Inspection on 03/11/08 for White Lights

This inspection was carried out on 3rd November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

1 Marten Road

Daubeney House

Three Gables

Aldwick House

49 Glendale

The Springs Community

Crossways Community

Belle Vue Country House

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: White Lights 20-22 Chapel Park Road St Leonards-on-Sea East Sussex TN37 6HU     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Michele Etherton     Date: 0 3 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 37 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 37 Information about the care home Name of care home: Address: White Lights 20-22 Chapel Park Road St Leonards-on-Sea East Sussex TN37 6HU 01424437995 01424437995 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Baldeo Seesarun Type of registration: Number of places registered: Mr Baldeo Seesarun care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 20. The registered person may provide the following category/ies of service only: Care home only ? (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia (MD) Date of last inspection Brief description of the care home White Lights is registered to provide accommodation for up to 20 people suffering from mental health issues and admits people with low to medium dependency needs. The premise is a well-maintained, large detached property in St Leonards on Sea with single and double rooms on the ground and two other floors. Residents have the use of two separate lounge areas (one is the designated smoking area), a small quiet room and a dining room with additional comfortable seating. The home has a good-sized well-maintained rear garden with seating areas for residents, lawn areas, fishpond and Care Homes for Adults (18-65 years) Page 4 of 37 Over 65 0 20 Brief description of the care home established borders. There is also a paved and lawn area to the front of the premises, which could be used for sitting. Car parking is available within the street outside. The building is located a short walk from Warrior Square station and the sea front and shops. The Home was recently sold and has been re-registered under a new owner Mr. B. Seesarun who owns another home and has many years expereince in the health and social care field. The new provider is currently in day to day operational control of the home. The current weekly fee for the service is between £322.40 and £337.00. The service has no current e-mail address Care Homes for Adults (18-65 years) Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: A key unannounced inspection of this newly registered service has been undertaken, this has taken account of information received from and about the service by CSCI since the service changed ownership and was re registered in July 2008. An Annual Quality Assurance Assessment has been requested from the service but this will be returned too late to inform this inspection, but we have discussed its completion with the new provider. The inspection of the service has included a site visit to the premises on 3rd November 2008 between 9:30 and 17:00. During the visit a tour of the home has been undertaken that included all communal rooms and the majority of toilets and bathroom areas, some resident bedrooms were viewed with permission. During our visit we were Care Homes for Adults (18-65 years) Page 6 of 37 able to spend time with residents and speak with staff on duty. Survey responses have not been received to inform this inspection. As a new registration but not a new service all key standards have been assessed in addition to those where shortfalls have become evident during the course of inspection. During our visit we examined a range of documentation including resident files, risk information, records of food provided, medication records and storage, staff recruitment, training, and supervision information. Complaints, accident and health and safety records. In arriving at our judgment we have tried to be proportionate in considering compliance with regulation and outcomes for the residents alongside overall risks and impacts of identified shortfalls bearing in mind the short timescale in which the new provider has had to make improvements. What the care home does well: What has improved since the last inspection? What they could do better: Our inspection has highlighted a number of shortfalls in key areas that the new provider has inherited from the previous ownership of the home. He is aware that an investment of time and money is now needed to bring the service up to standard, residents have made clear they feel more involved and that they perceive an improvement in the operation of the home that will lead to improved quality of life for them. We have identified the following areas where the provider is required to take action within the given timescales and he will be asked to provide a plan of improvement to tell us how this will be achieved: Information provided to residents about their terms and conditions.Residents individual support plans and risk information. Recording and storage of medication. Staff awareness and understanding of how to manage behaviours consistently. Upgrading and repair of the environment. A review of staffing levels, the development and implementation of a staff training programme, A review of the current recruitment system. The development of a quality assurance system for internal audit and review that also takes account of the views of residents and other stakeholders. That routine checks and tests of fire fighting, alarm and lighting equipment are undertaken and Care Homes for Adults (18-65 years) Page 8 of 37 records maintained of this. We have also made a number of good practice recommendations that we would urge the provider to also take account of and implement these are to ensure that information developed for prospective residents is also accessible to existing residents e.g Statement of purpose and user guide information. That opportunities are provided for residents to develop independence skills in the home, that arrangements for resident post and key