Care Home: Denmark Hill, 164

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What the care home does well Resettlement procedures are thorough and allow for a trial visits before a prospective service user has to make up their mind whether the service will meet their needs. Residents are able to make decisions about their everyday lives and are given help with major decision making as required. Residents have opportunity to develop their skills and to engage in activities of their choosing. Staff support residents to maintain their family links and friendships and their everyday responsibilities are encouraged. Residents have meals of their choosing, and often go out to eat as well. Staff take appropriate action and seek medical advice if they notice that there are health concerns for any of the residents. The home is comfortable, safe, clean and hygienic. Staff are recruited properly and there is training available on an ongoing basis. Denmark Hill, 164 DS0000022724.V378529.R01.S.doc Version 5.3 What has improved since the last inspection? A ceiling hoist has been repaired in one of the residents bedrooms. This benefits the resident because he now has the choice of having a bath again instead of a shower. The manager has better assessed the risks relating to the physical environment. The laundry room has an area of exposed hot pipe wok and the manager assesses this risk based on the changing needs of the residents. More female staff are employed recently and this has helped female residents who need assistance with their personal care. The manager is keeping better records of complaints that have been made and how they were investigated. There are opportunities for residents to raise their concerns and make complaints and the manager has got better at keeping records about any complaint made. The manager and staff have got better at recognising safeguarding issues and all of the staff receives training about this. Evidence of recent safeguarding indicates that the provider takes appropriate action when issues are raised. What the care home could do better: Care and support plans are reviewed regularly but they must also be updated and available to staff as and when peoples needs change so that staff are better informed about the changing needs of the residents. More should be done to record how residents are consulted about their written plans and agreed them. There have been problems with personal care at times since the last inspection as there were not enough female staff to properly assist the female residents. Reactive healthcare is generally good but more should be done to plan for preventative healthcare. Medications are handled adequately but there is a danger to residents if staff fail to sign the records when they administer.Denmark Hill, 164DS0000022724.V378529.R01.S.docVersion 5.3Staff must keep better records of the valuable documents such as passports, birth certificates and bank books that they look after for the residents. There is significant delay in registering the home manager with the Commission. The home has had no registered manager for over two years. Key inspection report CARE HOME ADULTS 18-65 Denmark Hill, 164 164 Denmark Hill Camberwell London SE5 8EE Lead Inspector Sonia McKay Key Unannounced Inspection 14th December 2009 09:30 Denmark Hill, 164 DS0000022724.V378529.R01.S.doc Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Denmark Hill, 164 DS0000022724.V378529.R01.S.doc Version 5.3 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Denmark Hill, 164 DS0000022724.V378529.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Denmark Hill, 164 Address 164 Denmark Hill Camberwell London SE5 8EE 020 7733 4979 0207 733 4979 h4060@mencap.org.uk www.mencap.org.uk Royal Mencap Society 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) Manager post vacant Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Denmark Hill, 164 DS0000022724.V378529.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 7 4th March 2009 Date of last inspection Brief Description of the Service: 164 Denmark Hill is a registered care home providing care and accommodation for seven people with learning disabilities. The Royal Mencap Society is the Registered Provider. The property is a large detached house in a residential street. It is adapted to make it accessible to people who use wheelchairs or other mobility needs. Accommodation is provided over two floors with all bedrooms for single occupancy. The home is close to local amenities and public transport connections. Prospective residents are given a copy of the Service Users guide that gives information about the home and the services provided. A copy of the most recent Commission inspection report is available, on request, from the staff office. Fees range from £963.97 to £1849.00 per week and depend on the individual care needs of each resident. Denmark Hill, 164 DS0000022724.V378529.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 Star. This means the people who use this service experience Adequate quality outcomes. This inspection was carried out in seven hours over one day. The methods used to assess the quality of service being provided were: • • • • • • • • • Talking with the deputy home manager during the site visit Talking with the home manager by telephone after the site visit Talking with the area manager during the site visit A tour of the communal areas of the home Looking at records about the care provided to two of the residents Looking at records relating to recent staff recruitment and training Looking at the way medicines are handled by staff in the home Looking at issues that the Commission has been notified about since the last inspection and how they were handled Talking to a placing authority social worker The Commission would like to thank all who kindly contributed their time, views and experiences to the inspection process. What the service does well: Resettlement procedures are thorough and allow for a trial visits before a prospective service user has to make up their mind whether the service will meet their needs. Residents are able to make decisions about their everyday lives and are given help with major decision making as required. Residents have opportunity to develop their skills and to engage in activities of their choosing. Staff support residents to maintain their