Inspection on 20/09/07 for Worcester Road, 38

This inspection was carried out on 20th September 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 25 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Worcester Road, 38 12/05/06

Worcester Road, 38 20/10/05

Worcester Road, 38 19/05/05

Worcester Road, 38 09/08/04

Worcester Road, 38 20/05/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Worcester Road, 38 Cowley Uxbridge Middlesex UB8 3TH Lead Inspector Jane Collisson Key Unannounced Inspection 20 September 2007 9:30 th Worcester Road, 38 DS0000027070.V349113.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Worcester Road, 38 DS0000027070.V349113.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Worcester Road, 38 DS0000027070.V349113.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Worcester Road, 38 Address Cowley Uxbridge Middlesex UB8 3TH 01895 272794 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) H4037@mencap.org.uk Royal Mencap Society Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Worcester Road, 38 DS0000027070.V349113.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home can accommodate one service user, currently living there, who is aged above 65 years. 12th May 2006 Date of last inspection Brief Description of the Service: Worcester Road is a registered home, providing personal care to seven service users with a learning disability. It is located off Cowley High Street, in a residential area, close to shops, public transport and other amenities. The shopping centre of Uxbridge can be reached by public transport and the home also has its own transport. There are seven single bedrooms, two on the ground floor and five on the first floor. The communal areas comprise of a lounge, dining room, kitchen and laundry room. A shower room and toilet are available on the ground floor and the first floor has a bathroom and toilet, separate shower room, and a third toilet. The office/sleeping-in room is on the first floor. There is a front garden with parking, and a lawned garden to the rear. Street parking is available in Worcester Road and the surrounding area. Dimensions Housing Association owns the premises and the Royal Mencap Society manages the home. The staff team consists of a manager and a team of support workers. Fees were seen to be up to £766 per week. Worcester Road, 38 DS0000027070.V349113.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection commenced on the 20th September 2007, between the hours of 9.30am and 5.05pm. One member of staff, who had been on the sleeping-in shift, was present and was working between 7am and 12 noon. Four residents were present, three of whom were being collected by transport for the day centre. Three residents had already left to go to centres or to work experience. The member of staff on duty was involved in supporting a resident who was unwell, while still assisting those going to the day centre. The second member of staff came on duty at 10am, staying until 6.30pm. The third staff member came on duty in the afternoon and was on sleeping-in duty that night. One resident was taken to Uxbridge on a shopping trip in the afternoon. Residents are encouraged to assist with the meals and one was helping to prepare the evening meal. When the Inspector left, six of the residents had returned to the home. The home’s Manager Designate has been on maternity leave since January 2007 and was due to return in January 2008. The home has not had a Registered Manager since 2004 and there had been a number of temporary managers in post. Two part-time Acting Managers have been covering the maternity leave since June 2007. A further visit was made on the 24th September to meet with the Area Manager. This was to discuss the situation with regard to the lack of staff cover and the incidents in respect of a resident twice leaving the home in the early morning. Temporary waking night cover had been employed in the weekend between the visits. Further action had been taken to put into place an alarm system to alert sleeping-in staff to the movements of the resident. Alterations to the rota have been made to provide double staff cover from mid-October. Reassessments were required, by Social Services, for two of the residents as a matter of urgency. The incidents involving the behaviour of one of the residents towards the others, and to staff, were shown to be potentially abusive. It was demonstrated in a number of ways, during the inspection, that the current staffing levels do not meet the needs of the residents. This included the lack of opportunity for individual activities in the community and the pressure on staff working alone with seven residents, some of whom have increased dependency and behavioural issues. Safe access to the bathing and toilet facilities on the ground floor were required to be addressed in June 2006 but limited action has been taken and the toilet is still difficult to access for one resident. Water was seeping from under the floor covering and, although reported to the Housing Association, had not been repaired by the second visit to the home, when a maintenance Worcester Road, 38 DS0000027070.V349113.R01.S.doc Version 5.2 Page 6 person had been to call. This was a potentially unsafe situation for the residents. There were also issues regarding the storage of food in an outside storage space. This was to be addressed by the Area Manager with the provision of locked boxes that could be stored in the kitchen. A longer-term solution is required to be found, as this is disadvantaging the residents who should have access to food and drinks to support their independent living skills. The Area Manager and the temporary Acting Managers provided the completed Annual Quality Assurance Assessment to the CSCI. Although this gives information about the home, its residents and staff, all of the managers are comparatively new to the service so have