Inspection on 19/03/08 for Yorkminster Drive

This inspection was carried out on 19th March 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 20 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Yorkminster Drive 06/06/09

Yorkminster Drive 04/09/08

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Yorkminster Drive 1-5 Yorkminster Drive Chelmsley Wood Birmingham West Midlands B37 7UG Lead Inspector Julie Preston Key Unannounced Inspection 19th March 2008 09:30 Yorkminster Drive DS0000070424.V361424.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 Yorkminster Drive DS0000070424.V361424.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. Yorkminster Drive DS0000070424.V361424.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Yorkminster Drive Address 1-5 Yorkminster Drive Chelmsley Wood Birmingham West Midlands B37 7UG 0121 788 2763 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) www.caretech-uk.com CareTech Community Services Ltd vacant post Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Yorkminster Drive DS0000070424.V361424.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only To service users of the following gender: Either Whose primary care needs on admission the home are within the following categories: 2. Learning Disability (LD) 12 The maximum number of service users to be accommodated is 12. Date of last inspection New Service Brief Description of the Service: Yorkminster drive is situated in Solihull within easy reaching distance of shopping facilities, the town centre of Chelmsley Wood and public transport. There are three bungalows in the complex housing four people in each bungalow. Facilities available included washing facilities, individual bedrooms, and lounge and kitchen space and laundry facilities. Each bungalow has its own front door and back door entrance and staff are designated to work in each bungalow and have knowledge of all 12 people who live there. Yorkminster Drive DS0000070424.V361424.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This is the first inspection to this service since it was taken over by CareTech. The new organisation has been running this service for six months since registration with us. The purpose of the visit is to ensure that the care and practices in this service are safe and protect the people who live there from potential and actual harm. We also look at the experience of the people living there, we do this through ‘case tracking’ which involves meeting the person, checking that the care they receive is needed and that the person is happy with the care and attitude of the staff. We also look at records related to medication management, safety of equipment and records of activities to ensure that practices and procedures in the service are safe. Discussion is undertaken with managers and staff in the home to find out how they view the service and their understanding of the needs of those who live there. Before the visit we examined any information we had received in relation to this service to help us decide what areas we needed to examine further. We have received information from the home regarding a resident’s behaviour and missing money. The management has dealt with both these incidents, records telling us what they had done were not available and it was not clear if these had been properly resolved. Overall the outcomes for those who live at this service are adequate, they reported that they were happy and the staff looked after them well. There was sufficient equipment to help with mobility and movement and each bungalow was nicely decorated. The administration and management of the home is not acceptable with information missing, poor record keeping and disorganisation. This has not affected the experience of those who live there but this could lead to oversight of actions needed and an increased risk of harm to those who live there. What the service does well: The staff have a good relationship with the residents, they know each other well. Yorkminster Drive DS0000070424.V361424.R01.S.doc Version 5.2 Page 6 We spoke to people who live in the home about the choices they make and were told“I can do what I want to do and I like going to the centre”. “The dinner is the one I chose”. “I go shopping to get our food”. “If I don’t want to go out, I don’t have to”. Each person has the equipment they need to help them move around and to manage day-to-day living. The home is good at supporting people to keep in touch with their friends and relatives so that they maintain relationships that are important to them. The bungalows are clean, free from unpleasant smells and homely. What has improved since the last inspection? What they could do better: Information about the home is not accessible to people to help them decide whether they would wish to live there. Records that explain how people like and need to be cared for are not well written and do not get reviewed often enough to make sure that people get the care they need. People do not get the food they need to help them stay healthy and well. Some people’s health is not being monitored so that they could be at risk of becoming unwell. Medicines are not being well managed and people cannot be confident that they will receive their medication as prescribed. There are sometimes not enough staff on duty to help people go out and do things they enjoy. This happens a lot at weekends and in the evenings. The management of this service is inadequate. The manager has had a period of sickness and temporary management is not sufficient to ensure smooth Yorkminster Drive DS0000070424.V361424.R01.S.doc Version 5.2 Page 7 running of the home. Record management and administration are haphazard and disorganised. The management of concerns and complaints is inadequate and it was not possible to establish if the service would address concerns and complaints properly. The information for relatives was incorrect and had not been up dated since the new organisation has taken over. The information for the management of suspected or actual abuse was not complete and there was no evidence that staff had received suitable training. During the visit it was confirmed when training in abuse would occur. The management should make sure that there are records of who attends this training and that staff are aware of the signs of abuse and how to report this. 