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Inspection on 09/03/09 for York Road (14a)

Also see our care home review for York Road (14a) for more information

This inspection was carried out on 9th March 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People who use the service have plans that include information on their needs, likes and dislikes. Provision is made so that people can attend appropriate social activities, day centres and become part of the local community. Appropriate arrangements are made so that people can have regular contact with their friends and families. People who use the service receive personal support in the way they prefer. There are appropriate complaints and safeguarding adults procedures in place.

What has improved since the last inspection?

The back door leading to the garden was being repaired. The registered manager sought advice from a local pharmacist on the storage and dispensing of medication. New garden furniture has been purchased for the garden. People had their placements reviewed by their care managers however these are need to be reviewed again.

What the care home could do better:

The registered providers must establish a team capable of meeting the needs of people who use the service and offer them continuity of care. The registered manager must be afforded appropriate time and support by the registered providers to fulfil their management duties at the service. The Statement of Purpose must be updated. The registered manager must make sure that the environment is safe and reasonably decorated. The service must take into consideration peoples views on how the service provides care and support to them. Peoples risk assessments must be reviewed at intervals agreed in their risk management plans. As Mencap considers that this service specialises in supporting people with challenging behaviour and autism all current members of staff including relief bank staff must attend training on challenging behaviour and autism. The registered manager must develop guidelines for staff to follow in relation to one persons asthma.Given the high turnover of staff and the reliance of relief bank staff at this particular service it is recommended that relief bank staff attends staff meetings until the service establishes a staff team capable of meeting the needs of people who use the service. The registered manager must ensure that relief bank staff that work at the service on a regular basis receive supervision. The registered manager must make sure that all new members of staff complete food hygiene training. The registered manager must make sure that weekly fire checks are carried out and recorded.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: York Road (14a) 14a York Road Sutton Surrey SM2 6HG     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: James OHara     Date: 0 9 0 3 2 0 0 9 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. that people have said are important to them: They reflect the things 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 38 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) 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 38 Information about the care home Name of care home: Address: York Road (14a) 14a York Road Sutton Surrey SM2 6HG 02086439612 02086431662 h4m062sohawon@mencap.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Royal Mencap Society care home 6 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 6 The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Date of last inspection Brief description of the care home 14a York Road is a purpose built facility situated in a mainly residential street, between Sutton and Cheam and close to local transport and facilities. The Metropolitan Housing Association owns the building although the residential unit is managed and staffed by Mencap. The service provides care to four people who have learning disabilities, autism and challenging behaviour. There are six single bedrooms, a lounge, dining room, kitchen and laundry. There is a large garden to the rear of the property. There is also ample parking to the front of the house. The service has its own transport in the form of a people carrier. The current fees charged for a placement at the servive range between £1139.57 and Care Homes for Adults (18-65 years) Page 4 of 38 Brief description of the care home 1266.45 per week. Care Homes for Adults (18-65 years) Page 5 of 38 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: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This key unannounced site visit was carried out between 10am and 2pm on a Monday morning and afternoon. Methods of inspection included a tour of the premises, observation of contact between staff and people who use the service and discussion with the registered manager. Records examined included the Statement of Purpose, care plans and person centred plans, risk assessments, medication, complaints, staff recruitment and selection, staff Care Homes for Adults (18-65 years) Page 6 of 38 supervision, staff training, regulation 26 reports and health and safety and fire safety. We also looked at information in the Annual Quality Assurance Assessment (AQAA) provided to the Commission prior to the Annual service Review carried out at the service in July 2008. Requirements and recommendations from the previous inspection were also discussed with the registered manager. What the care home does well: What has improved since the last inspection? What they could do better: The registered providers must establish a team capable of meeting the needs of people who use the service and offer them continuity of care. The registered manager must be afforded appropriate time and support by the registered providers to fulfil their management duties at the service. The Statement of Purpose must be updated. The registered manager must make sure that the environment is safe and reasonably decorated. The service must take into consideration