limited knowledge of the home’s previous history and its progress. Practical information was provided, such as information on servicing, maintenance, and policies and procedures. A sample of records was examined in the home. These included recruitment, care and health plans, medication and maintenance. All of the residents were seen on the second visit to the home, most returning from their day activities. During the inspection, all of the residents were met and two spoken with in private. Discussions were held with four of the staff team and the Area Manager during the course of the inspection. There are limited cultural needs to be met among the residents, but staff have tried to meet the needs of one person by redecorating their bedroom in a culturally appropriate style. There were six requirements at the last inspection, of which four were met. There have been an additional twenty one at this inspection. The lack of consistent management cover and the small number of staff on duty have not assisted the home to meet all of the National Minimum Standards and the Care Home Regulations 2001, although the staff have done their best to provide a good standard of the care to the residents. What the service does well: What has improved since the last inspection? What they could do better: Worcester Road, 38 DS0000027070.V349113.R01.S.doc Version 5.2 Page 7 All the documentation for the home needs to be updated, including the Statement of Purpose and Service Users Guide, to include the terms and conditions as well as the information on how the needs of the residents, whose needs fall outside of its category of registration, are met. The home’s management team needs to update all of the risk assessments for the residents to ensure that all of the identified hazards have risk reduction plans in place. Regular reviews of the residents’ needs were needed to ensure that changes were identified which could no longer be met by the home, or where changes were needed to be able to accommodate them. Regular reviews are needed in the future to ensure that appropriate referrals are made speedily when the needs of a resident can no longer be met by the facilities or the staffing levels in the home. The residents need to have the opportunity to retain and improve their independent living skills. The situation in respect of food storage has taken away some of their independence and alternative methods must be found to address the problems which caused this. The staffing levels also do not support the retaining of skills and the Registered Providers must provide sufficient staffing to meet the residents’ assessed needs. While the majority of the medication procedures were satisfactory, the practice of the “double dispensing” of medication can be unsafe. It needs to be demonstrated that staff are fully aware of good practice in medication administration. There are areas of the home where redecoration and refurbishment are required. The Registered Providers need to ensure that their arrangements with the Housing Association are sufficiently robust to provide the level of maintenance and improvements required. This includes a speedy maintenance service when items, such as the bathroom floor, need to be repaired. Up-to-date training records were not available for inspection. The home’s management staff must ensure that there is evidence of training being undertaken by all of the staff team. The Registered Providers must provide an Action Plan to show how the National Vocational Qualifications for staff will be achieved and the planned timescales. Although the current Acting Managers are now providing regular supervision to the staff, which is appreciated by them, there had been a lack of regular sessions prior to this. The staff need to have the opportunity of support in the periods when there are no managers in post. The home has been without Manager registered with the Commission for Social Care Inspection since 2004 and there have been a number of temporary managers. The Registered Providers must ensure that the process of Worcester Road, 38 DS0000027070.V349113.R01.S.doc Version 5.2 Page 8 registering a manager is commenced, within the shortest possible timeframe, when a new manager is appointed or an acting manager is in place. Temporary management staff must be provided with information about the Care Home Regulations 2001 to ensure they are able to carry out the necessary requirements of the Care Standards Act 2000. It has been a previous requirement, at two inspections, that a quality assurance/monitoring system is put in place to review the quality of care. This remains an outstanding requirement. It was a requirement in June 2006 that, to ensure the safety of one resident, either the ground floor bathroom must be fully adapted to cater for physical disability (this includes widening the doorway) or alternatively the person must be assessed and an alternative placement sought. Neither of these actions took place and the requirement remains outstanding. A number of health and safety issues were identified. These included the risk of propping of bedroom doors at night; the uncovered radiators; the space under the stairs, which houses the electrical boards, being without a door. A fire risk assessment, to identify and reduce any risks to the residents and staff, also needs to completed. The home’s management staff need to ensure that all of the required health and safety checks are up-to-date, including gas safety, and that action is taken where any potential hazards, such as excessively hot water, are noted. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Worcester Road, 38 DS0000027070.V349113.R01.S.doc Version 5.2 Page 9 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 Worcester Road, 38 DS0000027070.V349113.