holding are reviewed, that the availability of hot drinks is looked at with residents and dietary issues are made clear within support plans, that the system for weighing residents is reviewed and that falls monitoring is implemented for some residents. We would also like to see the development of medication profiles and PRN guidelines, the complaints procedure needs further update and should be displayed, staff observational supervision should be expanded to enable staff private one to one time on a regular basis with their supervisor If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 37 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about what the service offers and the terms and conditions of residence has been developed but is not routinely made available to existing residents. Prospective residents can be confident their needs will be assessed prior to admission to ensure these can be supported by the home. Evidence: The provider has revised the statement of Purpose and user guide information and is available for prospective residents, we would recommend that existing residents are also provided with a copy of this information in view of the change of ownership and aims and objectives. A master copy of the updated documentation should be maintained within the main policy folder for the home. Since the change of owners and the re registration of the service only one new resident has been admitted, staff had little knowledge of this individual and made clear they are not providing any support other than meals to the resident, we could not find Care Homes for Adults (18-65 years) Page 11 of 37 Evidence: a care plan for the resident but the provider has undertaken an assessment of need although this had not informed the development of a care plan however minimal the residents needs, nor was the assessment available to staff to view. In discussion with the provider it would seem the newest placement is in response to an accommodation crisis more than a need for the support and care afforded by a residential care home and this would seem to be an inappropriate use of such resources and an unsuitable placement in view of the vulnerability of the rest of the residents. Staff we spoke with had little knowledge of the needs of the service user in question and yet daily reports clearly indicate interactions they have with the resident sometimes of a negative nature with no clear guidance as to how they should be managing the situation. Our discussion with the provider and with staff suggest the resident may have needs outside the stated admission criteria for the home, whilst there is no indication that the service is unable to meet the minimal physical and accommodation needs of this resident their admission does raise questions about who the service is for and whether the new provider wishes to expand the range of needs supported by the home, if so this will need to be clearly reflected in all documentation, staff training and the impact on existing residents considered. We have addressed the need for staff to have information about all residents in another section, and that these are supported by appropriate risk assessments. The service has developed a terms and conditions document and is required to ensure all residents including those who are privately funded have either a completed contract or terms and conditions document making clear the their weekly contribution to the cost of their placement and any other costs they may be liable for. Care Homes for Adults (18-65 years) Page 12 of 37 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are generally well supported but staff lack information about residents needs and the agreed manner in which they are to be supported to support their practice. Residents lead the live they choose and are enabled to take risks but we consider that written risk assessment information is inadequately detailed to evidence this is carried out thoroughly and all risk reduction measures are in place to safeguard residents. Evidence: We viewed files for four residents three of whom we spoke with. The newest resident has no care plan in place and staff are unaware of the residents needs or risks associated with his placement. Other files we viewed provided evidence that the new provider is developing systems for recording health contacts and appointments, and recording weights. A system of monthly reviewing of changes to care needs has been introduced, in addition to the implementation of crisis care plans to respond to short term changes in needs owing to Care Homes for Adults (18-65 years) Page 13 of 37 Evidence: ill health or change of circumstances, but, we found there to be insufficient information within records currently to detail the day to day needs of individual residents and preferred daily routines of how staff support these e.g. staff told us about one resident we spoke with who has very specific rituals but these are not detailed within the support plan we examined. When we spoke with staff about the residents whose files we examined, we found that they demonstrated a good understanding of individual residents needs and routines, the absence of base line support plans however, means that there is an over reliance on information being relayed verbally between staff about resident needs, staff do not have a reference to ensure they are supporting residents in an agreed or consistent manner and newer staff would not be able to familiarize themselves with residents care plans as required for their induction. The service is required to ensure care support plans are in place for all residents and these are updated in response to existing review arrangements. We spoke with approximately eight of the current residents in some depth who reported that all are self caring, two said they required minimal support from staff with hair washing, two residents currently in hospital or convalescing will require more support on their return. All residents except one come and go freely from the home, and make their own decisions and choices about their day-to-day lives. Risk assessment information has been developed