peoples views on how the service provides care and support to them. Peoples risk assessments must be reviewed at intervals agreed in their risk management plans. As Mencap considers that this service specialises in supporting people with challenging behaviour and autism all current members of staff including relief bank staff must attend training on challenging behaviour and autism. The registered manager must develop guidelines for staff to follow in relation to one persons asthma. Care Homes for Adults (18-65 years) Page 8 of 38 Given the high turnover of staff and the reliance of relief bank staff at this particular service it is recommended that relief bank staff attends staff meetings until the service establishes a staff team capable of meeting the needs of people who use the service. The registered manager must ensure that relief bank staff that work at the service on a regular basis receive supervision. The registered manager must make sure that all new members of staff complete food hygiene training. The registered manager must make sure that weekly fire checks are carried out and recorded. 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 38 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 38 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. People planning to use the service should have up to date and accurate information about the service. This would enable them to make an informed decision about whether or not the service can meet their needs. No new people have moved in since the last inspection however all the procedures are in place should they be needed. Evidence: There is a Statement of Purpose and Service User Guide. It was recommended at the last key inspection that the Statement of Purpose be developed further to include more information on the objectives and philosophy and staff numbers and their experience and qualifications. The registered manager told us in the AQAA received on the 26th of June 2008 prior to an annual service review carried out on the 3rd of July 2008 that the Statement of Purpose and the Service User handbook would be revised and updated to and would include Makaton symbols. Care Homes for Adults (18-65 years) Page 11 of 38 Evidence: We recorded in the summary of the last key inspection report that the registered manager had a good track record of meeting requirements and recommendations set by the Commission however the registered manager told us that this recommendation had not been addressed. A requirement is set that the registered manager must ensure that the Statement of Purpose include information on the services objectives and philosophy and staff numbers and their experience and qualifications. Two people have moved out since the last key inspection. These people had been referred to the Safeguarding Adults Team following a high number of incidents of violence and aggression. It was agreed that in theirs and the other people who used the services best interests and safety that they would move on to a more suitable placement. The service currently supports four people with autistic spectrum disorder and a range of severe challenging behaviours. No new people have moved in since the last inspection. Mencap has its own guidelines for selecting and assessing people who wish to use the service. Mencap only accepts referrals following an assessment completed by a care manager. Mencap also completes its own assessment. Compatibility with others already living there is also taken into account. Any prospective people would have a gradual introduction with a series of short visits and overnight stays. The time frame would be flexible depending on the person. Care Homes for Adults (18-65 years) Page 12 of 38 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. People who use the service have plans that include information on their needs, likes and dislikes. The service could do more so that people are supported to take control of their own lives and encouraged to exercise their rights and make their own decisions and choices. The high turnover of staff has not afforded people continuity or a consistent approach in supporting them with their person centred plans. Evidence: Two peoples personal files were examined. Both had a Core Plan, the plan covered areas such as medication, health care, personal care, food and drink, social interests and community inclusion, communication, mobility, mental health, behaviour, safety in the home, monitoring tenancy, cultural and religious identity and agreed limitations. Care Homes for Adults (18-65 years) Page 13 of 38 Evidence: The plan included an assessed needs support plan, the support needed and a review date. The plan also had a record of health care appointments indicating that people had attended appointments with General Practitioners, dentists, chiropodists and relevant consultants. One Core Plan had been reviewed on the 29th of January 2008 and indicated that the plan was due for review on the 29th of January 2009 however the plan had not yet been reviewed. The registered manager must ensure that peoples core plans are kept under review. There was a risk management plan in place. People had risk assessments in place for areas such as bathing, swimming, road awareness, going into town, holidays, preparing food and self injurious behaviours. One persons risk management plan indicated that their risk assessment should be reviewed on a six monthly basis however the risk assessments had only been reviewed annually. The registered manager must ensure that peoples risk assessments are reviewed at intervals agreed in their risk management plans. We recorded in the summary of the last key inspection report that the service should move towards a person centred approach so that management and staff could listen to what people want from their lives, help people think about what they want now and in the future and help people plan their life the way they want to. We recommended that the registered manager contact Sutton