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The current information about the home, including the Statement of Purpose, would not fully support prospective residents or their representatives to make a decision about the home and its facilities. The admission procedures could not be assessed, as there have been no vacancies for some years. Staff are aware, however, that these need to be more robust if appropriate placements are to be made. EVIDENCE: The information that would assist people to make a decision about moving to the home had not been updated and a completed copy was not available. There were spaces for photographs in the copies of the Statement of Purpose seen at the home, and sent to the Commission for Social Care Inspection, and these need to be completed to make the documents more “user-friendly”. No copy of the Service Users Guide was seen. The Area Manager undertook to bring the information up-to-date. The Statement of Purpose needs to meet the requirements of Schedule 1 of the Care Home Regulations 2001, which the copies available did not do. Information is also required to be included to show the way in which the needs of the people who are outside of the home’s category of registration, which is for people with learning disabilities, are being met. This includes how the Worcester Road, 38 DS0000027070.V349113.R01.S.doc Version 5.2 Page 11 needs of the older people in the home, and those with mental health issues, can be met by the environment, facilities, staffing levels and by access to appropriate professional services. There have been no new residents admitted since 2002, so the referral procedure could not be fully assessed. Information received through the Annual Quality Assurance Assessment indicated that the home’s assessment procedure would be more thorough should any new residents be admitted in the future. This would include the levels of ability which, because of staffing levels and facilities, need careful consideration. The dependency levels of some of the current residents have changed and reassessments of the support they require were needed urgently. In the files examined, it was noted that each resident had information from the Local Authority regarding their fees, and a tenancy agreement from the housing association. No terms and conditions from Mencap were seen to be available and these should be completed for each person and be included in the Service Users Guide for prospective residents. Worcester Road, 38 DS0000027070.V349113.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is evidence that residents are encouraged towards attaining a more independent lifestyle but the staffing levels in the home do not support this. Risk assessments have not been maintained in line with the changes in the residents’ lives. EVIDENCE: A sample of three residents’ care plans and associated files were examined. These included information on the routines of the residents, and their likes and dislikes. The documentation includes a new “person centred” plan with photographs, which provides information on the activities of daily living and the pursuits which the residents enjoy. Information in the home indicates that the goals of the residents cannot always be met by the staffing levels, including holidays and activities. It was observed from the files and notes, that staff take every opportunity to try and meet these needs but have some difficulties in providing individual support. This was discussed with the Area Worcester Road, 38 DS0000027070.V349113.R01.S.doc Version 5.2 Page 13 Manager and discussions need to be held with Social Services regarding the implications on the staffing levels. The care plans contained a variety of information on risk assessments and reviews. Several risk assessments were in place for individual residents, including those for bathing, going to the shops and accessing the kitchen. They were in need of updating, as a number were no longer relevant to the individual resident. One of the Acting Managers said that this had been recognised and the work was in hand. It was noted at the inspection in May 2006 that the needs of one of the residents could no longer be met by the facilities in the home, including the use of the shower room. No changes have taken place since that inspection and there are still problems regarding access. Staff said that an assessment carried out by Social Services recently had been in respect of a move to less supported and inappropriate accommodation. Reviews have recently been held for four of the residents, by Social Services, but the documentation resulting from these had not yet been received. The needs of another resident have also changed and are impacting on the care and support of the other residents. This has resulted recently in the resident leaving the home, in the early hours of the morning, and being found by the police. For a short period, the front door was having to be locked. The Area Manager made arrangements for alarms to be fitted as an interim measure so that staff are alerted should the residents leave the premises. She was aware that this situation can only be short term as the staff sleeping in are required to work a shift on the following morning and there could be health and safety issues. Concerns with the resident have led to the food having to be locked away. This includes snacks and drinks, which affects all of the residents. On the first visit to the home, the member of staff had to lock the kettle away as well. Although the Area Manager was addressing this situation by having locked boxes of food stored in the kitchen, a longer-term solution must be found because of the impact on other residents and staff. The care plans, risk assessments and associated documentation are in need of some streamlining and updating. It is recommended that efforts are made to make the documentation easier to use in a way which involve the residents in this process. It was observed that most of the residents would be able to have input into their