but this would benefit from improved detail as it currently fails to record in detail risk reduction measures in place, the provider is required to review and improve the content of risk assessments Care Homes for Adults (18-65 years) Page 14 of 37 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents lead the life they wish and make good use of the local community and its facilities, they welcome plans to provide some in house activities but would also benefit from opportunities to develop skills and independence if they want to within a responsible framework for the assessment of capacity and risk. Residents are supported to maintain links with important people in their lives if they want to. Improved variety in menus that takes account of resident preferences is underway but clarity is needed for staff and residents about availability of alternatives and hot drinks, information about specialist diets needs to be made clear within support plans and subject to review. Evidence: At present all the residents currently in residence are fit and mobile to come and go from the home as they choose, with only one resident needing support from staff when Care Homes for Adults (18-65 years) Page 15 of 37 Evidence: out. We noted evidence in daily report of some residents returning quite late to the home when out with staff knowledge. residents told us that they attend activities of their own choosing in the community, sometimes other people have told them about activities or they have found them for themselves. Residents clearly enjoy the freedom to come and go but some said they do sometimes get bored and were interested in the new providers plans for turning an old smoking lounge into an activity area. Some thought this to be a good idea and it would be well used. None of the residents have a front door key but many have keys to their own rooms, it is not recorded in the files of those who do not why not and whether this is reviewed, capacity assessments are not in place in these we would recommend this arrangement is reviewed. Some residents said they would like to learn new skills or relearn those they had lost upon entering care. Some asked whether they could help with cooking and go into the kitchen, or do their own laundry, others made clear they would not wish to do this and had no interest in becoming more independent, clearly this is an area that needs to be explored with residents on an individual basis and opportunities for skills training in a responsible risk taking framework provided and tis is a recommendation. Some of the residents we spoke with have no family and have no contact with extended family or friends, other residents told us about regular visits and contacts they have from family members and clearly enjoy this additional support. Residents told us that they usually get their mail handed to them on a regular basis but this had not been the case over the last weekend and some expressed irritation that they had to wait for the provider to come in Monday and sort the mail, it is recommended that a system for managing the post on a daily basis is made clear to residents and staff and adhered to. Residents told us that they do not currently have resident meetings and some thought this would be a good idea, and clearly feel more confident about raising issues with the new provider. Currently none of the residents require specialist diets and staff demonstrated a good level of knowledge around individual resident likes and dislikes in respect of food. menu development is still underway and although residents are currently offered only one choice they made clear that they could ask for something else if they did not like what was on offer. Residents commented that things have improved with the new provider, staff seem more flexible about offering meal choice. Records are maintained of meals provided to residents and this demonstrates a generally varied diet, with residents reporting that they are provided with fresh fruit options for desserts. Some residents reported that they are able to have kettles in their bedrooms to make hot drinks, no risk assessments were noted for these, some residents who dont have this facility to make their own drinks stated that they would like hot drinks offered more Care Homes for Adults (18-65 years) Page 16 of 37 Evidence: often, some reporting that they found staff to be rigid in sticking to specific times when drinks could be offered. daily records indicate that residents who are active during the night are often provided with hot drinks, although when asked residents commented that this happened only if you found d staff in a good mood as they were not supposed to offer drinks during the night. We would recommend that the availability of hot drinks is reviewed and arrangements are made clear to staff and residents, we would further recommend that where there are dietary related issues these are clearly recorded in resident care plans. Residents also commented: Food is pretty good Food varied dependent on whose cooking it They give you something else if they have time I would like to do a bit of cooking Care Homes for Adults (18-65 years) Page 17 of 37 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff demonstrate awareness of the personal, physical and emotional support needs of residents but lack written documentation, specialized training and guidelines to support their practice. Arrangements for the storage, administration and recording of medication would benefit from suggested improvements. Evidence: Residents require minimal personal care support from staff and whilst staff demonstrate an understanding of the physical and emotional support needs of the majority of residents this is not detailed within individual support plan information. Files we viewed indicate that residents are independently or with staff support accessing routine and specialist health care appointments and residents we spoke with confirmed they receive staff support at appointments. There is evidence that the home staff appropriately seek interventions by health care professionals in the event of residents