Social Services Person Centred Planning Coordinator for advice and training on Person Centred Planning. The registered manager told us that they had attended training on person centred planning facilitated by Sutton Social Services in March 2008 and that they found this very useful and positive. Following the training they had trained the staff team on person centred planning and person centred plans were then developed for people who use the service. They told us in the AQAA submitted prior to the annual service review that person centred planning has helped the service understand what people want in the short term and the long term. However since then all of the staff have left the service and three of the people who use the service have not been supported to realise their person centred plans. The registered manager told us that these three peoples person centred plans are currently being reviewed by new members of staff. The registered manager agreed that the high turnover of staff had not afforded people continuity or a consistent approach in supporting them with their person centred plans. One person showed us their person centred plan. This had recently been reviewed by them and their key worker. They told us that they were happy with what they had decided to put on the plan and they had been supported to achieve many of the goals. The registered manager told us that people who use the service would be supported to Care Homes for Adults (18-65 years) Page 14 of 38 Evidence: complete an essential lifestyle plan. These plans will include a relationship circle, what people like and admire, what is essential to them, preferences, desirable, what kind of person supports them well, what people need to know to support them best, what people need to know to keep them healthy safe and happy, how the person communicates and an action plan. It was recommended at the last key inspection that the registered manager contact the Speech and Language Therapy service for advice on communication. The registered manager told us that they had contacted the Speech and Language Therapy service for advice on communication however they had not had any input from them. The registered manager told us that they had reviewed peoples communication assessment profiles in 2007. A requirement was set at the last key inspection that the registered manager must make sure that all peoples placement and needs assessments are kept under review. All of the people who use the service have had their placements and needs assessments reviewed by care managers from their placing authority since at the last key inspection. Two peoples placement reviews are due again. The registered manager told us that they had contacted by the placing authority to arrange review dates but had yet to agree a suitable date. The registered manager told us that two people had their placements reviewed by their care managers in 2008 however reports from these reviews had not yet been forwarded to the service. It is recommended that the registered manager obtain copies of peoples placement reviews and retain these in their personal files. It was required at the last key inspection that in order that people can offer their views on how the service provides care and support that the registered manager should consider how peoples views can be sought. This could be done by enlisting the help of a facilitator to hold residents meetings or developing questionnaires with the support of the Speech and Language Therapy service. The service does not seek the views of people through questionnaires. The registered manager told us that peoples views are sought at key worker meetings. However the key worker checklist of does not include a section seeking peoples opinion of the service. It is recommended that the services key worker checklist include a section seeking peoples opinion of the service. Care Homes for Adults (18-65 years) Page 15 of 38 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Provision is made so that people can attend appropriate social activities, day centres and become part of the local community. Appropriate arrangements are made so that people can have regular contact with their friends and families. Evidence: People attend daily activities at the Jan Malinowski Centre, St Michaels Church, Sutton College of Learning for Adults, OLA and FE College. Some people also attend social activities at the Sunday Club, Tuesday Club, Gateway Club and the Greenshaw centre. People are able to go to Church on Sunday if they wish and some people go to the cinema and bowling. In house activities offered to people include arts and crafts and games. Some people are able to travel alone to Sutton for personal shopping or to visit Care Homes for Adults (18-65 years) Page 16 of 38 Evidence: cafes, some people need support from staff to do this. People have a set day when they carry out personal tasks such as cleaning, laundry, shopping and cooking. The registered manager told us that all but one person has regular contact with their relatives. One person has a Mencap befriender who acts as an advocate. There is a visitors policy and that asks that visitors phone to ensure their family member is going to be in before they visit. Visitors are welcomed and peoples families are invited to their reviews. Visitors can meet with people in any of the communal areas as well as in peoples bedrooms. As recommended at the last key inspection the registered manager sought the advice of a dietician for planning menus. The registered manager told us that the advice obtained from the dietician had really helped one person to reduce their weight and improve their health. This person also attends Weightwatchers and finds this both helpful and enjoyable. The registered manager told us that on Sundays people are supported by staff to draw up a weekly menu. They produced a recipe book with pictures of prepared meals and told us that people choose what they would want to eat that week. They