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. Yorkminster Drive DS0000070424.V361424.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Yorkminster Drive DS0000070424.V361424.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information is not available to prospective service users and their relatives in a way that can be easily understood so that they can be confident that their needs would be met on admission. EVIDENCE: There have been no new people admitted to the home since CareTech took over as registered providers. All of the people who live at Yorkminster Drive have lived there for a considerable period of time. The service user guide was observed. This was presented in a format called “Widgit” which is a system of symbols used to describe the written word. It was reported that none of the people who live in the home were able to understand the Widgit system and upon asking two people whether they had seen the service user guide they responded that they had not. The service user guide should provide information about the home and the services provided to enable people to make an informed choice about whether to move in. The current guide is not accessible to the people who live there Yorkminster Drive DS0000070424.V361424.R01.S.doc Version 5.2 Page 10 and would not be suitable to provide information to anyone other than those who communicate in the Widgit system. The home’s statement of purpose contained information about the previous registered provider (Craegmoor Healthcare) and was not specific to the current provider. A senior member of staff did comment that both the statement of purpose and service user guide was due to be reviewed to reflect the aims, philosophy and objectives of the current provider, CareTech. Information about the procedure for assessing the needs of potential residents was not available. The most recent document related to the procedures used by the previous registered provider. Staff did state that should vacancies arise a procedure for assessment prior to admission would be implemented according to CareTech’s established policies. Yorkminster Drive DS0000070424.V361424.R01.S.doc Version 5.2 Page 11 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, 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems of care planning and risk assessment are in place but are not reviewed on a regular basis nor detailed enough to make sure that people receive care in a consistent manner that meets their individual needs. People that live in the home receive support to make choices and decisions about their lifestyles. EVIDENCE: The care plans and risk assessments for four people were looked at during this visit. Information was stored in up to four different folders for each person and included many out of date documents that made it difficult to establish which information was relevant to people’s current needs. Yorkminster Drive DS0000070424.V361424.R01.S.doc Version 5.2 Page 12 Behaviour guidelines were referred to in some of the care plans sampled that related to supporting people to stay safe and well. The guidelines referred to could not be found for one person and the care plan stated that staff should work in “a positive way with X” but gave no details of how to do this. Two staff at the home were not clear about the level of support that people need to maintain their safety when out in the community. Two care plans sampled gave contradictory information about the number of staff that should be available to support people to go out to reduce risks to their well-being. This does not provide staff with clear information to meet the person’s needs and could lead to inconsistent care practice. Some of the care plans had not been dated so that it was not clear they related to people’s current needs or that they had been reviewed on a regular basis. The home completes risk assessments for people so that consideration is given to supporting them to take responsible risks and promote their independence. Risk assessments sampled had not been reviewed on a regular basis to make sure that they remained relevant to the person’s needs and continued to promote their safety. Risks had been identified such as people “wandering off” when out or “lashing out” at others. There were no strategies in place to manage these risks, which could lead to people being placed at further risk of harm or injury. We spoke to people who live in the home about the opportunities they have to make choices and decisions about their everyday lives and were told: “I can do what I want to do and I like going to the centre”. “The dinner is the one I chose”. “I go shopping to get our food”. “If I don’t want to go out, I don’t have to”. Staff members told us that they are supporting people to make food and activity choices