becoming unwell. We noted in a file for a resident currently in hospital that there are specific concerns around choking, and respiratory problems but the client file contains no information about this to support staff in managing choking episodes or Care Homes for Adults (18-65 years) Page 18 of 37 Evidence: breathing problems, should they return to the home. With an aging and increasingly less mobile client group there is a likelihood that this resident and others will also be at a higher risk of developing pressure areas but staff have not previously been trained to support residents with these needs and documentation needed to assess risks around skin viability, continence, falls, nutrition and moving and handling have not routinely formed part of the tools used by the home to maintain residents quality of life and the new provider will need to address this if the service is to continue to meet the day to day needs of the present resident group. One resident indicated that they fall on a regular basis but no reference is made to this is the resident file, falls monitoring is not conducted and the home could not evidence that an accident report had been completed on behalf of this resident for the fall, although the accident report book would seem to indicate that accident reporting is happening but there would seem to be a lack of clarity as to where such reports are filed, we would recommend that the home commence falls monitoring for those residents where risk of falls is becoming more apparent and this is a recommendation. The new provider has introduced a system for weight recording and whilst this has been completed on some files viewed this has not be applied routinely to all residents, in discussion the provider reported some difficulty in finding a place where an accurate reading could be recorded, and that some residents objected to where they are weighed, the provider is reminded that the privacy and dignity of the resident must be maintained at all times and that one place should be identified and compensations made for any minor inaccuracies caused by uneven flooring and this is a recommendation A care staff member we spoke with commented that they had recently undertaken medication refresher training. Medication cabinets are in place but tighter control of the medication key should be introduced. No controlled drugs are administered currently, Temazepam is secured away from other medications but should be kept within the controlled drugs cabinet. We viewed Medication administration records at this visit and whilst staff are making good use of codes we noted a number of handwritten entries that are unsigned and undated, all such entries should be are signed and dated by the person entering the change. Medications received into the home are checked by the provider and a senior staff member and recorded on MAR sheets. We noted some lactulose belonging to two clients currently away from the home was being stored on a kitchen shelf, it was unclear why this was the case and the provider is reminded that all out of date medications should be disposed of and all other medications kept securely within the medication storage cupboard at all times. The provider is required to address these shortfalls. Care Homes for Adults (18-65 years) Page 19 of 37 Evidence: None of the present residents self medicate but files viewed provided no evidence of capacity assessments to support this and the provider is reminded of the need to ensure that where residents lack capacity or are deemed at risk there is clear evidence and rationale to support these restrictions. We are aware that some residents self administer some homely remedies but no medication profile exists currently for residents to ensure staff are made aware of the full range of prescribed medications and homely remedies residents are taking, PRN guidelines are not in place to ensure staff administer this type of medication consistently and these are recommendations. Risk assessment is not in place for those residents who self-administer homely remedies and has been addressed elsewhere in the report. Care Homes for Adults (18-65 years) Page 20 of 37 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents feel more confident about raising issues of concern and that these will be listened to, improvements in staff training and guidance will better safeguard residents Evidence: We are advised by the provider that since taking over ownership of the home no complaints have been made to him about the service, although he is aware that confidential complaints have been made to both CSCI and social services and these have been dealt with under adult safeguarding . The complaints procedure has been updated but also needs to incorporate details of the local social services department as a point of contact for complaints about the service, the complaints procedure should be displayed for residents and visitors to view and this is a recommendation. Residents told us that previous to the new owner they did not feel listened to or confident of raising issues of concern they might have, one resident told us that: things feel better now I feel I can go to the new owner, you can tell him anything youre worried about I feel more confident about raising issues Residents do not currently have a residents meeting and this has been addressed elsewhere in the report. Care Homes for Adults (18-65 years) Page 21 of 37 Evidence: Staff have not received training in adult safeguarding and the present owner is aware of the need to provide this in addition to other mandatory training and this has been dealt with elsewhere in the report in respect of staff training. Staff have some awareness of adult safeguarding and their reporting responsibilities to other agencies. As stated confidential complaints to both CSCI and the social services mental Health team have been received expressing concerns about the overall care and welfare of residents these have been investigated by the mental health team representative under adult safeguarding and found to be unsubstantiated, the investigation has however highlighted some historical