Inspection on 14/06/06 for White Cliffs Lodge

This inspection was carried out on 14th June 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 18 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

White Cliffs Lodge 17/01/10

White Cliffs Lodge 27/06/08

White Cliffs Lodge 05/12/07

White Cliffs Lodge 05/02/07

White Cliffs Lodge 22/11/05

White Cliffs Lodge 15/06/05

White Cliffs Lodge 12/01/05

White Cliffs Lodge 25/11/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Primrose Lodge and Primrose Court Primrose Lodge Primrose Road Dover Kent CT17 0EX Lead Inspector Kim Rogers Unannounced Inspection 14 & 17th June 2006 10:00 th Primrose Lodge and Primrose Court DS0000058791.V294529.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 Primrose Lodge and Primrose Court DS0000058791.V294529.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. Primrose Lodge and Primrose Court DS0000058791.V294529.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Primrose Lodge and Primrose Court Address Primrose Lodge Primrose Road Dover Kent CT17 0EX 01304 219213 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) Beacon Care Holdings PLC Miss Amy Price Care Home 18 Category(ies) of Learning disability (18) registration, with number of places Primrose Lodge and Primrose Court DS0000058791.V294529.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Bedroom eight is the specified room for one Service User with LD/PD. Date of last inspection 22nd November 2005 Brief Description of the Service: Primrose Lodge and Primrose Court are one registered service, comprised of 2 adjacent buildings. These are situated in a residential and industrial area of Dover. They are close to the town centre and local facilities, and near to the sea. Primrose Lodge is a purpose built Home for up to 8 learning disabled Service Users. All bedrooms are for single occupancy, and there are 6 on the ground floor, and 2 on the lower ground floor. The lower ground floor has doors opening out on to the rear garden. One of the bedrooms on this floor has been altered to accommodate a wheelchair user, and has a disabled shower and toilet facility opposite to it on the same corridor. Primrose Lodge provides 3 communal rooms for both buildings, and also includes staff and laundry facilities. Primrose Court is a purpose built unit of 6 flats: two 1-bedroom flats, and four 2-bedroom flats, and therefore providing accommodation for up to 10 Service Users. These have been designed for use by more able Service Users who require minimal support. Each flat has its own kitchen/lounge/diner, separate bedrooms, a bathroom with toilet, and a separate toilet. Service Users have access to the communal and laundry facilities at Primrose Lodge. The fees at this home range from £1169.08 to £1350.00 per week. Please apply to the home for what is not included in this fee. The home ‘s e mail address is primrose@beaconcaregroup.co.uk Primrose Lodge and Primrose Court DS0000058791.V294529.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An inspection of the service was carried out over 2 days. The inspector made a short visit to the home on Wednesday 14/6/06 and returned on Saturday 17/6/06 to complete the site visit, which totalled 8 hours. The Inspector spoke to service users in private and as a group and spoke to staff. The inspector spoke with the manager during the first visit. Some records were sampled and the inspector had a look around the property. Service user plans were inspected in detail. Progress towards meeting the requirements and recommendations made at the last inspection was assessed. The inspector was concerned to find that both requirements and most of the recommendations have not been met. Some major shortfalls against some of the National Minimum Standards were evidenced. Service users commented that they couldn’t always choose what to do at weekends and during evenings. Service users said that their support could be inconsistent. Staff said the manager is approachable but ‘does not really have a say in what service users are admitted’ ‘The staff team work well together but there is no consultation with staff’ Some pre inspection fieldwork was carried out. This means the inspector spoke with care managers and gained the views of family, friends, advocates and health professionals about the service. The manager provided the Commission with a pre inspection questionnaire and other information. One care manager returned a survey form, which said ‘I feels standards have improved. My client who lives there is thriving. They appear happy and are being promoted to make choices. Their advocate who visits regularly is in agreement with me’. Unfortunately the inspector could find no evidence of this during the two visits. The Inspector was very concerned to find that staff are struggling to meet the needs of service users who have recently moved in. One service user who requires lifting and handling had no care plan or risk assessment, no aids or adaptations to assist in moving and handling and the staff said they are not trained in safe moving and handling. An immediate requirement was issued to address this concern. What the service does well: Primrose Lodge and Primrose Court DS0000058791.V294529.R01.S.doc Version 5.1 Page 6 The home has a homelike feel with a good standard of furniture, which is domestic in nature. Some staff have attended person centred planning training although this is not yet part