by using pictures and photographs to help them. We were shown menu books that a person said he used to choose his meals and to plan the weeks shopping list. This indicates that staff are considering people’s communication needs to assist them to make choices about their day-to-day lives. Yorkminster Drive DS0000070424.V361424.R01.S.doc Version 5.2 Page 13 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): 12, 13, 15, 16, 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Activities are not well planned and there are not always enough staff on duty to support people to maintain a meaningful lifestyle. Menus available do not show that people always receive a balanced diet as part of a healthy standard of living. EVIDENCE: Two staff explained that each person living at the home has a plan that describes their weekly activities based on their preferences identified in their care plan. Two of the four care plans sampled contained no information about the type of things people like to do so it was not clear how staff know what all the peoples preferences are. Yorkminster Drive DS0000070424.V361424.R01.S.doc Version 5.2 Page 14 Records of daily activities varied from stating basic information about people being “fine” and “OK today” to some more comprehensive detail about going out for meals and shopping, visiting family members, going to college and to a local day centre. There were many gaps in the daily records sampled, which could mean that people have done very little during their day. In many cases it was recorded that people had spent time in other houses “for activities”. There was no information about what had taken place, whether the activity had been enjoyed or why the person had had to go to another house to take part in the activity. We were told by three staff that sometimes there were not enough staff on duty to support people to remain in their own homes during the day and that this usually occurred at weekends. For two of the four people “case tracked” over the period of eight days, the only activity noted for four of those days was watching television or DVDs. Records referred to people taking part in “room management”, which staff explained meant that they helped to tidy and clean their bedrooms. There was no information about how the individual would contribute to or benefit from this activity. Two people did say that “college is good” and one person said “I like going to the centre”. However, the way in which activities are planned for people is not always consistent with their preferences and a lack of staff support has an impact on what they are enabled to do. The home is good at supporting people to keep in touch with their friends and relatives. Within the care plans sampled there was information about the support people need to maintain contact with those that are important to them. At this visit people received visits from their relatives and one person said that he saw his friends at an evening social club. Menus and records of food eaten by people were looked at to see that a balanced and varied diet is provided that meets peoples’ needs and preferences. This was raised as an area of concern with staff during the visit as the records showed some people had refused meals on several occasions and had not been offered an alternative. Some records of food consumed had been left blank so that it was not possible to evidence that people were receiving a well-balanced and varied diet. People with specific dietary needs had not been well catered for and had not been offered the portions of fresh fruit and vegetables that healthcare professionals had advised as being necessary to maintain good health. In one case a person’s eating guidelines stated that they should avoid spicy and fatty foods to maintain good health. The records of food consumed over a fourteenday period showed that their diet consisted of meals of faggots, take aways, sweets, biscuits, pizza and chips on a regular basis. Yorkminster Drive DS0000070424.V361424.R01.S.doc Version 5.2 Page 15 Yorkminster Drive DS0000070424.V361424.R01.S.doc Version 5.2 Page 16 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 poor. This judgement has been made using available evidence including a visit to this service. Systems to meet peoples’ health and personal care needs are not robust which could lead to individuals’ needs not being met and their health affected. EVIDENCE: Four personal and health care plans were sampled at this visit. People who live at the home have a range of healthcare needs and from the records observed it was not evident that their health was being monitored effectively or that they received health care services according to their individual needs for example. A notification to the CSCI made in 2007 described a person choking on a piece of food, for which the person had been taken to the Accident and Emergency Unit by ambulance. A further incident had taken place in February 2008, which was recorded in the person’s daily records and not reported to the CSCI where a piece of food had to be removed from the individual’s mouth to “avoid choking”. No referral had been made to Speech and Language Therapy Yorkminster Drive DS0000070424.V361424.R01.S.doc Version 5.2 Page 17 services for a swallowing assessment as a result of the two incidents so that the risks to the person’s health and well being could be determined by professionals competent to do so. Staff did confirm that they cut the person’s food into small pieces and always offered supervision at mealtimes although this was not reflected in the plan of