told us that people are supported to prepare and cook meals on a daily basis. Some people participate in this task more than others. Some people prefer to prepare vegetables or to make their own sandwiches. Care Homes for Adults (18-65 years) Page 17 of 38 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. People who use the service receive personal support in the way they prefer. Appropriate policies and procedures for handling medicines are in place however the service could do more to support people with their assessed health care conditions. Evidence: The registered manager told us that following safeguarding meetings relating to a number of concerns about the medication procedures at 14b York Road, a Mencap Service next door to 14a York Road, that a comprehensive review of the services medication procedures had been carried out. The recommendations from that review had also been implemented to improve the services medication procedures at 14a York Road. The registered manager showed us the medication folder, this included a medication induction list with staff names and signatures, administration of medication guidelines, evidence of daily medication checks, advice on when things go wrong, procedures for stopping, starting, changing and reviewing medication, medication ordering guidelines Care Homes for Adults (18-65 years) Page 18 of 38 Evidence: and a record of returned medication signed and stamped by the local pharmacist. A local pharmacist provides medication. Medication is obtained mainly in a blister pack system and is stored in a locked cabinet in the office. Medication administration records are now signed by a member of staff when administering and signed by another member of staff to agree that they had witnessed the medication being administered. Medication administration records checked on the day of the inspection indicated that on one occasion that a second member of staff had not signed that they had witnessed the medication being administered. The registered manager told us that they had spoken to the member of staff concerned. The registered manager showed us a format used to discuss medication errors with members of staff. A requirement was set at the last key inspection that the registered manager must contact a pharmacist for advice on storage and dispensing of medication. The registered manager told us that the local pharmacist had visited the service in November 2008 and had offered advice on the storage and dispensing of medication however the pharmacist did not leave a report of their findings. It is recommended that the registered manager requests that following visits from the local pharmacist that a report of the pharmacists findings are provided to the service. Although the registered manager produced evidence that the two full time members of staff had attended medication training and the medication folder included a medication induction list with staff names and signatures including relief bank staff, they could not provide evidence that the relief bank staff or agency staff had attended training on medication. The registered manager told us that Mencap relief bank complete the same induction and training as full time staff however this information was held by the relief bank manager, the registered manager told us that the organisation would always ensure that this training was completed before relief bank staff would allowed to work at any Mencap service. The heavy reliance on relief bank staff and agency staff means that relief bank staff sometimes works without the support of full time staff. On the day of the inspection two relief bank staff were on shift in the morning prior to the arrival of the registered manager. Two full time members of staff arrived for work later in the day. The home currently supports four people with autistic spectrum disorder and a range of challenging behaviours. A requirement was set at the last key inspection that the registered manager must develop a training programme for the service that takes into consideration the physical and emotional health care needs of people who use the service. As Mencap considers this service to be a specialist challenging behaviour Care Homes for Adults (18-65 years) Page 19 of 38 Evidence: service that supports people with autism, challenging behaviour, mental health and some people use makaton to communicate the whole staff team should attend training on these topics. The registered manager told us that the previous staff team had attended training on these topics but all of the staff have left. It was recommended at the last key inspection that the registered manager contact the National Autistic Society for advice on autism. The registered manager is a Team Teach trainer on autism, Team Teach are accredited by the British Institute for Learning Disability, and told us that they had trained the staff team on the topic however all of the staff that had been trained on autism have since left the service. One person living at the service suffers from asthma. The registered manager told us that the person attends regular appointments at the General Practitioners Surgery to monitor this. The registered manager told us that there were no guidelines in place for staff to follow or health care professionals advice in relation to the persons condition. The registered manager must develop guidelines for staff to follow in relation to the persons asthma. The registered manager could also seek advice and guidance on asthma from the persons General Practitioner or district nurse. Care Homes for Adults (18-65 years) Page 20 of 38 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The are appropriate complaints and safeguarding adults procedures in place. Evidence: It was recommended at the last key inspection that the service develop a complaints procedure in a format that people who use the service can understand. The registered manager produced a complaints procedure in words and pictures that was easier