of the culture of the home. What has improved since the last inspection? What they could do better: The inspector was concerned to find that service users have moved into the home without the required assessments, equipment and staff training to meet this persons needs. This places service users at potential risk. More detailed assessments must be carried out by the home and must include a person’s aspirations. One service user who requires lifting and handling had no care plan (service user plan) or risk assessment, no aids or adaptations to assist in moving and handling and the staff said they are not trained in safe moving and handling. A second service user had no service user plan. Risk assessments must be in place especially relating to moving and handling needs. Risk assessments must be reviewed regularly. Each service user should be issued with a contract which details the terms and conditions of their stay. This is outstanding from the last inspection. Service users must be supported to make decisions and choices. Staff must be competent in alternative communication methods and service users should have communication interventions where necessary. Some service users do not participate in daily activities like washing, ironing, cooking or cleaning as staff feel this is too risky. This means that levels of engagement are low leading to less choice control and independence. Service users would benefit from staff attending active support training, which includes an element of skills teaching. Personal care guidelines should include reference to cultural needs. Primrose Lodge and Primrose Court DS0000058791.V294529.R01.S.doc Version 5.1 Page 7 Service users would benefit from more detailed health assessments and individual health action plans. Current medication practices place service users at risk and must be reviewed in line with the National Minimum Standard. Service users must have the aids and adaptations they need to keep them safe and promote and maximise their independence. Any necessary aids and adaptations should be in place before a person is admitted to the home. Staff must be trained and competent for the job they do. There should be regular staff meetings, staff supervision and an appraisal system. A quality assurance system must be developed to ensure that the views of service uses and stakeholders underpin the review, development and improvement of the service. There is a lack of effective audit and monitoring. Staff feel that they are not consulted leading to low morale at present. The health and safety of staff must be protected. Staff should be competent in all areas of health and safety. The manager should develop an action plan to address broken and worn out fixtures and fittings. Policies and procedures should be fully implemented and in line with legislation requirements. Information about the home should be given to prospective service users in a format they understand to enable then to make an informed decision. 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. Primrose Lodge and Primrose Court DS0000058791.V294529.R01.S.doc Version 5.1 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 Primrose Lodge and Primrose Court DS0000058791.V294529.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,5 If service users are to be supported to lead the lives they want to lead, their aspirations must be assessed by the home. Service users are not given a contract or terms and conditions of their stay therefore are unaware of their role and responsibilities. Service users are not provided with accessible information to make a decision about moving to this home. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector sampled in detail the service user plans of two service users who have moved into the home very recently. Each service user has two files. One is a working file and is kept on the ground floor of the home where one service user lives. The other is kept locked in a filing cabinet in the duty office. The inspector sampled both sets of files. Each service users file sampled contained an assessment by care management. Both had limited detail. Both had an assessment carried out by the manager of the home. The manager and senior staff said they visited both service users to carry to this assessment. Neither had an assessment of the person’s aspirations as required by the standard. Primrose Lodge and Primrose Court DS0000058791.V294529.R01.S.doc Version 5.1 Page 10 In one of the assessment the section relating to education and job opportunities was dismissed as not relevant stating the ‘X has no needs in this area’ when in fact x has a profound need and requires lots of support in this area. One assessment suggested the service user might benefit from an intervention however; this was not transferred to a care plan with guidelines for staff and there was no monitoring. One assessment by the home stated ‘no health issues’ although it was clear from other records that there are health issues. The standards recognise the assessment process as crucial as the assessment forms the basis of the service user plan. For two service users who were case tracked there was no service user plans. Neither file nor a third file sampled had a contract detailing the terms nor conditions of the persons stay. There is still a need for service users and their relatives to be informed about the services to be provided to them, the cost of their stay and