financial irregularities preceding the present owner and these are still under investigation. The new provider has decided at this time not to be responsible for holding monies on residents behalf although this may be reviewed if appropriate systems for doing so are developed. Residents told us they are happy in each others company most of the time and generally get on well with rare outbursts or anger against each other, daily reports we examined highlighted some behaviour issues amongst residents and yet no clear guidelines have been established to inform staff how to manage these in an agreed and consistent manner and the provider is required to develop these and ensure these are reviewed. Care Homes for Adults (18-65 years) Page 22 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a spacious comfortable home that will benefit from a planned programme of refurbishment and repairs. Evidence: We undertook a tour of the premises and found the accommodation to be spacious and clean although in need of upgrading and refurbishment. Carpets in communal areas are in need of replacement being worn and dirty in places, the floor boards in the dining room/lounge need urgent replacement and the provider has advised that plans are in hand for these repairs to be done. We found bathrooms/shower rooms and toilets to be in need of refurbishment with sanitary wear, shower trays, tiles and grouting being stained and in poor condition. The environmental health officer has also commented on the condition of the kitchen work surfaces. The new provider recognizes the need for investment in the property to bring it to a good state and it is a recommendation that he assesses and prioritizes the shortfalls and develops a programme of upgrading and refurbishment with clear timescales for achieving them. Owing to the potential risks to residents we will require the repair of the lounge/dining room floor to be progressed as a matter of urgency. Care Homes for Adults (18-65 years) Page 23 of 37 Evidence: Residents we spoke with commented on plans for some new furniture and change of use of the previous smoking lounge with the purchase of a pool table and other activities. Bedrooms viewed are individually furnished and reflect the individual tastes and interests of the residents, we noted shared rooms lacked screening and the home is required to ensure that screening is provided in shared rooms to support the privacy and dignity of residents. There is evidence that the fire alarm has been serviced and the provider is able to evidence that a contract is being pursued for gas servicing, the provider has also indicated plans for servicing of the electrical installation and Pat testing are to be established and we will monitor that this has happened. Staff we spoke with confirmed they had attended a fire drill in the past year and the new provider is recommended to ensure that staff attend at least two drills annually. We did not on this occasion view the fire log. The home has only one bedroom on the ground floor with others in the basement and first floor, the home currently accommodates an aging group of residents some of whom have decreasing mobility which is currently not supported by the use of bath hoists/seats/shower seats to enable easier use of baths, it is necessary for the provider to consider how accessibility for these residents can be improved and that appropriate aids and adaptations are provided to support this and their daily care and this is a recommendation. Care Homes for Adults (18-65 years) Page 24 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The number and experience of care staff on day time shifts in addition to the provider needs review. Residents and staff will benefit from the planned programme of training already underway. The recruitment procedure needs strengthening to ensure residents are better safeguarded. The monitoring of staff performance would benefit from inclusion of opportunities for private discussion about training and development. Evidence: On the day of our visit we found only one carer and one cook/cleaner on duty who indicated that she was the person in charge, an additional cleaner was on duty to cover the cleaning duties of the usual cleaner whilst she undertook cooking duties. The provider was absent for the first part of our visit but staff we spoke with made clear that he is usually on site each day and in operational day to day control. No duty rota was available for the week of our visit, when we asked staff how they knew what shifts they were working those present stated that they usually worked fixed hours although they did not always know who they might be working with, there is evidence of planned rotas in place for previous weeks but these are not the rotas actually worked and these were unavailable to view. Whilst we accept that the home is currently experiencing some shortage of staff , it is not acceptable for carer numbers on shift to be supplemented by untrained ancillary staff. The provider is required to ensure that a Care Homes for Adults (18-65 years) Page 25 of 37 Evidence: minimum of two care staff are on day time shifts in addition to any ancillary staff, and that a senior or manager must be present who is over the age of 21 years. An accurate staff rota must be maintained and available to view at all times. Residents we spoke with whilst not raising concerns directly about the level of staffing in the home did comment that it had reduced and said that they sometimes found it hard to find a staff member if they needed one. The new provider has indicated a commitment to ensuring all the staff team achieve NVQ level 2 as a minimum and has advised that another two staff have recently completed this qualification. The provider recognizes that existing staff have not been provided with opportunities previously to maintain their mandatory training or to receive specialist training in mental health, and has already provided two courses for staff since taking over the home in July these are: medication and food Hygiene. Clearly some residents currently absent from the home have moving and handling needs