for some of the people who use the service to understand. Some people who use the service have difficulty in communicating and would have difficulty in understanding the procedure however copies of the procedure is available to their friends, relatives and advocates. The new complaints procedure advised people of how they can make a complaint and who they can complain to however the procedure did not indicate how the complaint would be responded to or when they should expect to receive acknowledgement of their complaint. It is recommended the new complaints procedure indicates when and how the complaint would be acknowledged and how the complaint would be responded to. The service has a protection of vulnerable adults file that includes Mencaps, Sutton Social Services and Wandsworth Social Services adult protection procedures. The two full time members of staff have attended adult protection training. The registered manager could not provide evidence that the relief bank staff or agency Care Homes for Adults (18-65 years) Page 21 of 38 Evidence: staff had attended training on adult protection. The registered manager told us that Mencap relief bank complete the same induction and training as full time staff however this information was held by the relief bank manager, the registered manager told us that the organisation would always ensure that this training was completed before being relief bank staff would allowed to work at any Mencap service. Care Homes for Adults (18-65 years) Page 22 of 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples bedrooms are comfortable and well furnished and they enjoy having a nice garden however more must be done to make sure that the rest of the house is kept clean, comfortable, safe and reasonably decorated. Evidence: A requirement was set at previous inspections that the registered manager replaces the bulbs in the circular ceiling lights in communal areas and investigates the reason why they have a short lifespan. The registered manager explained that the Metropolitan Housing Association had visited the service and replaced the bulbs but they had blown again, the Housing Association and Mencap are currently investigating the issue. A requirement was set at the last key inspection that the registered manager must ensure that the back door leading to the garden is repaired and loose toilet seating is tightened. During this visit a workman was seen fixing the back door. Some toilet seats were loose and one was cracked. The registered manager told us that all of the toilet seats had been tightened following the last inspection however due to the way in which people use the toilets they had become loose again. The registered manager must ensure that all of the toilets seats are properly fitted and the cracked toilet seat Care Homes for Adults (18-65 years) Page 23 of 38 Evidence: is replaced. The registered manager should regularly check to make sure that toilet seats are safe for people to use. It was recommended at the last key inspection that the living room be redecorated and that people who use the service are involved in the choice of decoration. The living room had comfortable furniture however this appeared worn and untidy, some of the laminate flooring was chipped, there were some pictures on the wall but one picture frame was empty and the paint on the walls had been badly marked. The registered manager told us that the living room had been redecorated since the last key inspection but due to wear and tear it needed to be done again. Peoples bedrooms viewed had been nicely decorated and contained good quality furniture however the decoration of all of the communal areas and hallways was in a poor state. Some areas had been replastered and cupboards hade been removed and the walls had been painted over in a different colour. The registered manager told us that they had sent a proposal to the Metropolitan Housing Association for this work to be done and was awaiting their response. The living room, communal areas and hallways must be redecorated, the flooring in the living room must be repaired or replaced and empty picture frames should be removed and replaced with pictures chosen by the people who use the service. The registered manager must make sure that all areas of the house are reasonably decorated. The registered manager produced a property inspection form completed by the Metropolitan Housing Association on the 22 of January 2009. The author rated the internal communal areas as 1, meaning poor, indicating that the environment and services are of poor standard and consideration is to be given to a Neighbourhood Review and action would be taken to improve the environment and services. The form also included an issues log including action required and timescales. This included a number of repairs and cleaning that needed to be carried out at the service. There are appropriate laundry facilities separate from the kitchen and the preparation of food. The washing machine is capable of washing clothes at high temperatures, which helps with the control of infections. The laundry has suitable flooring. There is a locked cupboard for the Control of Substances Hazardous to Health products. There is a large well kept garden to the rear of the house, as recommended at the last key inspection garden furniture have been purchased. Care Homes for Adults (18-65 years) Page 24 of 38 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. Due to a very high turnover of staff the service has not been able to offer people continuity of care or consistency. Evidence: It was recommended at the last key inspection that the registered manager consider all of the points raised in the Psychology report. Prior to two people moving out of the service there had been a very high number of incidents involving violence and aggression between some of people who use the service. A number of adult protection strategy meetings had been held with Sutton Social Services. The Psychology