how it is to be funded and the conditions of living in the home and their rights. When asked service users and staff were not aware of the fee, what it includes and what is not included. Service users and staff were not clear about service users role and responsibilities. There was no evidence that this information had been made accessible for service users with more complex needs. Ideally the home should go through this information with any new service users and their stakeholders before they move in. A recommendation about contracts was made at the last inspection. The manager said that neither service user had visited the home before they moved in and neither had any of their relatives or friends. Staff confirmed this. The manager said that a brochure was given to one service user about the home. The home must be providing prospective service users with information they need about the home in a suitable format. Otherwise service users do not have the information they need to make an informed choice about moving in. There was no evidence that current service users had been consulted about people moving in. After discussions with staff and making observations it was evident that staff need additional training if they are to meet the new service users needs. The home should be proactive when admitting new service users and ensure that all measures have been taken to ensure that the home can meet the person’s needs and manage any potential risks. The home is currently building user numbers and the current user group vary greatly in their abilities. Staff were observed chatting to more able verbal service users but not much interaction was observed with more vulnerable service users. Clearly there is a need to attain a balance within the household to ensure the needs of more vulnerable users do not become marginalised. Primrose Lodge and Primrose Court DS0000058791.V294529.R01.S.doc Version 5.1 Page 11 Primrose Lodge and Primrose Court DS0000058791.V294529.R01.S.doc Version 5.1 Page 12 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 Service users cannot be sure that their changing needs and goals will be supported. Without effective communication service users are unable to make choices and decisions. Some strategies in place to manage risks limit freedom, choice and independence. Behaviour management guidelines are in place but without effective review lead to inconsistency in the continuity of support. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Inspector viewed all five service user plans. The two new service users both had a second working file but all the sheets inserted were not filled in. This meant that the information from the assessment had not been developed into a support plan or service user plan. There were no guidelines for staff on how to meet the support needs of these individuals. Primrose Lodge and Primrose Court DS0000058791.V294529.R01.S.doc Version 5.1 Page 13 This places service users at potential risk especially due to moving and handling and communication needs. For one service user a care management assessment stated that the person’s food and drink intake should be monitored although there was no record of any monitoring. Goals in some service user plans had been identified but not planned for. Some goals had been planned for using a PATH, which is a tool of person centred planning. Although the tool is being used lack of effective review or evaluation means that the plans are not supporting the person to lead the life they want. Service users told the inspector about things they want and would like to do however this was not always reflected in their plan. Service users said that their support could be inconsistent depending on the staff member. The inspector spoke with one service user in private at length. The service user told the inspector about significant life events and about their hopes and dreams for the future. This was not recorded nor being supported by the home. The inspector asked staff about how much cooking one service user takes part in and was told ‘We do it all for her’. ‘She might harm herself’ The service user plan confirmed this stating ‘x could burn herself on the kettle or the oven. X could cut herself on a knife, blade or grater. X could electrocute herself on the toaster or food processor.’ The question was then asked ‘Can we reduce the risk to x’ the answer was ‘X does not prepare food or cook. X does not make her drinks’ This service user with complex needs has been marginalised and stopped from taking part on ordinary daily tasks due to her disability. The risk strategy restricts the person rather than creatively thinking about supporting the person. For example the cooker and appliances can be unplugged when the service user is in the kitchen and knives put away. The home must ensure that risks are supported and managed as part of an everyday life. Two service users had no risk assessments although they are both at risk of harm especially due to moving and handling needs. Some behaviour management guidelines were seen. One was dated 3/01/06 the other 27/01/06. Both encouraged staff to use diffusion and distraction techniques although neither had been evaluated or reviewed. The inspector could not tell if the techniques worked or not. It was evident after making observations and talking to staff that some service users have cultural needs. Staff said that one service user likes Gospel music and