care observed. Staff were observed supporting this person during the evening meal. The staff member stood over the person and when food was spilled the staff member scooped it up onto a spoon and put it back into the person’s mouth. This practice is not respectful or dignified and indicates a lack of understanding on the part of staff. The incident was immediately reported to a senior member of the team who gave assurances that the matter would be addressed. Weight records for people who need to maintain a stable body weight had been randomly completed; one record had not been updated since November 2007. There was conflicting information about people’s continence care needs and the type of support needed within the same care plan and bowel monitoring records had not been completed for a person who’s care plan made it clear that medication was needed to assist regular movements which could lead to poor health if irregular. People with epilepsy did not have care plans to describe how staff should respond to seizures so that their health and well being would be protected. The food records for one person showed that a range of food that “should be avoided to avoid X getting ill” had been offered and eaten frequently. This indicates that people’s health and personal care needs are not understood and that current practice could place people at risk of ill health or harm. A system of Health Action Planning (a document that explains what a person needs to do to stay healthy and the health care services they need to access to do so) has been introduced, although some plans have not been completed in full and some not at all. Moving and handling risk assessments for people who experience difficulty bearing their own weight and mobilising around the home were not dated and it was not clear that they had been reviewed to make sure that they were relevant to individuals current needs. Three staff training records looked at did not show that training in moving and handling had been completed in the last twelve months. Within the records sampled a checklist entitled “night checks” had been filled in by staff for some people at hourly intervals during the night. There was no written and agreed plan to explain how these checks should be made, the reason for them or how individuals privacy would be respected by the staff team. The system of storing, administering and recording medicines kept in the home was looked at to establish that people are protected by robust procedures. Yorkminster Drive DS0000070424.V361424.R01.S.doc Version 5.2 Page 18 We received information before this visit that one person had not received prescribed medication for three days, as the pharmacist had not delivered it. This person’s medication records were looked at. Staff had recorded that the medication had not arrived at the home, however no one reordered it until three days later. When we asked that the reasoning for this be explained staff could not give a definitive answer. There were differences in the amount of medication in stock against the medication record in houses 1 and 3. This indicates that medication is not being given as prescribed and could affect people’s health. In house 3 staff could not open the medication cabinet for administration at 5pm as the keys had been taken off the premises and the spare set were missing. Keys were eventually tracked down before 5pm, however if people had needed to have any “as required” medicines they would not have been able to do so. We were advised of a previous occasion when keys had gone missing and a cabinet could not be locked to store medicines safely. Key holding arrangements are clearly inadequate to ensure that medicines are stored safely. Written guidance for the administration of “as required” medication such as inhalers and topical creams had not been completed so that staff know how and when to administer medications to make sure that people receive them consistently and according to their individual needs. We were told that there had been several errors in medicines administration since September 2007. The majority of staff have not received training in the safe handling of medicines, although a representative from CareTech did advise us that further training is planned. Yorkminster Drive DS0000070424.V361424.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): Standards 22 & 23 were assessed Quality in this outcome area is adequate. Those who live at this services and their relatives can not be sure that all concerns and complaints will be dealt with properly as procedures have not been up dated. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a complaints procedure produced in simple language and supported by pictures to assist the people who live there to understand the policy. This was seen in the complaints folder and is also made available to each individual. However no copies were seen in any of the bedrooms or the communal or personal rooms of the bungalows. The complaints procedure for staff is clear, the address for the local social service department and us are missing. It is important that this information is available so that any concerns and complaints can be shared with the appropriate people if necessary. Within the Complaints folder there are two complaints and two compliments. One complaint was about manual handling practise, as the home did not have a hoist or sling in place. The Environmental Health Department looked at this and told the home what changes were required, they then checked that the work had been done to enable safe movement of the person