care planning and this needs to be evidenced. It was demonstrated that the residents have the opportunity to express their views and to participate in the running of the home. Efforts are made to involve the residents in domestic tasks, such as preparing meals. This was observed on both visits to the home. Regular residents’ meetings are held and minutes of these were seen. All of the residents were observed to be able to make their wishes known and they have input into the activities they undertake, within the constraints of the staffing levels. Worcester Road, 38 DS0000027070.V349113.R01.S.doc Version 5.2 Page 14 While two of the residents are quite independent, and go to their daily activities without escorts, the staffing levels do not always allow for the level of input which would support the more able residents to develop their skills further and those less able to retain theirs. Worcester Road, 38 DS0000027070.V349113.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 13, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are committed to providing the residents with a varied and interesting activities but are restricted by the staffing levels. Wherever appropriate, people are supported to help in the running of the home. Links with families are maintained. A good variety of meals are provided and residents are encouraged to assist with the preparation. EVIDENCE: Residents are encouraged to help to clean their rooms and to prepare their packed lunches, although staff said that supervision is required for some people. Although there is evidence that staff make every attempt to involve the residents in the day-to-day running of the home, they are limited during the periods of single staff cover to provide sufficient time to develop the skills of those who would benefit from this additional support. Worcester Road, 38 DS0000027070.V349113.R01.S.doc Version 5.2 Page 16 At the time of the inspection, all of the residents were attending a variety of day services, including work experience. However, one of the residents was due to have a reduction in their day centre attendance, and another was ceasing to attend because of age. This will add more constraints to the staff time available and needs to be addressed with the Social Services department. One resident is supported to attend two work placements, one in a playgroup and one in a hotel. The resident spoke enthusiastically to the Inspector about this work. Two of the residents are able to go independently to the day centre and others are collected by the centres’ transport. One person has an outing each week to a luncheon club for older people. Five of the residents attend social clubs in the evening or on Sundays. There is limited family involvement for most residents although those who have families are supported to stay in touch and they are invited to reviews. One person visits family members on a regular basis. The home has its own transport and one resident was taken to the shops in Uxbridge on afternoon of the inspection, coming back to the home with many items of shopping and having enjoyed the experience. The other resident at home assisted the second member of staff to make two curries for the evening meal. The home is situated in a residential area, with local shops within walking distance. Some residents need to be accompanied to the shops. The daily notes for the residents recorded visits to a variety of parks and other places. This are usually in small groups, undertaken when there are two staff on duty. The home has its own six-seater transport, which can be used for outings, and there are four drivers available among the staff team. While some residents are happy in the company of others, there are some relationships between the residents which make group activities difficult. There have been recent incidents reported to the Commission for Social Care Inspection, regarding the behaviour of one resident, which is affecting the lives of other people in the home. A number of residents have taken the opportunity to keep their rooms locked when not using them. Some of these issues have been discussed elsewhere in this report. People living in the home need to know that they have the right to live as quietly as they wish and the Registered Providers need to address these issues. Staff generally prepare a meal for all of the residents, although alternatives can be offered. A list of the meals provided is kept, which appeared to be varied. Most of the residents eat in the dining room, although the wishes of one person to eat separately are respected. Worcester Road, 38 DS0000027070.V349113.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are adequate facilities for personal care for all but one of the residents. Insufficient attention has been paid to providing more suitable facilities for this resident. Health needs are monitored and appropriate action taken to meet them. The medication administration was satisfactory but the dispensing system is potentially unsafe. EVIDENCE: Personal care is provided for the majority of the residents. For the use of the seven residents, there is one bathroom and two shower rooms. Because of mobility concerns, one person is only able to use the ground floor shower room and toilet and with some difficulty. There is insufficient space in the room for the resident to use the toilet safely and a commode is provided at night for safety. There is one male staff member who, on occasions, provides personal care to the female residents. The staff were not aware of a policy on same gender care and said that the residents would be asked about their personal choice. Worcester Road, 38 DS0000027070.V349113.R01.S.doc Version 5.2 Page 18 It needs to be ensured that residents are aware that a choice is available. Assessments are needed to be made to protect both residents and staff. The care planning files contained lists of the