family links and friendships and their everyday responsibilities are encouraged. Residents have meals of their choosing, and often go out to eat as well. Staff take appropriate action and seek medical advice if they notice that there are health concerns for any of the residents. The home is comfortable, safe, clean and hygienic. Staff are recruited properly and there is training available on an ongoing basis. Denmark Hill, 164 DS0000022724.V378529.R01.S.doc Version 5.3 Page 6 What has improved since the last inspection? What they could do better: Care and support plans are reviewed regularly but they must also be updated and available to staff as and when peoples needs change so that staff are better informed about the changing needs of the residents. More should be done to record how residents are consulted about their written plans and agreed them. There have been problems with personal care at times since the last inspection as there were not enough female staff to properly assist the female residents. Reactive healthcare is generally good but more should be done to plan for preventative healthcare. Medications are handled adequately but there is a danger to residents if staff fail to sign the records when they administer. Denmark Hill, 164 DS0000022724.V378529.R01.S.doc Version 5.3 Page 7 Staff must keep better records of the valuable documents such as passports, birth certificates and bank books that they look after for the residents. There is significant delay in registering the home manager with the Commission. The home has had no registered manager for over two years. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Denmark Hill, 164 DS0000022724.V378529.R01.S.doc Version 5.3 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 Denmark Hill, 164 DS0000022724.V378529.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2 & 4. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Resettlement procedures are thorough and allow for a trial visits before a prospective service user has to make up their mind whether the service will meet their needs. EVIDENCE: Needs assessment is part of the referral process for accommodation in Mencap services. The home has two vacant placements during this inspection but there is no resettlement work underway at this time. Local authorities who wish to refer someone to the service do so by sending a community care assessment of care needs for consideration and if a placement seems appropriate there is then a series of visits and assessments. This helps prospective residents to experience life in the home before making a decision to move in for a trial period. Denmark Hill, 164 DS0000022724.V378529.R01.S.doc Version 5.3 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care and support plans are reviewed regularly but they must also be updated and available to staff as and when peoples needs change so that staff are better informed about the changing needs of the residents. Residents are able to make decisions about their everyday lives and are given help with major decision making as required. More should be done to record how residents are consulted about their written plans and agreed them. EVIDENCE: Staff maintain files of written information about each resident. These are stored in the office but are available to the resident if they wish. Some of the residents have worked with key staff to develop their own plans and some are produced in accessible formats with pictures (for example, photographic physiotherapy exercise plans produced in photographs). Denmark Hill, 164 DS0000022724.V378529.R01.S.doc Version 5.3 Page 11 Other plans are written by staff alone and there is no evidence of how these plans have been agreed with the resident themselves. A member of staff explained that most often these plans are discussed with the resident concerned and that is how they are consulted. This consultation should be recorded and if the resident is able to sign the plan then they should be given the opportunity to so. I note that there is a section on some of the plan templates that allows for this, but the plans I saw had not been signed. Each resident has numerous files storing a variety of assessments and plans. Both old and new are mixed together and it is not easy to locate comprehensive information about the current care and health needs in some cases. Some additional care planning and risk information was supplied after the inspection by the home manager as they could not be located by staff in duty on the day. This is important because some of the residents have rapidly changing, and in some case, increasing, health care and support needs. The information should be available on file and files should be rationalised so that current information is easily accessible to staff, some of whom are new. We note that an outcome of a safeguarding investigation about poor personal care for one female resident also highlighted the need for more frequent review of her health care needs and care plan to be updated accordingly. Advocates are involved when major decisions are to be made. Best Interests meetings are convened if people are assessed as needing multi-disciplinary assistance in making decisions about healthcare and treatment. Residents meet with their key workers each month to discuss their plans and how things are going for them. This is a good way of monitoring things in between more formal planning and review meetings. Key workers write monthly reports to provide a record of what is happening for each resident. Residents also attend house meetings where they can discuss house issues together with staff. Residents each have a set of documents called risk assessments. These are about everyday risks that the resident may be exposed to, for example health and safety in the home environment and in the community and risks related to moving and handling operations. The risk assessments seen were detailed and had been reviewed recently. Denmark Hill, 164 DS0000022724.V378529.R01.S.doc Version 5.3 Page 12 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): This is what people staying in this care home experience: 12, 13, 15, 16 & 17. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have opportunity to develop their skills and to engage in activities of their choosing. Staff support residents to maintain their family links and friendships and their everyday responsibilities are encouraged. Residents have meals of their choosing, and often go out to eat as well. EVIDENCE: Each resident has an individual weekly activities programme that includes a range of leisure and educational activity. Residents are encouraged and supported to be involved in household chores such as shopping, cooking and cleaning their bedroom. Denmark Hill, 164 DS0000022724.V378529.R01.S.doc Version 5.3 Page 13 Each person has a range of community based activity, for example one resident attends a gardening workshop, another attends a music class and another art class. There are regular shopping trips and visits to cinemas and museums. Residents are supported to maintain family links and friendships, staff support this by helping to remind people about birthdays. Residents can attend the religious services of their choosing and staff help by providing information and support to observe religious festivals. The communal lounge has a television and musical equipment and there is large rear garden with a lawn and seating area. The large dining room is also used for arts and crafts. There are trips to local pubs, cafes, restaurants and cinemas. There is also a computer with internet access. Mencap fund staff costs for each resident to have an annual holiday. The local community is culturally diverse, as is the group of residents and the staff team. This means that people’s cultural needs are better understood and catered for. Residents are able to choose what to have for breakfast and lunch and each person chooses the menu for one evening meal each week. Menu cards with pictures and photographs are available to help people make choices. Food stocks are adequate and correctly stored. Staff and residents eat together in a large dining room. During this inspection visit residents were observed to be being supported with their individual activities. One resident was going out with a member of staff to do some personal shopping at the local shops. Three of the residents were unwell and were resting in bed as they did not want to do any of their planned activities. Staff were checking on them while they were resting. Denmark Hill, 164 DS0000022724.V378529.R01.S.doc Version 5.3 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There have been problems with personal care at times since the last inspection as there were not enough female staff to properly assist the female residents. Reactive healthcare is generally good but more should be done to plan for preventative healthcare. Medications are handled adequately but there is a danger to residents if staff fail to sign the records at the time they administer the medication. EVIDENCE: There are written plans about the preferred personal care routines of each person and any staff assistance needed. The home currently provides a service to two women and three men and there are both male and female staff on the team. Same gender personal care assistance is available. This has not been available consistently and at times there have been an inadequate number of female staff to properly support the female residents with their personal care routines and this resulted in a Denmark Hill, 164 DS0000022724.V378529.R01.S.doc Version 5.3 Page 15 safeguarding investigation. A day service complained that one of the female residents was not being helped with her personal care. More female staff have been employed as a result and this has improved personal care arrangements. Technical aids and equipment are available to maximise independence. A bedroom ceiling hoist to an en-suite bathroom has been repaired and the resident, who has mobility needs, now has the option of using his own bath or a communal shower room. All residents are registered with a local GP. A record is made of the healthcare of each resident. I looked at health care records for two of the residents. Records show that staff have supported the first resident to attend a wide range of healthcare appointments. Records show that he gets the specialist input that he requires and systems are in place for staff to monitor his health. There is evidence that staff seek healthcare advice appropriately and take residents to accident and emergency clinics and doctor’s appointments as necessary. Health records for a second resident show that staff have been working closely with health professionals and the placing authority to support her with her increasing healthcare needs. These needs have affected her mobility and as her bedroom is on the first floor, the home is no longer ideal. A stairway chair lift is being used as an interim measure. Information about routine health screening is available in formats accessible to residents with a learning disability. The home makes referrals to a specialist psychology team for adults with a learning disability as necessary. Accessible health action plans are in place. These plans have been developed for people who find text only plans difficult to understand. The plans are not currently being used to best effect in planning routine healthcare appointments and health screening, for example, a female resident has a health action plan that has little information about the frequency of health checks to be arranged and no contact details for the health professionals involved in her healthcare. Staff maintain good daily records for each person. Mood, general health, continence, additional medication required and behaviour and healthcare appointments are generally well documented. Weight records could not be located during this inspection, although staff had noticed that one resident had gained weight and are making a referral to a dietician as a result. Detailed records are kept of any epileptic seizure. Denmark Hill, 164 DS0000022724.V378529.R01.S.doc Version 5.3 Page 16 One of the residents has increasing health needs and local authorities are looking for alternative nursing care placements so that these needs are better met. None of the residents are self medicating. The current residents are assisted with taking their medication, which is stored securely in a locked medication cabinet in a locked room on the first floor. A measured dose system is in place, provided by a new local pharmacy. Staff induction training includes the safe administration of medication and medication administration procedures