concerned. A Yorkminster Drive DS0000070424.V361424.R01.S.doc Version 5.2 Page 20 relative raised concerns about the care received by her relative who lives here. The information states that this was passed to the Area Manager; there was no further information available in the Complaints log. We discussed this with the manager and they agreed that this information was not available. This does not give confidence that concerns and complaints are dealt with seriously and addressed appropriately. It is important that information about the concern or complaint, the investigation and details of any feedback given to the complainant are available. We have not received any concerns or complaints. While walking around the bungalows it was noticed that Complaints Procedures referring to the previous company were on the walls, this was pointed out and the manager asked for these to be removed during the visit. It is important that all information available is up to date and current. This will ensure that any concerns are dealt with promptly. Multi-Agency Guidelines and the document ‘No Secrets’ is available in the manager’s office. There is no company process or format for staff to follow in relation to safeguarding for the people who live there. We were told that this is in process. Three care staff spoken to state that they would tell a senior member of staff of any acts of suspected or actual abuse, they were not aware of what the complete process would be. The deputy manager was also unsure about the process and this lack of knowledge may result in a safeguarding issue not being dealt with properly. No staff had not received up to date training in safeguarding. During the visit information was received which confirmed that an outside organisation would ensure that all staff would have received this training by the end of May 2008. Clear records of staff that attend must be kept and records maintained. Yorkminster Drive DS0000070424.V361424.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): Standards 24 & 30 were assessed Quality in this outcome area is good. The home is clean, tidy and homely and offers pleasant surroundings for those who live there enhancing their quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All three bungalows were visited they were clean, homely of good décor and the individuals are able to decorate their own rooms to their taste and are assisted to put individual touches such as music, TV, books and photos and other personal items Each bungalow has its own kitchen, in one bungalow this has been full re-fitted with a new kitchen and all the corridors have been decorated. There are plans to replace the kitchens in No. 3 & 5 of Yorkminster Drive. Both of these kitchens were clean, tidy and in good repair. Yorkminster Drive DS0000070424.V361424.R01.S.doc Version 5.2 Page 22 Each unit has a laundry, these are well organised and clean, and there was no excessive laundry. Staff told us how they manage soiled laundry and their role in maintaining infection control. Each bungalow has individual garden space, which is maintained and has ramps going from kitchen door to assist those with limited mobility to go into the gardens. Bungalow 5 is fitted with an assisted bath and tracking hoists to assist one individual with mobility there is also a manual hoist with sling. The other bungalows do not have a manual hoist as these are not at this time needed as those living there are mobile and do not need assistance. The garden is at the back of the bungalows and a ramp leads from each kitchen, which means that all those people living at the bungalows can go into the garden with little or no assistance. The gardens are small with a grassed area, which is mowed making it easier for walking on. Yorkminster Drive DS0000070424.V361424.R01.S.doc Version 5.2 Page 23 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): Standards 32, 33, 34, 35 & 36 were assessed Quality in this outcome area is adequate. There are not always enough competent and qualified staff available to support people and enable them to experience a good quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff records could not been viewed as the acting manager is on holiday and she has the key to the cupboard these are locked in. This was discussed with the deputy manager and the senior manager that keys belonging to the service must always be available and that they need to consider how this is to be managed in the future. We were told that all staff records have been checked by head office and the main information is held centrally, each staff member has an individual record at the home, which states what is available in their records. As a large national company CareTech have a Provider Relationship Manager who is employed by us, and they check these records every six months to ensure that the process Yorkminster Drive DS0000070424.V361424.R01.S.doc Version 5.2 Page 24 of employment remains good. We were told that the following is maintained in the service Individual proforma – photograph of the person and clear records of documents to demonstrate who they are. Supervision records Copies of sick notes None of this could be checked at the time, it was agreed that these will be checked at the next visit. There is a separate rota for all three bungalows. Each bungalow has its own designated staffing team. The rotas for Bungalow 1 show that there is not the same number of staff on duty each day of the week and each week is different. Some days there are two staff for both the morning and afternoon shift and some days this