medical and health appointments undertaken with the residents, and their outcomes. Health Action Plans had been completed. This was a recommendation from the last inspection, and a number of other health assessment forms have also been completed. Staff were aware of the need to rationalise this different documentation so that there is one record, of up-to-date information, in place. The care plans are also being changed to a more person-centred style. It is strongly recommended that the files are streamlined in the near future. This would ensure that the files are easier to maintain and contain the most relevant information in respect of each resident’s support. Several of the residents are capable of being fully involved in their care planning and need to be shown to have this opportunity. The current systems do not allow for easy access or the maintenance of records. The medication administration used in the home is a monthly Monitored Dosage System. None of the residents self medicate. A check was carried out on the medication, during the first visit, and it was found to be in order. In the files examined, medication reviews had been carried out. A recent audit has been undertaken by the pharmacy company supplying the medication, which had been satisfactory. They had advised, however, that when changes are made to medication, it is noted on the Medication Administration Record sheet, with the name of the general practitioner authorising the change. On the second visit the home, it was noted that the medication was being dispensed from the blister packs into containers, in the office, and then taken downstairs to the residents. The staff were advised that, for safety, medication should not be “double dispensed” and given only from the original containers, directly to the residents. Worcester Road, 38 DS0000027070.V349113.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are generally to express their concerns and are given the opportunity to do so. There is an open culture which would encourage the residents to be able to make their views known. Staff showed an awareness of ways in which residents can safeguarded. EVIDENCE: There was one recorded concern noted in the complaints file. This had been from a relative in regard to the lack of management and shortage of staff. Although there was no reply in the file, the Area Manager said that a reply had been provided within the complaints procedure’s timescale. She was asked to ensure that this information and the reply is recorded in the complaints file. A “grumbles book” had commenced in May 2007, primarily for the use of the residents to record any concerns they have. Twenty five concerns had been recorded to date, usually about the behaviour of one resident to another. There is a column for recording the action which has been taken to try and alleviate the situation. There have been no adult protection issues raised in the home through the Safeguarding Adults procedures. A full training record was not available of the staff training courses undertaken, so it was not shown if the safeguarding adults training was up-to-date. This has been addressed in the “Staffing” section. Worcester Road, 38 DS0000027070.V349113.R01.S.doc Version 5.2 Page 20 The financial arrangements for the residents were discussed with staff. One person had asked to be allowed to manage their own money and this request was accommodated and documented. Other residents had a plan in their files of their specific financial arrangements. A sample of the records was seen and examined. It was noted that one resident had a large amount recorded as being spent but there were no details on the sheet as to the reasons for this. Receipts were filed separately and staff reported that the sum has been spent on furniture for the resident’s bedroom. They were advised to ensure that the full details are written on the record in case there should be queries in the future. Worcester Road, 38 DS0000027070.V349113.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the home provides a pleasant environment for the majority of the residents who live there, it would benefit from a regular programme of redecoration. More appropriate seating is required in the lounge to provide everyone with the opportunity to use the room in comfort. People are encouraged to personalise their rooms. The bathroom facilities are accessible to six of the residents but unsuitable for the seventh person. The area where food was being stored was unsuitable for the purpose. EVIDENCE: The home is situated in a residential area of Cowley, within walking distance of the High Street and bus routes. Although the home is generally comfortable and homely, there are areas where redecoration and refurbishment are required. The alternative seating in the lounge, to the three-seater sofa, are several “bean bags”. Staff said that they are not used and consideration needs to be given to providing more suitable seating. In the dining room, some chairs are in need of replacement or repair as they are damaged. The dining Worcester Road, 38 DS0000027070.V349113.R01.S.doc Version 5.2 Page 22 table has space only for six people, although this suits the needs of the current residents, as one prefers to eat alone. Areas of the home are in need of upgrading but staff said the Housing Association has reported that home was not yet due for redecoration. Staff said that they would consider repainting some parts themselves but a programme of cyclical refurbishment is required to maintain the home to a good standard and a budget needs to be available for this. The garden to the rear of the home was neat and tidy. There is garden furniture but little in the way of interest such as flowers or other features. The overgrown hedges are in need of trimming as the lounge is quite dark because of this. One resident is unable to access the garden because of poor mobility and the lack