use to attend a Gospel church, although there was no mention of any cultural need in the service user plan. Primrose Lodge and Primrose Court DS0000058791.V294529.R01.S.doc Version 5.1 Page 14 One service user is able to attend the local Catholic Church independently although it was not clear if another service user with more complex needs has the opportunity to attend church. Review of service user plans appears to be six monthly. Plans must be reviewed at least monthly in line with the standard. Some service users do not use words to communicate but use signs, sounds, facial expressions and gestures etc. Staff told the inspector about what certain signs and gestures mean. This was very limited for example that means x is agitated. There were no communication assessments or interventions in service user plans sampled. One assessment read ‘I communicate through limited Makaton and body language. No one knows how much I really understand’ There seemed to be no attempt made to find out how much this individual understands and no mention of what Makaton etc staff should use. Staff said that referrals have been made to speech and language services. In the meantime the home should develop individual communication guidelines so service users can be supported to make choices and decisions. Primrose Lodge and Primrose Court DS0000058791.V294529.R01.S.doc Version 5.1 Page 15 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): 12,13,15,16 Some service users are supported to take part in a variety of activities. Some service users feel part of the community. Service users know that their current relationships will be supported but would benefit from support to develop new relationships and friendships. Levels of participation and engagement are low leading to a lack of choice, control and independence. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each service user has an individual daily activity planner, but there appeared to be no guidelines in pace for staff to follow to support development of individual service users. This was an outstanding recommendation at the last inspection. Staff and service users said that activity planners could be inflexible and inappropriate. Staff felt that service users are not always given the opportunity to choose the activity and planned activities were not always what the person Primrose Lodge and Primrose Court DS0000058791.V294529.R01.S.doc Version 5.1 Page 16 wants to do. Activities are usually as a group rather than on an individual basis. Two service users attend college and local day centres. One service user said he enjoys attending the local church and socialising at church functions. One service user said he wants to watch some of the World cup football games but is being restricted by his activity planner. On the first day of the inspection 4 of 5 service users were preparing to attend a hydrotherapy session at a local centre. Staff said that they also access the sensory room at the centre regularly. Some service users attend local clubs and discos. One service user said the can usually decide what they do each day another said they could always choose what to do with their day. These service users are the more able, vocal service users. Thought must be given to other service users who need more support to plan their individual activities. The second day of the inspection was a Saturday. All service users were at home when the inspector arrived. Three male service users were supported to go out during the morning together and the two female service users went out during the afternoon. Staff said that outings are planned if there are staff that drive on duty and if service users have funds. Therefore activities and outings are ad hoc. Staff said that when the scheme was built and first opened there had been problems with the neighbours. Staff feel that this has been resolved and has settled down. Contact details of current family and friends are recorded in assessments. However, the inspector saw no plans in place to increase relationships and build new friendships or to reacquaint service users with past friends and estranged family. This is particularly important for one service user who has no family and no friends in the area. Research shows that service users with a learning disability who participate in daily living skills (household chores) have more choices and control and are more independent. Higher engagement and participation levels also leads to less challenging behaviour. The inspector asked staff about how much cooking and cleaning one service user takes part in and was told ‘We do it all for her’. ‘She might harm herself’ The service user plan confirmed this stating ‘x could burn herself on the kettle or the oven. X could cut herself on a knife, blade or grater. X could electrocute herself on the toaster or food processor.’ The question was then asked ‘Can we reduce the risk to x’ the answer was ‘X does not prepare food or cook. X does not make her drinks’ This service user with complex needs has been marginalised and stopped from taking part on ordinary daily tasks due to her disability. Primrose Lodge and Primrose Court DS0000058791.V294529.R01.S.doc Version 5.1 Page 17 The inspector looked at the risk assessment folder and could see no assessment relating to this. Staff said the kitchen is locked due to the behaviours of two service users. Staff said the kitchen remains locked if these two service users leave the house and said ‘X previous home suggested we keep the kitchen locked’. Environmental restrictions that restrict service users freedom (e.g. the kitchen, laundry and front door locks) must be reviewed to ensure they are appropriate to the risks and do not become institutionally accepted. One service user said they have to be home by 6pm to take their medication. Staff confirmed this. The service user said that they would like to stay out later then 6pm at times. Staff said that if the service user is not back by 6p they follow the missing person guidelines and report it to the police. Although there was a risk assessment for this person accessing the community there was no effective review or mention of the medication. This risk management strategy is restricting and needs to be reviewed after consultation with the service uses and their representatives. The inspector observed service users in the lounge for a period of nearly two hours. One service user on a beanbag had two interactions from staff in this time. This service user was not supported to participate in any daily living skills for the duration of the inspection. This was the case for other service users. The inspector noted that levels of engagement are low. The television was turned on in the lounge although service users were not watching it and had no control over which programme was on. One service user was on a beanbag for much of the visit and another playing with a hand held toy for much of the visit. Thought must be given to increasing service users participation in daily living skills at home. Primrose Lodge and Primrose Court DS0000058791.V294529.R01.S.doc Version 5.1 Page 18 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 Service users cannot be sure that their personal care needs will be met in a consistent and safe way. Service users would benefit from more detailed health assessments and health action plans. Medication practices must be reviewed to ensure safe practice. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector noted that personal care needs are recorded in some service user plans. Two service users have no service user plan. One service user had cultural needs relating to hair and skin care although there was no mention of this in the service user plan. The home has no assisted baths nor suitable aids and adaptations. When asked staff told the inspector that two staff lift a service use in and out of the bath. There were no guidelines in place for this. This places staff and the service uses at risk of harm. The inspector concluded that service users couldn’t be sure that they will be supported safely and in the way they prefer. Service users are registered with local GP surgeries. Records are kept of health appointments. The inspector noted that some referrals have been made for support from health professionals. Primrose Lodge and Primrose Court DS0000058791.V294529.R01.S.doc Version 5.1 Page 19 Health assessments had limited detail. For one service user the assessment for health stated ‘no health needs’ although it was clear the person has some health needs including epilepsy. One service user’s care management assessment stated that they are at risk of dehydration and food and drink intake should be monitored. There was no evidence of any monitoring. Service users would benefit from more detailed health assessments and health action plans. No service user at this home controls their own medication, although one service user takes medication with them when they go out. Medication is stored securely and the senior staff on duty has the keys to the storage. The window must be screened to enhance security. The home uses the monitored dosage system of medication supplied by a local pharmacy and has no controlled drugs. Staff told the inspector about how they obtain medication on behalf of service users. There was no record of medication received into the home. Staff said that senior staff administer drugs after attending training. The inspector observed medication being administered by staff. Staff ‘popped’ the tablets out of the blister pack, then looked at and signed the medication administration record then gave the tablets to the service user. This practice is contrary to the Royal Pharmaceutical Society guidelines and not in line with the minimum standard. The medication administration records had some gaps. There was a tablet left in a blister pack although the MAR had been signed that his tablet had been given. It was not clear if service users had their medication or not. Staff said that one service user would often refuse their medication. A code was recorded appropriately on the MAR. One service user said ‘I can’t stay out late because of my tablets’ There was no evidence that steps had been taken to remedy these situations. No consent to medication and health matters was seen as required at the last inspection. Medication practices must be reviewed to ensure practices are safe and in line with the minimum standard. These shortfalls in medication practices were noted at the last inspection. Primrose Lodge and Primrose Court DS0000058791.V294529.R01.S.doc Version 5.1 Page 20 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 More able service users are able to talk to staff about any complaints they have however, service users with communication needs are not supported to make complaints or raise concerns. Service users are at risk of harm. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home caters for a range of user abilities. One service user said they would talk to staff if they were not happy about something. The inspector was concerned about service users with more complex needs including communication needs. There were limited or no communication interventions in place to enable staff to support service users to speak out or indicate they were not happy about something. The inspector saw no other systems to enable service users to communicate. The pre inspection questionnaire stated that the home has received one complaint since the last inspection, which was partly substantiated. The inspector expressed the view that the lack of detailed behaviour management strategies, moving guidance, care plans, risk assessments for staff to work to, left service users at risk of receiving inconsistent and inappropriate responses from staff, and could compromise the safety of all concerned. The inspector heard that one service user had some of their property removed by another service user. Although this has now been resolved staff must ensure that vulnerable service users are protected. Primrose Lodge and Primrose Court DS0000058791.V294529.R01.S.doc Version 5.1 Page 21 Staff were able when asked to give types of abuse and signs of abuse and could say who they would report to. Staff said they have recognised that service users are at risk of harm due to current working practices and have reported this. An immediate requirement was made to address this. Primrose Lodge and Primrose Court DS0000058791.V294529.R01.S.doc Version 5.1 Page 22 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): 24,29,30 Service users benefit from a clean, pleasant home although some parts needs attention. Service users safety is compromised due to the lack of suitable aids and adaptations. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector had a look around the home. The court is currently empty. The inspector saw some service users bedrooms. Bedrooms viewed had been personalised to reflect individual tastes and interests, as had the communal lounge on the lower ground floor and the main lounge. The home was generally clean on both days of this inspection. Service users told the inspector that the home is kept clean. One en suite was in need of cleaning, the tap was leaking, the bin and toilet seat were broken and the laundry basket was broken. There was a hole in the wall behind the door ad brown splash mark up some walls. Some service users are supported to take part in the household tasks including the cleaning. However, staff said that the less able service users do not take part in any cooking or cleaning. Primrose Lodge and Primrose Court DS0000058791.V294529.R01.S.doc Version 5.1 Page 23 Both of the laundry rooms and kitchen are kept locked although there was no assessment in place to show that this is done in the best interests of all service users or is the least restrictive option. A service user said ‘I like to do my ironing at night and staff say ‘no ironing after 6pm’ The inspector could find no reason for this restriction. The laundry on the ground floor is in line with the standard however the laundry on the first floor has some equipment stored there restricting space and presenting a hazard to service users. The manager reported delays in addressing maintenance issues due to delays at head office but reported that the majority of outstanding issues have now been addressed. The pre inspection questionnaire stated that the home has no clinical procedure policy although deals with clinical waste. A recommendation was made to address this. Bathrooms are domestic in nature with no assistance of aids and adaptations as is furniture. Some service users are in need of aids and adaptations to maximise their independence and protect their health and safety. Staff said that although the home has a hoist there are no slings to fit service uses and staff have not been trained. There were no moving and handling assessments or risk assessments for safe moving and handling. Staff said they are lifting service users and described how they get a service user in and out of the domestic bath. The inspector observed staff lifting a service user in the lounge. This practice places service users and staff at risk of harm. An immediate requirement was made to address this. Primrose Lodge and Primrose Court DS0000058791.V294529.R01.S.doc Version 5.1 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,35 Staff do not have the training they need to ensure competency, especially relating to service users specialised needs. Staff feel that more staff meetings and supervision would be beneficial. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector viewed a copy of the training records for staff. Some shortfalls were noted especially relating to safe working practices i.e. moving and handling and fire awareness. 1/7 staff has attended moving and handling training and 0/7 staff are competent in fire awareness. The manager said that moving and handling training was organised and cancelled at short notice by head office. It is of concern that service users who require moving and handling have been admitted to this home without the necessary staff competency and skill to meet their needs. There was no record of specialised training relating to some service users needs. 