is reduced to one member of staff. The rotas for bungalows No 3 and 5 show a similar pattern. It was noted that on a few occasions it appeared that there were no staff available for the morning shift. The gaps required to be filled were not clear and logic and there was no written evidence that this had been done. On the day of the visit there were two staff available in all the bungalows. The people who live there did not wish or were unable to comment on the levels of staff. On the day of the visit Bungalow 1 was initially visited and there were two staff available. One staff went out with one of the person’s and the other remained. As the written information about the staffing was unclear and disorganised it was not possible to be sure that there are always enough staff available to meet the needs of those who live there when required. A manager from another service is going to assist Yorkminster two days per week to help with the duty rosters and to give managerial support. Staff told us that they were happy with the change from the last organisation to CareTech and said that they ‘felt that CareTech were more person orientated and that the changes were positive’. They both voiced that there had been some teething problems initially but that this was now settled. The induction programme for new staff involves a 2-week induction prior to commencement of working in the service. This is undertaken in the home but they are not included as a working member of staff. Each new member of staff has up to six weeks training, which also includes mandatory training. The manager is responsible to oversee this process and report to senior management about any issues or concerns raised. No records of this were Yorkminster Drive DS0000070424.V361424.R01.S.doc Version 5.2 Page 25 available to view, so it was not possible to determine if the plan of induction is adhered to. All staff have a six month probationary period and if they are satisfactory they are given a permanent contract. Supervision is monthly for all staff, a new rota of supervision was shown to us and we will check if this has been carried out at our next visit. The people who live here are not at this time involved in the process of employment of staff. We were told that a process to involve individuals who live at the service is being considered. Staff have received training in various areas related to the needs of the people who live there. The records were disorganised and it was difficult to see where up date is training is needed. Yorkminster Drive DS0000070424.V361424.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): Standards 37, 39, 41 & 42 were assessed Quality in this outcome area is adequate. There is no clear management of this service and the management of records is disorganised and poorly maintained. This may impact on the quality of the service provided and reduce the positive experience for those living there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager from another home in the area is managing this service, as there is no registered manager at this time. The original acting manager has gone onto long-term sickness. The deputy manager was available to assist with us. Yorkminster Drive DS0000070424.V361424.R01.S.doc Version 5.2 Page 27 The acting manager has been based at this service but also continues to manager her own service. A manager from another service will commence 2 days a week from 2nd April, and the acting manager will also two days a week in Yorkminster and the remaining three days in the service she is a registered manager for. The Area manager will continue to support the service and there is also an on call system. The post for a manager has been advertised in the local paper. Interviews were undertaken on 01/04/08. The organisation will then inform us of any employment made. There have been reviews of the attendance to day services and it has been found that some individuals do not like the day services so the plan is to integrate a day service within the home. The Day Service Manager will work with the manager of this service to develop a day service. This can only begin when the management structure has been set up. There is an audit of accidents, this lists each individual and states the accident with any injury sustained. It does not look at the number of incidents per individual or discuss any further assessments or actions taken to minimise accidents. Accident forms are completed properly and signed by the manager. It was explained that risk assessments are done for people who have regular occurrences. This report has identified that in the case of one person choking on two occasions, the level of risk had not been reviewed so that the individual would be adequately protected from further harm. An ‘open surgery’ takes place regularly where relative, advocates and the resident can meet with management to discuss care and any concerns they may have. A relative attended an ‘open surgery’ while we were there but declined to speak to us. Staff meetings should be monthly, last meeting was within the last week, these have not been happening as frequently as required due to changes and sickness of manager. Staff have both full staff meetings and individual bungalow meetings. At the smaller meeting the staff team develop appropriate action plans and then revisit these to ensure that new initiatives are working. This has just commenced in bungalow 1, it is planned to continue this with the other two bungalows. The larger staff meeting will be used to discuss the new methodology and also to share