of a suitable path. The hall carpet has a hole on the stair tread, which is potentially hazardous. The upstairs hall carpet has also stretched and needed to be refitted or replaced. The Area Manager said that a budget had been found to replace the hall carpet and estimates would be sought. The ground floor bathroom was in need of urgent attention to have the flooring resealed where water was seeping underneath. The staff had reported this to the Housing Association but it had not been repaired. Although someone was due to call on the second visit of the inspection, no one arrived. The bathroom could not be put out of use as it is the only one which can be accessed by one of the residents. The paint was “blistering” on the outside of the shower room walls, in the hallway, and this needs investigation. Staff said that this was only painted last year. Three of the residents’ bedrooms were seen on this inspection. One had been decorated by the staff to suit the cultural needs of the resident. The rooms seen were pleasantly decorated and personalised. Staff are responsible for the cleaning of the home and no domestic staff are employed. It was mostly found to be clean and hygienic. However, the area which was being used to store the food was not suitable for this purpose. The food was being kept in a store outside of the kitchen, in the corridor opening onto the garden. There were cobwebs, a non-impervious floor, the walls were in need of cleaning and it was not pest proof. Action was to be taken shortly after the second visit to try and buy lockable containers so that the food could be kept in the kitchen. The laundry walls are also in need of painting. The room was warm and may require better ventilation. This needs to be investigated. There was also a problem in the toilets, where it has not been possible to keep toilet paper or soap. Hygienic hand drying facilities are not available. This situation was to do with the behaviour of one of the residents who takes the items. They were being kept in the office, with residents and staff having to Worcester Road, 38 DS0000027070.V349113.R01.S.doc Version 5.2 Page 23 dispense them as required. The staff said that they have been unable to find a solution to this problem but there needs to be better accessibility to these items. Worcester Road, 38 DS0000027070.V349113.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 34, 35, 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a competent staff team but insufficient numbers on duty to fully meet the needs of the residents. The level of staffing restricts the ability of the service to deliver person-centred support. Staff have access to some training but there is little evidence of staff development plans or up-to-date records. Supervision, and support through meetings, has been irregular but is improving. EVIDENCE: Two temporary Acting Managers have carried out, since June 2007, and on a part-time basis, the management of the home. This is due to cease in November 2007. There is also a Deputy Manager, who was on leave during this inspection. The small team of support workers have prioritised the support for the residents and maintaining the home as best they can. With the small number of staff on duty, and changes of management, both at senior level and in the home, there appears to have been a lack of consistency. The concerns with the residents should have been addressed much earlier so that solutions could have been sought. Worcester Road, 38 DS0000027070.V349113.R01.S.doc Version 5.2 Page 25 As mentioned elsewhere in this report, the staff team work alone from 7am to 10am and from 6.30pm to 10pm. The current problems, with the increased needs of the residents, were placing undue pressure on the staff team, and on some of the residents. Discussions were to be held with the Social Services department regarding the reassessment of two of the residents. A waking night staff was put in place over the weekend between the two inspection visits but this has been a temporary solution because of the funding issues. The Area Manager had, in conjunction with one of the Acting Managers, managed to reconfigure the rota to provide, from mid-October, double staff cover throughout the day and evenings. However, the staff establishment does not allow for any additional cover for holidays, training or sickness. The Registered Providers need to ensure, as a matter of urgency, that action is taken to rectify the situation and have sufficient staff on duty to meet the needs of the residents. Only one of the current staff team has a National Vocational Qualification and one staff member is undertaking the qualification currently. The Inspector was informed that there is no training budget available for NVQ training for the staff. One staff has been able to register on a free scheme, but this has limited criteria for access so is not open to everyone. The Registered Providers need to provide an Action Plan to show how staff will be offered the opportunity to undertake their National Vocational Qualifications. A sample of three staff records was examined on the second visit to the home. The application forms, references and Criminal Records Bureau disclosure numbers were in place. There were also supervision records in the files, although those seen would not demonstrate that the National Minimum Standard of six sessions a year was being met. The Acting Managers have been carrying out one-to-one supervision with the staff team since coming into post in June 2007 and a record of these is being kept. Staff said that they felt supported by the two Acting Managers in post. A matrix of some of the training which has been undertaken was displayed in the office but was not up to date. It was not possible to ascertain all of the training that staff have undertaken, or their development needs, and this is required to be addressed. Worcester Road, 38 DS0000027070.V349113.