are in place at the home. A sample staff signature list is available so that there is a clear records of which member of staff has administered each dose of medication. Consent to be administered medication by staff has been obtained from each resident by use of a form with symbols to aid understanding. A spot check of medication administration showed that a member of staff had failed to sign the record for the administration of one of the morning medications he had given. I pointed this out and the member of staff signed the record. The deputy manager said that this would have been noticed and addressed at the end of the morning shift when staff hand over to the afternoon shift. This is evidence that staff are not signing at the time that they administer and this is dangerous as it can lead to overdose or omission. A requirement is made about this. We note that failure to administer a prescribed medication was also the subject of a safeguarding investigation in September 2009. Staff were retrained in medication in October 2009 as a result and the handover check was put in place as an additional safeguard. There are no controlled drugs prescribed or in stock although correct storage is available if any are prescribed. Denmark Hill, 164 DS0000022724.V378529.R01.S.doc Version 5.3 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are opportunities for residents to raise their concerns and make complaints and the manager has got better at keeping records about any complaint made. The manager and staff have got better at recognising safeguarding issues and all of the staff receive training about this. Evidence of recent safeguarding indicates that the provider takes appropriate action when issues are raised. There must be better records of what valuables are being looked after by staff. EVIDENCE: Residents have opportunity to raise concerns during regular house meetings and meetings with their key workers. During the last inspection we noted that the record of complaints was not being kept properly and we made a requirement about this. During this inspection the staff could not find the file used to record complaints. The manager was contacted and the file was found. Records within the file show that the manager has responded appropriately to one complaint made by a family member since the last inspection. Denmark Hill, 164 DS0000022724.V378529.R01.S.doc Version 5.3 Page 18 There is ongoing staff training in adult protection and POVA (Protection of Vulnerable Adults). Home managers have attended training this year. There are adult protection procedures in place, and a copy of the local authority (Lambeth) adult protection procedures are available for staff reference. There have been two safeguarding referrals made by the home since the last inspection. The first referral was not done quickly or effectively and the home manager has since met with the local authority to ensure that correct and timely referrals are made in future. During the last inspection we made an immediate requirement as many incidents that had been recorded in a written log in the home had not been reported to the placing authority or the Commission and feedback from the placing authority indicated that they have not been kept up to speed properly. The manager has improved the reporting of such incidents as a result. Residents need staff assistance to claim benefits, manage their money and to keep their cash and valuables safe. Residents have money and financial plans to help staff to do this. Money is locked away and residents and staff sign a record when money is given to a resident or purchases are made. There is also a computerised record. Receipts for personal expenditures are retained. I observed the process as one resident withdrew a small amount of cash and both the resident and staff member signed for the transaction. I checked the record and cash balance for another resident. It was one pound short but staff said that this would be investigated and rectified if there really was a shortfall. I checked the contents of the safe and noted that valuable documents are held in safe keeping but there are no records of the documents held. This is unsafe and does not provide residents with proper protection. There must be a record of valuable documents, such as passports, birth certificates and bank books. A requirement is made about this. Denmark Hill, 164 DS0000022724.V378529.R01.S.doc Version 5.3 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30. People using the 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 home is comfortable, safe, clean and hygienic. EVIDENCE: The home is comfortable, homely, cheery and bright. A domestic assistant is employed to help the staff and residents to keep the large home clean. The home is reasonably clean and tidy although areas, such as the kitchen, are in need of re-decoration. The home is situated in an area that affords good access to local amenities and public transport. Level access, adequate doorway widths and ramped access are provided to enable people who use wheelchairs, and other mobility aids, easy access to the ground floor communal areas and garden. Denmark Hill, 164 DS0000022724.V378529.R01.S.doc Version 5.3 Page 20 The home is in keeping with other homes in the local area. A stair lift is available as one of the residents of the first floor has increasing mobility needs. All bedrooms are single occupancy. There are two bathrooms, one with a Jacuzzi facility, and one with a level access shower. All have toilets. There is also a separate toilet. The bathrooms and toilets are bright and airy and are located close to bedrooms and communal areas. The doors are fitted with locks with an appropriate override facility to be used in an emergency. The home has adequate and accessible communal space comprising of a large well-furnished lounge, dining room and kitchen/diner. There is also a large garden with tables and chairs and ramped access. The kitchen has a wheelchair accessible food preparation area. There is a laundry room on the ground floor. The washing machine and dryer have been replaced recently. The laundry room also houses a large boiler and pipe work. Risks relating to this boiler have been assessed and the manager said that the boiler does not need to be covered as residents are not likely to touch it and burn themselves because staff