information from the larger organisation. Staff receive supervision on a two monthly basis. A matrix was available of when supervision is to take place, records could not be viewed as the manager has taken the key and she is on holiday. A discussion took place in regards to the management of keys that are necessary to access records. Yorkminster Drive DS0000070424.V361424.R01.S.doc Version 5.2 Page 28 CareTech took over in July 2007, since this time they have been implementing new ways of managing the services, as part of this they are changing the auditing process. The organisation are going to send out ‘Quality and Performance Surveys’ for professionals, relative/advocates with a further survey that is referred to as ‘What do you think’ these are both available in written format and a format with pictures and symbols. This information will be assessed and a report written with actions about improvement. We will examine the results of these when we visit again to see if this has resulted in improvements being made to the service provided to those who live there. The organisation have started a ‘Reference Group’, this is for the Midlands and has people form all the registered care services. The group contains a mixture of people who use the service and their support workers. The purpose of this group to look at the care planning process – looking at what is good not so good and the individuals are involved in producing care plans that are meaningful to them. Minutes of the meeting are made available in an easy read format and the quality performance manager will over see this process and look at the changes that could be implemented and track changes and their effectiveness. This is to be addressed to the individuals at Yorkminster and each person will be given the opportunity to decide if they would like to be involved, the reference group will commence in April. Statutory training has been assessed and new training has been put into place. Further training planned includes ‘Total communication training’. This involves and audit prior to training and an audit six months after the training to demonstrate if the training has improved communication. This will commence in May. Three records of money held by the service for each individual was checked and found to be correct. A record of money received and money used with receipts were maintained and no discrepancies were found. The Senior Care staff have access to the safe, which ensures that each individual can get their 7 days a week. The money is checked twice a day by senior staff to ensure that the money tallies and receipts are added to the spreadsheet. Each resident has an individual building society book – at this time no withdrawals can be made, as the second signatory is the manager who is off sick. The home had to contact her while off sick to sign for money to be withdrawn for each individual. The organisation is advised to consider contingency plans for this area. Also it is important to assess the capacity of each person to ensure that it is appropriate for the organisation to manage their personal finances or if other ways to support people to take control over their money can be achieved to improve their independence, within a risk assessment framework this. Yorkminster Drive DS0000070424.V361424.R01.S.doc Version 5.2 Page 29 There was an incident where a member of staff had left money in an envelope unattended, this was in part destroyed and the remainder not recovered. Money owing to individuals was replaced. The management spoke to staff regarding this incident and the importance of ensuring that all money is safe. Records of this and actions taken were not available. Record keeping is important to ensure there is an audit trail and actions taken can be checked to see if improvements made are continuing. Various aspects of maintenance and health and safety were checked. The tracking and manual hoists had been tested in October 2007; the fire annual test was carried out during our visit. Stickers on the portable electrical equipment stated that a full check had been undertaken in 2007 and was due again this year. The last written report available was for July 2005. Again these records were disorganised and information was not readily available. This could result in equipment not being checked and faults would then be missed outing both those who live and work there at risk. Fire testing by home is up to date and fire drills, the ADT fire inspector told us that the records for fire drills was very good as many services do not bother to record these. Yorkminster Drive DS0000070424.V361424.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 3 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 1 1 X 2 X 2 2 2 2 X Yorkminster Drive DS0000070424.V361424.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15(1-2) Timescale for action Each person must have a plan of 16/05/08 care that clearly describes how their needs in respect of health and welfare are to be met and must be reviewed at such intervals that they remain relevant to the person’s needs. Risk assessments must be reviewed on a regular basis to make sure they remain relevant to the person’s needs and continue to promote their safety. Arrangements must be made to enable people who live in the home to take part in social and leisure activities as part of a meaningful lifestyle, with support from staff in accordance with their needs. Records of food consumed must be maintained so that it can be determined that people are being offered a well balanced and varied diet. Menus must be reviewed so that people living in the home are offered meals that are well balanced and nutritious. DS0000070424.V361424.R01.S.doc Requirement 2 YA9 13(4)(c) 16/05/08 3 YA12 YA13 16(2)(m) 16/05/08 4 YA17 17(2) Sch 4(13) 01/05/08 5 YA17 16(2)(i) 01/05/08 Yorkminster Drive Version 5.2 Page 32 6 YA18 12(4)(a) 7 YA19 8 YA19 9 YA20 10 YA20 11 YA20 12 YA20 13 YA22 Personal care must be offered to people who live in the home in a manner that respects their privacy and dignity. 