and will continue to have these when they return and it is essential that the staff team is trained to support them appropriately and safely and are mindful of their own health and safety in this area. The provider is therefore recommended to assess the training needs of the staff team and progresses the training of staff by the establishment of a rolling programme of induction, mandatory and specialist training. Staff records are in Place for all staff but their content is not compliant with Care Homes regulation 19 and schedule 2, or consistent in the information they contain out of eight files viewed only three contained two references, one contained none and others only 1, the quality of references accepted was variable. We found one file without an application form and no evidence on all files that gaps in employment history or reasons for leaving previous care roles had been verified with applicants, current photographs and ID were also missing on some files, all but one file provided evidence of POVA first checks and CRBs , we discussed the absence of CRB for a long serving staff member and it may be this has become mislaid and a new one will need to be applied for at the earliest opportunity, the provider has given assurances that the worker concerned will co work with other staff until a new CRB is returned and should ensure a risk assessment is in place. From our examination of staff files we do not consider that the previous recruitment procedure has been sufficiently robust to safeguard residents and the new provider is required to address the identified shortfalls. The new provider indicated an awareness of the need to provide new staff with skills for care induction training but could not evidence that this had been put in place for the newest staff member. Care Homes for Adults (18-65 years) Page 26 of 37 Evidence: There is evidence that the provider is implementing a system of observational supervision and this should be developed to allow staff opportunities to meet in private with the provider where their practice, training and development needs can be discussed. And this is a recommendation. Care Homes for Adults (18-65 years) Page 27 of 37 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will benefit from the planned improvements to the service by the new provider but it is too soon to assess how effective this has been in improving overall service quality and the day to day experiences of those living in the home and the staff who support them. Evidence: The provider has only recently taken over the home and recognizes the service is in need of investment of time and money. The provider is still assessing the service and how to develop it further and we would recommend that a service development plan is developed to highlight areas identified for improvement and timescales for implementing such improvements. The provider is unaware of any quality assurance system routinely used within the home and will now need to implement one that also takes into account the views of residents, and this is a requirement. residents have already told us that they feel more confident about raising issues with the new provider and that they feel listened to, Care Homes for Adults (18-65 years) Page 28 of 37 Evidence: further opportunities to consult with them through user surveys and resident meetings should now be developed. Health and safety checks in respect of the fire alarm and extinguishers were noted, the provider is to establish a gas serving contract, and also one for the routine servicing of the electrical installation and PAT testing of electrical items, weekly tests and checks of fire points and emergency lighting could not be evidenced on this occasion and it is a requirement that systems are in place to ensure this is maintained. There are shortfalls in the mandatory and specialist training of staff that the provider is beginning to address. Accident reporting is happening and notifications are being made to both CSCI and other agencies, although some clarity is needed in regard to the completion of numbers and dates within the accident book to correlate to individual accident reports. We asked to see the current employers liability insurance for the home and a copy of this has been made available post inspection, we are not satisfied with the accuracy of the provider name details recorded on the insurance and have asked the provider to have this checked and amended and this is a recommendation. This visit highlighted shortfalls in an number of key areas that we recognize the provider has had limited time to address since taking over the home we have therefore tried to be proportionate in our judgment of the home and the impact these shortfalls currently have on the residents, and have taken into consideration their views about the service which they perceive to be an improving one. Care Homes for Adults (18-65 years) Page 29 of 37 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 5 5 All residents must be provided with information about the terms and conditions of their stay (privately funded residents must receive a contract) This is to ensure that residents are made aware of their rights and responsibilities and how much they are expected to pay, including additional costs not covered by the residential fee 30/12/2008 2 6 15 The provider must ensure 30/12/2008 that a support plan detailing the assessed needs and how these are to be supported by staff or others on a day to day basis is developed in consultation with and for every resident within a maximum of five days of admission This is so that staff receive information consistently Care Homes for Adults (18-65 years) Page 31 of 37 about the needs of residents and how they are to be supported in a way they would prefer 3 9 13 The provider must review the content of risk assessment information to ensure this details all risk reduction measures considered and in place. So that the home can evidence that its decisions and judgments around risk have been based on good evidence 4 20 13 The provider is required to : 30/12/2008 ensure all handwritten entries on MAR sheets