted on the home. The reports of which must be lodged at the home and a copy sent to the CSCI. The registered person must ensure that fire evacuation drills are conducted with the required frequency. 30/09/06 30/09/06 28/07/06 31/08/06 28/07/06 28/07/06 11. YA42 23(4)(e) 28/07/06 Vine, The DS0000022768.V292496.R01.S.doc Version 5.1 Page 29 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 2 3 4 Refer to Standard YA9 YA19 YA20 YA20 Good Practice Recommendations The registered person should develop an overall risk assessment audit tool. The registered person should develop Health Action Plans for each service user. The registered person should implement a system for justified medication stock checks. The registered person should revise the medication policy to cover the following topics: • The supply of medication when away from the home for example, while at work, day centres or on holiday • Over the counter medication • Handling of medication errors • Use of oxygen The registered person should investigate the method of medication administration in use for one service user to ascertain whether staff are administering medication covertly. If medication is being administered covertly then this method should be agreed by the GP and social worker. Staff should be given clear medication plans to set out the reasons for this method of administration, whether covert or not. The registered persons should obtain a copy of the Lambeth Adult Protection Procedures and keep it in the home for staff reference. 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. 5. YA20 6. 7. YA23 YA35 Vine, The DS0000022768.V292496.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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