3/7 staff have an NVQ qualification. Service users said that the support they get varies between staff member so is inconsistent. After talking to staff and observing their work the inspector recommended that staff have person centred active support training. This should include an element of skills teaching for service users with profound needs. Primrose Lodge and Primrose Court DS0000058791.V294529.R01.S.doc Version 5.1 Page 25 The manager said that recruitment is underway for new staff due to the increase in numbers of service users. There are plans to recruit a deputy manager. The senior staff said they have been interviewing with the manager although have not had any recruitment and selection training. The home is currently using agency staff. The inspector observed an agency member of staff on the second day of the inspection and observed no interaction with any service user by this staff. There were 3 staff on duty on the second day of the inspection, one female staff and two males in the morning and two females and a male in the afternoon. One staff could drive so was able to facilitate an outing. This left one staff with 2 service users. One of these service users needs two staff to move. Staff said there is a contingency plan in place in case of an emergency and they would contact the manager. Staff work early and late shifts and long days i.e. 07.30 – 22.00. This is a 14.5-hour shift. From one rota sampled a staff member arrived at the home at 14.30 on a Friday and worked until 07.45 on Sunday. Another staff arrived to work at 07.30 on a Saturday and worked until 15.00 on the Sunday. Staff said that these 14.5 hour shifts are ‘long and tedious, quite stressful and tiring’ With staff commenting about this and service users commenting about the inconsistent support the inspector required that staff deployment and the rota be reviewed. Shift planning is not used therefore activities are ad hoc. Shift planning would increase service users participation levels and this is a recommendation. Staff said that they have supervision meetings with the manager although these can be infrequent. One staff said their last supervision was cancelled. Another staff said that they could talk to the manager at any time as the manager works with staff and service users. Staff said there was no appraisal system at the home. Staff said that staff meetings do not happen ‘very often’. Staff said they could not remember when they last attended a staff meeting. The minutes in the file were dated 9/2/06, 16/11/05 and 30/9/05. Staff indicated that morale is low and they feel they are not consulted about current and prospective service users. Staff expressed dissatisfaction with the support from senior managers. Staff feel that that do not have the specialised training to meet service users needs. Staff must be competent for the job they do and must have the training they need to meet service users needs. A requirement was made to address this. This was also noted at the last inspection. Primrose Lodge and Primrose Court DS0000058791.V294529.R01.S.doc Version 5.1 Page 26 Primrose Lodge and Primrose Court DS0000058791.V294529.R01.S.doc Version 5.1 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39,42 The lack of and non-implementation of some polices could place service users and staff at risk. The home needs to implement a system of self-auditing and quality assurance that engages with all service users and stakeholders and can evidence how this influences change and development in the service Lack of safe working practices means that the health safety and welfare of service users is not protected. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The pre inspection questionnaire stated that the home does not have some of the required policies including physical intervention and guidance on clinical procedures. Primrose Lodge and Primrose Court DS0000058791.V294529.R01.S.doc Version 5.1 Page 28 Staff spoke to the inspector about their experience of a disciplinary matter. The inspector cross-referenced this with the homes disciplinary procedures and it was clear that the procedure had not been followed. Polices and procedures protect staff and service users and should be fully implemented and regularly reviewed. A recommendation was made to address this. As found at the last inspection there was no evidence that service users and stakeholders views underpin the development and improvement of the service. The inspector saw quality assurance system file. A letter dated 3/5/05 was sent to stakeholders. Some were completed and returned and some graphs were produced with actions like more staff meetings and better communication. There were no views of service users and no action plan to develop and improve the service. The Commission as required by the standard has received no annual quality assurance report. Staff said that a senior manager visits the home monthly and completes a report. The Commission have received these reports. However, some of the issues found at the inspection had not been noticed during thee monthly visits. Staff said that the senior manager talks to the more able verbal service users leaving the less able service users marginalised. As mentioned shortfalls in staff training relating to health and safety places service users at potential risk. The home is in breach of moving and handling regulations. Staff said there have been several different managers at the home since it opened. The current manager has been in