are signed and dated That medication keys are kept in a secure place at all times if not in the possession of the person administering medication. Unused/out of date medication must be returned or disposed of, and all prescribed medications should be securely stored. Temazepam should be kept within the controlled drugs cabinet Medicines in the custody of the Home are handled according to the Medicines Act 1968 5 23 13 The provider is required to 31/01/2009 develop behaviour management guidelines for residents who have behaviours that require staff 30/12/2008 Care Homes for Adults (18-65 years) Page 32 of 37 to respond in an agreed manner and is subject to review In order that residents behaviour is managed in an agreed manner consistently by the staff team 6 24 13 The provider is required to arrange and implement the repair of floor boards within the dining/room lounge as a matter of urgency To safeguard residents, staff and visitors and minimize risk of injury 7 25 23 Screening is to be provided in shared rooms so that residents who choose to share can also be private and maintain personal dignity 8 33 18 The provider must review 30/11/2008 the number and experience of care staff on day time shifts to ensure that residents needs are adequately supported this should not be less than two carers in addition to ancillary staff and the provider manager To ensure that residents are adequately supported particularly those residents who require more support with their personal and emotional care 9 35 19 The provider must ensure that the recruitment of staff 30/12/2008 30/12/2008 30/12/2008 Care Homes for Adults (18-65 years) Page 33 of 37 is undertaken robustly and is compliant with regulation 19 and schedule 2 of the care Homes regulations 2001 in that: all staff must have an application form, statement of health, ID and current photograph, 2 references, a CRB relevant to their role at the home, the home must evidence that gaps in employment and verification for the leaving of previous care roles has been sought from applicants So that residents are safeguarded 10 39 24 The provider is required to implement a system of quality assurance that incorporates consultation with residents and other stakeholders So that residents views can be taken account of and influence service development. So that the service is able to undertake internal review of its service and systems 11 42 23 The provider must ensure that tests and checks of fire equipment and alarm and lighting systems are undertaken on a regular basis and records of these are maintained So that residents are safeguarded 30/11/2008 31/01/2009 Care Homes for Adults (18-65 years) Page 34 of 37 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 The provider should review the existing eligibility and admission criteria to ensure this does not exclude prospective residents that the home may wish to offer a service to and staff have the appropriate skills and knowledge to support them. Residents should be provided with opportunities to learn or maintain daily living and independence skills if they wish and this should be supported by appropriate documentation around risks. The management of post needs review to ensure both staff and residents understand the system and post is not delayed in going to residents. Where room keys are not provided to a resident a clear rationale for this should be recorded within the resident file and subject to review 2 11 3 16 4 17 Arrangements for meals the provision of alternatives and avaialblility of hot drinks needs review, decisions need to be made clear to both staff and residents, andwill ensure consistency in delivery of support in this area by staff. The provider should implement falls monitoring in respect of residents where there is a risk of recurrent falling, evidence of appropriate accident reporting and referral to health professionals should be maintained where pose a continued risk to health and well being The provider should establish a location for the weighing of residents that takes into consideration their mobility and privacy and dignity, compensations should be made for any inaccuracies as a result of uneven flooring. The provider should establish a medication profile for each resident that takes account of prescribed and homely remedies, allergies, side effects The provider should also establish individual guidelines for those residents in receipt of PRN medication to ensure that administration is undertaken consistently by staff The provider is recommended to incorporate the details of the local social services department as another agency to whom complaints can be referred and should ensure the amended procedure is displayed for residents and visitors to see. Page 35 of 37 5 19 6 19 7 20 8 22 Care Homes for Adults (18-65 years) 9 24 The provider should assess and prioritize the shortfalls identified within the accommodation and develop a programme of planned works to address these within timescales. The provider should assess the needs of residents whose physical needs may require additional aids and adaptations to enable full access of the home and bathing facilities these should be provided to promote and protect the health and safety of residents and staff, The provider should assess the training needs of individual staff members and establish a programme of training that meets their induction, mandatory and specialist training needs and enables them to support residents safely and effectively The provider should offer opportunities for staff to meet privately with him on a regular basis to discuss their personal training and development needs in addition to observational monitoring of practice The provider is urged to develop a service development plan detailing the assessed shortfalls and their priority for completion within set timescales The provider is asked to clarify with the homes insurers the accuracy of the provider details recorded on the insurance information and if necessary seek their amendment. 10 29 11 35 12 36 13 43 14 43 Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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