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There has been a lack of consistent management to provide the necessary support for the residents and the staff team. Training, supervision and development have been inconsistent but there are some signs of improvement. The home has a committed staff team who do their best to deliver good support to the residents. Health and safety issues have not been given the priority they require. EVIDENCE: There have been various changes of management of home since the CSCI registered the last person in September 2004. Since then, there had been a number of managers in post. The home had some difficulty in the recruitment of a permanent manager and there have been periods without a manager. The current Manager Designate commenced in May 2006 but has been on maternity leave since January 2007 and was not due to return until January Worcester Road, 38 DS0000027070.V349113.R01.S.doc Version 5.2 Page 27 2008. Information was not available on the qualifications and experience of the Manager Designate. Since June, two Acting Managers have been in post for a total of 30 hours a week. Neither has had experience of working in the management in a registered home. No copy of the National Minimum Standards or Care Home Regulations 2001 could be found. Staff need to have a working knowledge of these in order to manage the home satisfactorily. The staff were observed to work well together and the home has a pleasant atmosphere. However, working alone, with seven residents, has limitations both in the time that can be spent with those residents who have a higher dependency and those who require the retention and development of their skills. The opportunities for people to undertake activities outside of the home are also severely limited. Staff have obviously tried their best to ensure that residents are not disadvantaged, but the current situation with the residents who need a much higher input from staff, has led to a situation which must be resolved. No quality assurance reports have been produced for the home. The Area Manager, when she took over the home, produced an Action Plan for the Acting Managers to complete, which they were working through. Some work has been carried out by the staff in improving the filing system and most of the files were easy to access. However, the information in some of the files still requires streamlining to ensure that only the current information is in place. Policies and procedures were not checked on this occasion. Regular checks are made of the hot water temperatures throughout the home but it was noted that, on some occasions, these had been recorded as over the level for safety. The action taken to remedy this needs to be seen to be recorded. One of the residents prefers to have the bedroom door left open at night and the door was found to be propped. Staff sleep on a different floor. For the safety of the resident, a suitable device, which will ensure that the door closes in the event of the alarm being activated, needs to be in place. Risk assessments on the safety of residents at night, with sleeping in cover only, need to be compiled and reviewed on a regular basis. The space under the stairs has electrical equipment, which has only a curtain fixed to the doorway. For safety, a door which can be locked should be installed. Advice from a fire safety officer needs to be sought to ensure that the correct fire precautions are in place as there appeared to be limited directions regarding fire escapes in the home. No fire risk assessment was found on this inspection and must be completed and available for inspection. Worcester Road, 38 DS0000027070.V349113.R01.S.doc Version 5.2 Page 28 Although the staff team have been completing accident and incident forms for Mencap, the notifications required under Regulation 37 of the Care Home Regulations 2001, to the Commission for Social Care Inspection, had not always been completed for the incidents which had given cause for concern. The Area Manager took action to rectify this situation and notifications are now being made. The majority of radiators in the home are uncovered. There is no waking night cover and no call alarm system which could be used should someone fall against a hot radiator. Risk assessments must be in place to assess the possible risk to residents, particularly where there is poor mobility. Where risks are identified, appropriate action needs to be taken to cover the radiators or replace them with those of a low surface temperature type. A sample of the maintenance records was examined. The last fire alarm was tested on the 15th September 2007. There had been fire evacuations from the home in May, July and August 2007. The extinguishers were checked in May 2007 and the emergency lighting in August 2007. The last gas check was noted as taking place in June 2006 on the Annual Quality Assurance Assessment and in the records. This should be carried out annually. The Environmental Health Officer last visited in May 2005. Worcester Road, 38 DS0000027070.V349113.R01.S.doc Version 5.2 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 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 2 28 X 29 X 30 2 STAFFING Standard No Score 31 3 32 X 33 1 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 2 3 2 X X 1 X Worcester Road, 38 DS0000027070.V349113.