13(1)(b) Identified concerns about the health of people living in the home must be referred to health care professionals so that individuals receive the intervention they require to enable them to maintain good health. 12(1)(a-b) Health care plans and health care monitoring plans must be adhered to so that people living at the home are supported to maintain good health. 13(2) People living in the home must receive their medication as prescribed so that their health is maintained. 13(2) Written guidance must be agreed and implemented for the use of “as required” medicines so that people receive such medicines consistently and according to their individual needs. 13(2) Medicines must be stored securely and medicines must be accessible to people at all times so that their health is not compromised. 18(1)(a)(c) Staff who have responsibility for administering medicines must have training to make sure that they are competent to do so to avoid unnecessary risks to people’s health and well being. 22 Records of all concerns and complaints received must be recorded and any investigations, outcomes and replies kept together. This will ensure that auditing can take place, checking that improvements have been 01/05/08 01/05/08 01/05/08 01/05/08 01/05/08 01/05/08 16/05/08 16/05/08 Yorkminster Drive DS0000070424.V361424.R01.S.doc Version 5.2 Page 33 implemented and sustained. 14 YA23 13(6) A robust procedure must be developed to guide staff on the actions to take in regards to safeguarding vulnerable people. This will ensure that in the event of a safeguarding issue staff will know who to inform and immediate actions to take, increasing the safety of those who live there. 15 YA32 YA33 18 The records of numbers of staff at work and their role must be clearly defined. This will ensure that there are enough staff with the right training to meet the needs of those who live there at all times. 16 YA41 YA42 YA39 17 The recording of information related to maintenance, Health and Safety, Staffing numbers and accidents and incidents must be clear and concise. This will ensure that these can be audited and the service can demonstrate that the bungalows are safe to live in and needs are being met. 01/05/08 01/05/08 01/05/08 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 Refer to Standard YA1 Good Practice Recommendations The statement of purpose and service user guide should be reviewed so that it is specific to the registered provider’s DS0000070424.V361424.R01.S.doc Version 5.2 Page 34 Yorkminster Drive 2 YA1 3 YA2 4 5 6 7 8 9 10 YA6 YA6 YA19 YA12 YA18 YA19 YA20 YA22 YA37 11 12 13 YA40 YA34 YA35 aims, philosophy and objectives. This will contribute to people making an informed choice about whether to move into the home. The service user guide should be presented in a format that is accessible to people who may wish to live in the home so that they can make an informed choice about whether they wish to live there. The procedure for assessing the needs of people before they move into the home should be implemented so that it is reflective of the policies of the registered provider. This will enable people to be confident that their needs can be met within the home. Information that is not relevant to people’s current care needs should be stored separately to their working care records so that they are easier for staff to read and digest. Records relating to people’s care should be dated and signed so that it is evident they are relevant to the person’s current needs and to aid the process of review. Records that describe the activities undertaken by people should be completed so that it can be determined that people are leading a meaningful lifestyle. Night checks should be completed according to an agreed and recorded rationale so that people’s privacy is respected during this time. Health Action Plans should be completed for each person so that their healthcare needs are clearly recorded and to enable staff to assist them to maintain good health. The system of auditing medicines should be reviewed so that errors are identified promptly to enable people to maintain good health. The complaints procedure should be up dated so that there is clear information about how any concern or complaint will be dealt with. This should include the contact details for Social Services and us. The senior management should ensure that the management and administration of the home is consistent and clear so that both those who live there and the staff can be assured that they are in a safe and caring environment. The senior management must ensure that the keys to locked cupboards holding information regarding staff is available at all times. Induction information of each member of staff should be held in the service so that this can be monitored and checked to ensure that new staff have suitable induction training within an acceptable time. Yorkminster Drive DS0000070424.V361424.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Yorkminster Drive DS0000070424.V361424.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. 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