and Challenging Behaviour Services at Sutton carried out a challenging behaviour audit on The 27th June 2007 and produced a report. The report concluded that the number of residents was too high to offer a safe individualised responsive service within one house. Smaller units for people with autism are always desirable as disorder results in major difficulties with social interaction and communication. The lack of relevant experience, qualifications and the high turnover of staff were all areas for concern. This was particularly so for clients with autism and or challenging behaviour where continuity and consistency are paramount. Care Homes for Adults (18-65 years) Page 25 of 38 Evidence: It was recorded in the last inspection report that Mencap managers felt that they had supported people successfully at this specialist challenging behaviour service for many years, but the behaviours of two people in particular had become increasingly challenging. A number of factors could have led to the increase in challenging behaviors; however the very high turnover of staff in 2005 and 2006 may have been one of the major contributors. Seven experienced staff left over the period between December 2005 and September 2006. Although a number of staff had been recruited in October 2006 it had taken time to train them up. Since then one member of staff has left and a deputy manager has been promoted to a management position elsewhere in the organisation. Mencap managers also stated at an adult protection conference on the 5th of July 2007 that once these two people had moved from the service they planned a period of consolidation and team building. The need was identified so as to stabilise the situation at the service. The registered manager told us in the AQAA prior to the annual service review, July 2008 that since the two people moved out of the service the staff team had been through a period of consolidation and building and staff retention had also improved. The service aimed to recruit staff with greater experience and qualifications in support of Autistic Spectrum Disorder and or challenging behaviour. The registered manager told us that since the annual service review all but one member of staff who started work at the service in May 2008, have left. They told us that some have moved onto management posts in other Mencap services. One other member of staff started work at the service in October 2008. The registered manager told us that currently there are three full time support worker posts and a deputy manager post vacant. These shifts are being covered by relief bank and agency staff. The registered manager told us that a recruitment drive took place in February 2009 and three support worker posts have been offered to people pending references, Criminal Records and Protection of Vulnerable Checks. The registered manager agreed with the psychologists report that people with autism and or challenging behaviours need continuity of care and consistency was paramount. They agreed that the service had not yet established a staff team capable of offering this to the people who use the service. The registered manager must develop a training programme that takes into consideration the needs of the people who use the service and establish a staff team that can meet their needs on a continuous and consistant basis. Care Homes for Adults (18-65 years) Page 26 of 38 Evidence: It was recommended at the last key inspection that the registered manager and the Mencap relief bank select and small number of bank or agency staff and attach them to the service. That way they could make sure that people who use the service are supported in a consistent manner. The registered manager told us that they use the same relief bank staff when possible. The rota was checked for the previous month and indicated that regular relief bank staff had been working at the service. Although bank staff attends handovers it was suggested to the registered manager at the last key inspection that the experienced bank staff should attend team meetings so that they could pass on their positive experiences and aid consistent working practices with people who use the service. The registered manager told us that they had discussed this with the relief bank manager but agreed that this would not happen as this would set a precedent within the organisation. Given the high turnover of staff and the reliance of relief bank staff at this particular service it is recommended that Mencap relief bank staff attends staff meeting until the service establishes a staff team capable of meeting the needs of people who use the service. Staff supervision records indicate that the two full time staff are receiving supervision on a regular basis however the registered manager told us that relief bank staff do not receive supervision at the service. The registered manager must ensure that relief bank staff that work at 14a York Road on a regular basis receive supervision until the service establishes a staff team capable of meeting the needs of people who use the service. Two new members of staff started work since the last key inspection. These members of staff personnel files included two written references, proof of identification, a Criminal Records Bureau Check and completed application forms including a full employment history. The registered manager told us that they did not have access to Mencap relief bank staff personnel records as they were held by the relief bank manager at the head office. The registered manager told us that Mencap have received the same documents for relief bank staff and that the organisation would not allow people to work at any Mencap service without full checks being carried out. The two full time members of staffs training records were examined. Both were completing Mencaps induction. Mencaps induction covered training on medication, first aid, fire safety, accident reporting, protection of vulnerable adults and moving and handling. It