are with them when they are doing their laundry. COSHH materials (substances hazardous to health, like cleaning materials) are locked away in the laundry room. There are adequate hand washing facilities available. As required in the last report, a ceiling hoist in an en-suite bedroom is now repaired and fire fighting equipment is in place and checked regularly. Freezers have been defrosted. Denmark Hill, 164 DS0000022724.V378529.R01.S.doc Version 5.3 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are recruited properly and there is training available on an ongoing basis. EVIDENCE: There are three members of staff on duty during the day and two members of staff on duty at night. One member of staff stays awake at night and another is asleep, but available for emergencies. A staff sleeping room is available. There are both male and female staff in the team. There is also a manager on-call by telephone at all times. There is a team of relief/bank workers available to cover sickness and staff holidays and agency staff are used as well. All new staff undergo Mencap induction and foundation training that covers learning disability, health and safety, risk assessment, challenging needs, inclusion, medication, mental health issues, manual handling, first aid and fire Denmark Hill, 164 DS0000022724.V378529.R01.S.doc Version 5.3 Page 22 safety. Training in valuing, protecting, including and involving residents is also provided. An induction and training programme for the Denmark Hill service is also in place and covers in-house procedures and individual guidelines and training for working with the people living in the home. Mencap offer a wide range of staff and management training. A training and development schedule for 2010 is yet to be fully developed. Recruitment records for two of the newer staff were examined and were in accordance with Regulation. This means that satisfactory checks had been made before they commenced work in the home. Each member of staff is issued with an Identity card and these cards are replaced every two years. Denmark Hill, 164 DS0000022724.V378529.R01.S.doc Version 5.3 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 & 42. People using the 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 home manager is experienced but is yet to register with the Commission. There is better communication with authorities when incidents or accidents happen but records are hard to find and it is not clear that required records are kept. EVIDENCE: A home manager has been in post for almost three years. He is qualified and experienced but has yet to complete his registration with the Commission. The home manager has got better at keeping the Commission and local authority updated on any incidents occurring in the home. Denmark Hill, 164 DS0000022724.V378529.R01.S.doc Version 5.3 Page 24 There are monthly visits conducted on behalf of the registered provider. At the last inspection the reports of the outcomes of these visits were not available for inspection as they were on a computer. At this inspection we note that these reports are available and this shows that the visits are carried out regularly and the manager informed of the findings. The visits form part of the quality assurance. The views of the residents and other stakeholders should also be considered in a quality assurance system. The manager said he plans to introduce new feedback systems and stakeholder surveys in the coming year. The future of the home is uncertain. Recent rent increases have reduced the financial viability of the home and de-registration and relocation of the current residents is being considered. Residents and their families are being consulted about this. This has been a difficult year for the home, and at times the quality of the service provided has fluctuated. The future of the home is still uncertain. Recent rent increases have reduced the financial viability of the home and de-registration and relocation of the current residents is being considered. Residents and their families are being consulted about this and the Commission is being kept up to date. Systems are in place to monitor the safety of the physical environment. This involves in house checks conducted by staff and professional checks of the electrical and gas appliances and fire detection system. I note that some records could not be located during this inspection, for example incident forms and accident records. It is not clear whether they are just stored on the computer or whether staff could not find them. Denmark Hill, 164 DS0000022724.V378529.R01.S.doc Version 5.3 Page 25 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 X 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 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 3 33 34 35 36 2 2 X 3 X LIFESTYLES Standard No Score 11 12 13 14 15 16 17 X 3 3 X 3 3 3 X 3 3 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000022724.V378529.R01.S.doc Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Denmark Hill, 164 Score 2 2 2 X 2 X 2 X 1 3 X Version 5.3 Page 26 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 17 Requirement Timescale for action 28/02/10 2. YA23 17 3. YA41 17 Staff must sign the medication administration records at the time that they administer the medicine. There must be a record of all medicines administered. There must be a record of all of 28/02/10 the valuable documents held in safekeeping for any of the residents, for example passports, birth certificates and bank books. There must be a record of any 28/02/10 accident or incident. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA6 YA19 YA7 Good Practice Recommendations Care plan files could be better organised so that information about current needs is more easily located by staff. Care plan files contain too much old information. Preventative health care should be better planned. Residents must be consulted about their planned care and evidence of this consultation and agreement should be DS0000022724.V378529.R01.S.doc Version 5.3 Page 27 Denmark Hill, 164 recorded in their individual care plans. Denmark Hill, 164 DS0000022724.V378529.R01.S.doc Version 5.3 Page 28 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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) Care Quality Commission (CQC). 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