post for about one year and is the Registered manager. The manager works some time on shift and some time in the office. Staff said ’we all work together well’ although the general consensus of staff was that they feel unsupported by senior management and not consulted about current and prospective service users. It was clear that service users have been admitted to the home recently without the necessary equipment and staff competency to meet their needs. This places service users and staff at risk of harm. Any future admission to the home must be managed to ensure service users needs can be fully met. This is the responsibility of the registered manager. The Commission are concerned about the management of this home due to the amount of outstanding requirements and recommendations and the unsafe working practices that place service uses at risk. The Commission expect a detailed action plan on how the manager plans to improve the home and meet the requirements and recommendations made and the National Minimum Standards. Primrose Lodge and Primrose Court DS0000058791.V294529.R01.S.doc Version 5.1 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 X 4 X 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 1 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 X 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 1 1 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 2 16 1 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 1 X 2 X 1 X X 1 X Primrose Lodge and Primrose Court DS0000058791.V294529.R01.S.doc Version 5.1 Page 30 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA9 Regulation 13(6) Requirement Risk assessments are to be reviewed to address shortfalls and actions taken to minimise risk identified by 31/12/05 NOT MET Detailed behaviour management guidelines are to be developed for staff to ensure they manage behaviour in a consistent and appropriate manner that has been endorsed by all parties. The effectiveness of the guidelines should be monitored and reviewed regularly by 1/02/06 NOT MET The Registered person must ensure that assessments are carried out in line with the standard. The Registered person must ensure that they develop a contract of terms and conditions of residency with each service user. The Registered person must develop an individual service user plan with each person in line with the standard. The Registered person must ensure that service users are DS0000058791.V294529.R01.S.doc Timescale for action 30/06/06 2 YA23 13(6) 30/06/06 3 YA2 14 31/08/06 4 YA5 17(2) 31/08/06 5 YA6 15 31/08/06 6 YA7 12(2) 30/09/06 Primrose Lodge and Primrose Court Version 5.1 Page 31 7 YA16YA8 16 8 YA9 13(4) 9 YA18 12 10 YA19 12 & 13 11 YA20 13(2) 12 YA23 13(5) 13 YA29 12 & 13 14 YA35YA32 18(1)c 15 YA39 24 supported to make decisions and choices about their lives. The Registered person must ensure that service users have opportunities and the support they need to participate in everyday activities at the home. The Registered person must ensure that risks are assessed and managed to maximise service users independence and safety. The Registered person must ensure that service users personal care and cultural needs are recorded and supported. The Registered person must ensure that health needs are assessed and health action plans are developed with individuals. The Registered person must ensure that medication practices are reviewed and improved in line with the minimum standard. The Registered person must ensure that there are safe systems in place for moving and handling service users so they are protected from risk of harm. IMMEDIATE The Registered person must ensure that service users have the aids and adaptations they need. The Registered Person shall ensure that the persons employed to work at the care home receive training and supervision appropriate to the work they are to perform. This especially relates to moving and handling of service users. IMMEDIATE The Registered person must ensure that a quality assurance system is developed to ensure that service user and stakeholders’ views underpin the DS0000058791.V294529.R01.S.doc 31/08/06 30/06/06 31/07/06 31/08/06 31/07/06 30/06/06 31/07/06 30/06/06 30/09/06 Primrose Lodge and Primrose Court Version 5.1 Page 32 16 YA42 12 & 13 review and development of the service. The Registered person must 31/10/06 ensure that the health and safety of staff and service users is protected. Staff must be trained in all areas of health and safety including moving and handling and fire awareness. 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 5 6 Refer to Standard YA1 YA15 YA22 YA24 YA40 YA32 Good Practice Recommendations Service users must have the information they need about the home before they make a decision to move in. Service users should be supported to develop and maintain relationships. Service users should be supported to make complaints and raise concerns. The Registered person should provide an action plan to address the issue of broken and worn own decorations and fittings. The home polices and procedures should comply with current legislation and be fully implemented. Service users would benefit if staff had person centred active support training. Primrose Lodge and Primrose Court DS0000058791.V294529.R01.S.doc Version 5.1 Page 33 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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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