was noted at the last key inspection that none of the staff team had Care Homes for Adults (18-65 years) Page 27 of 38 Evidence: attended training on food hygiene. A requirement was set that the registered manager must make sure that all members of staff complete food hygiene training. The registered manager told us that staff had attended training on food hygiene however all of these staff had now left. The new members of staff were due to complete training on food hygiene as part of their induction. The registered manager told us that staff would be expected to complete the Mencap induction within the first twelve weeks of employment, given that one member of staff started employment in May 2008 and the other in October 2008 the induction including training on food hygiene should have been completed. The registered manager must make sure that all new members of staff complete food hygiene training. The registered manager told us that the two new members of staff had enrolled on an NVQ course. Care Homes for Adults (18-65 years) Page 28 of 38 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. The overall impression when visiting the service is that it is not well managed because the registered manager has not been afforded appropriate time and support by the registered providers to fulfil their duties as a manager registered with the Commission to run 14a York Road. Evidence: Mencaps plan is to deregister the service in order to provide Supported Living. The registered manager told us that initial plans to deregister service in December 2008 had been put back to June 2009. The registered manager told us that they had also managed 14b York Road as agreed with the Commission. The Commission agreed this as a short term after considering the information provided in the AQAA prior to the annual service review, particularly that since two people had moved out there had been no serious incidents reported at the service, the staff team had been through a period of consolidation and building and staff retention had improved. The registered manager told us that they currently Care Homes for Adults (18-65 years) Page 29 of 38 Evidence: dedicate fifteen hours per week of their management time to a supported living service. The Commission had not been advised about this. The author of Mencaps Annual Quality Service Review completed in January 2009 recorded that merging the team across three services did not work well and the manager needed time to get the service back on track. The registered manager told us that they stopped managing 14b York Road in December 2008 when the deputy manager from 14a York Road took over as the acting manager at 14b York Road. The author of Mencaps Annual Quality Service Review also recorded that the moving on of all the previous team into management roles has been positive to them and a clear demonstration of good support and development by the manager. Although this may demonstrate that the registered manager has supported staff to develop their careers, the moving on of all the previous team into management roles left the service seriously short of experienced staff despite Mencaps managers indicating at the last key inspection that the service would undergo a period of consolidation and team building so as to stabilise the situation at the service. The registered manager told us in the AQAA prior to the annual service review in July 2008 that the service aimed to recruit staff with greater experience and qualifications in support of autistic spectrum disorder and or challenging behaviour. However the organisation has yet to establish a staff team capable of meeting the long term needs of the people who use the service. Currently there is no deputy manager in post and two relatively new members of staff are supported by relief bank and agency staff. These two relatively new members of staff have not yet fully completed the Mencap induction. Mencaps relief bank staff do not attend team meetings or receive supervision at the service. One member of staff told us that when the registered manager was not available they would contact the acting manager at 14b York Road in case of emergency. As the registered manager told us that they work fifteen hours per week at a supported living service it is reasonable to consider that they are working on a part time basis at 14a York Road. Given the number of requirements and recommendations set in this and previous inspection reports the Commission considers the registered manager has not been afforded appropriate time and support by Mencap to fulfil their duties as a manager registered with the Commission to run a care home. In order to make sure the requirements and recommendations set in this report are addressed the registered provider must ensure that the registered manager is afforded the appropriate time and support to fulfil their duties as a manager registered with the Care Homes for Adults (18-65 years) Page 30 of 38 Evidence: Commission to run 14a York Road. It was recorded at the last inspection that the registered manager would be restarting the Registered Managers Award and NVQ Level 4 in Care in September 2007. It was recommended at the last key inspection that the registered manager write to the Commission indicating their plans to complete the Registered Managers Award and NVQ Level 4 in Care and their plans to continue training and developing themselves as a manager. The registered manager told us that they had not had an opportunity to restart the Registered Managers Award as planned and as the Registered Managers Award would not be relevant to the supported living service they were considering whether or not it was worth completing. Monthly Regulation 26 visit are recorded on monthly continuous improvement plans. The area manager responsible for carrying out the visits referred in the last report to the need for the service to recruit staff. The continuous improvement plan also looks at a number of key areas such as health and