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard 1 YA1 Regulation 4&5 Requirement The Statement of Purpose and Service Users Guide must be updated in accordance with the Care Home Regulations 2001. The Statement of Purpose must include information on how the needs of the residents, whose needs fall outside of its category of registration, are met. The Registered Providers must ensure that the residents are issued with terms and conditions. A copy of these must be included in the Service Users Guide. The home’s management staff must ensure that risk assessments are completed for all of the identified hazards, in relation to each resident, and that they are reviewed as required. Risk reduction plans must be in place. The home’s management staff must ensure that regular reviews are held for each of the residents and appropriate referrals made when the needs of the resident can no longer be met by the facilities or the staffing levels in the home. DS0000027070.V349113.R01.S.doc Timescale for action 30/11/07 2 YA1 4 (1)(a) 30/11/07 3 YA5 5 (1)(c) 30/11/07 4 YA6 13 (4) 31/10/07 5 YA6 12(1)(a)(b) 14(2)(a) 30/11/07 Worcester Road, 38 Version 5.2 Page 31 6 YA6 12 (1)(a) 7 YA9 12 (1)(b) 8 YA16 12 (1)(a) (b), (2)(3) 9 YA18 12 (4)(a) 10 YA20 13 (2) 11 YA24 23 (1)(b) (c) 12 YA27 23 (1)(a) 13 YA30 23 (2)(a) (b) The home’s management staff must find a solution to the storage of food which ensures that residents have access to food and drinks, as they require them, and to maintain their daily living skills. The home’s management staff must ensure that every effort is made to maintain and develop the residents’ independent living skills. The home’s management staff must ensure that all of the residents have their rights and responsibilities safeguarded by monitoring of residents’ behaviour, suitable professional support and adequate staffing. The home’s management staff must ensure that residents have choices in relation to their personal care provision and that suitable assessments are in place to safeguard residents and staff. The Registered Providers must ensure that the practice of the “double dispensing” of medication is discontinued. Staff must be made aware of good practice in medication administration. The Registered Providers must ensure that there are arrangements in place for redecorating and refurbishment of the home when it is required. The Registered Providers must ensure that the bathroom and toilet facilities on the ground floor are safe to be used by the residents and that the defects are investigated. The Registered Providers and the management of the home must ensure that all areas of the home, including those used for the storage of food, and the laundry, are suitable for these uses. DS0000027070.V349113.R01.S.doc 31/10/07 30/11/07 30/11/07 30/11/07 31/10/07 30/11/07 30/11/07 30/11/07 Worcester Road, 38 Version 5.2 Page 32 14 YA33 18 (1)(a) 15 YA35 18 (1)(c)(i) 17(2) Sch 4 (6)(g) 16 YA35 18(1)(c)(i) 17 YA36 18 (2) 18 YA37 8 (1) 19 YA39 24 The Registered Providers must ensure that sufficient staff are available to meet the assessed needs of the people using the service. The home’s management staff must ensure that records are available of staff development and training to evidence that training has been completed and is suitable to meet the needs of the residents. The Registered Providers must provide an Action Plan to show how the National Vocational Qualifications for staff will be achieved, and the planned timescales. The home’s management staff must ensure that staff are supported through regular supervision sessions and staff meetings. The Registered Providers must ensure that the home has a manager registered with the Commission for Social Care Inspection and that the process is commenced within the timescale given. A quality assurance/monitoring system must be put in place to review the quality of care. (The previous timescale of 01/05/06 and 01/09/06 not met) To ensure the safety of one resident, either the ground floor bathroom must be fully adapted to cater for physical disability (this includes widening the doorway) or alternatively the person must be assessed and an alternative placement sought. A plan of action must be developed this must be forwarded to CSCI by the date given. 30/11/07 31/12/07 30/11/07 30/11/07 31/12/07 30/11/07 20 YA42 13(4)(a) 31/12/07 Worcester Road, 38 DS0000027070.V349113.R01.S.doc Version 5.2 Page 33 21 YA42 13 (4) 22 YA42 23 (4A)(b) 13 (4) 23 YA42 13 (4)(a) (c) 24 YA42 37, 18 (1)(c)(i) 25 YA42 13 (4) (Previous timescale of 15/07/06 not met). The Registered Providers must ensure that all areas where residents may be at risk during the night are assessed for safety. This must included the practice of propping open the bedroom door of a resident. The Registered Providers must ensure that home has a fire risk assessment and that an assessment of the home is made to minimise any risks to residents and staff. This includes the use of fire signage and the safety of the electrical equipment housed under the stairs The home’s management staff must ensure that all of the required health and safety checks and records are up-to-date, including gas safety, and that action is taken where any potential hazards, such as excessively hot water, are noted. The Registered Providers must ensure that staff are provided with sufficient information to ensure they are familiar with the requirements of the Care Home Regulations 2001 and National Minimum Standards, including the notification of events. The home’s management staff must ensure that risk assessments are completed for all risks in relation to uncovered radiators. The lack of waking night cover, an alarm system and mobility of the residents must be taken into account. 31/10/07 30/11/07 30/11/07 31/10/07 31/10/07 Worcester Road, 38 DS0000027070.V349113.R01.S.doc Version 5.2 Page 34 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 Refer to Standard YA6 YA19 Good Practice Recommendations That care planning files are streamlined to make improve access to records and make maintenance of the files easier to keep up-to-date. That the health records are streamlined to ensure that there is one up-to-date record of health needs and outcomes. Worcester Road, 38 DS0000027070.V349113.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Worcester Road, 38 DS0000027070.V349113.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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