safety, management systems, environment, resources and complaints. The registered manager told us that this information is passed to senior managers at Mencap so that they can monitor the service. A requirement was set at the last key inspection that the registered manager must ensure that weekly fire checks are carried out and recorded. Weekly checks are carried out on the fire alarm system. Records indicated that on two occasions staff had not tested the system that particular week but did the following week. The registered manager told us that relief bank staff had not carried out these checks and they had spoken to the people concerned. The registered manager must ensure that weekly fire checks are carried out and recorded. A full fire evacuation drill was carried out in January 2009. There is a fire risk assessment that is updated when required. Care Homes for Adults (18-65 years) Page 31 of 38 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 4 (1) c, Schedule 1 of the Care Homes Regulations. In order that the people who 30/10/2007 use the service can be involved in the day to day running of the home and have an opinion of how the home provides care and support registered manager should consider how their views can be sought. 2 24 23 (4) b & 13 The registered manager 29/07/2007 (4) c. must ensure that the back door leading to the garden is repaired and loose toilet seating is tightened. Toilet seats need to be replaced and kept tightened. 3 32 18 (1) c (i) The registered manager 30/10/2007 must develop a training programme for the home that takes into consideration the physical and emotional health care needs of people who use the service. As Mencap considers this home to be a specialist challenging behaviour service that supports people with autism, challenging behaviour, mental health and some people use Makaton to communicate the whole staff team should attend training on these topics. Page 32 of 38 Care Homes for Adults (18-65 years) 4 42 23 (4) c The registered manager 29/07/2007 must ensure that weekly fire checks are carried out and recorded at the home. Care Homes for Adults (18-65 years) Page 33 of 38 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 1 4 The registered manager must ensure that the Statement of Purpose include information on the services objectives and philosophy and staff numbers and their experience and qualifications. So that people planning to use the service have up to date and accurate information that would enable them to make an informed decision about whether or not the service can meet their needs. 11/05/2009 2 6 15 The registered manager must ensure that peoples core plans are kept under review. So that peoples needs can be met. 11/05/2009 Care Homes for Adults (18-65 years) Page 34 of 38 3 7 4 The registered manager 15/05/2009 must make sure that the key worker checklist includes a section seeking peoples opinion of the service. So that people can offer their views on how the service provides care and support. 4 9 13 The registered manager 11/05/2009 must ensure that peoples risk assessments are reviewed at intervals agreed in their risk management plans. So that people can live as independently as possible. 5 19 18 All members of staff including relief bank staff must attend training on challenging behaviour and autism. So that people can be sure that their health care needs are being met. 29/05/2009 6 19 18 The registered manager 11/05/2009 must develop guidelines for staff to follow in relation to the persons asthma. The registered manager could also seek advice and guidance on asthma from the persons General Practitioner or district nurse. So that people can be sure that their health care needs are being met. 7 32 18 The registered manager must develop a training 29/05/2009 Care Homes for Adults (18-65 years) Page 35 of 38 programme that takes into consideration the needs of the people who use the service and establish a staff team that can meet their needs in the long term. So that people who use the service are offered continuous and consistant support. 8 35 18 The registered manager 11/05/2009 must make sure that all new members of staff complete food hygiene training. To ensure that people who use the service are protected from spread of infection 9 37 10 In order to make sure the 30/04/2009 requirements and recommendations set in this report are addressed the registered provider must ensure that the registered manager is afforded the appropriate time and support to fulfil his duties as a manager registered with the Commission to run 14a York Road. To make sure that the service meets the needs of people who use the service and complies with the Care Homes Regulations. 10 42 23 The registered manager 27/03/2009 must ensure that weekly fire checks are carried out and recorded. Care Homes for Adults (18-65 years) Page 36 of 38 To make sure that people who use the service and staff are protected from the risk of fire. 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 2 3 4 6 7 8 20 The registered manager should obtain copies of peoples placement reviews and retain these in their personal files. The persons wishes regarding not wanting to attend residents meetings be recorded in their care plan. The registered manager should consider how peoples views can be sought. The registered manager should request that following visits from the local pharmacist that a report of the pharmacists findings are provided to the service. The new complaints procedure should indicate when and how peoples complaints will be acknowledged and how the complaint will be responded to. It is recommended that Mencap relief bank staff attend staff meetings until the service establishes a staff team capable of meeting the needs of people who use the service. 5 22 6 36 Care Homes for Adults (18-65 years) Page 37 of 38 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. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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