Care Home: Ethel Road (7)

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What the care home does well The service user is familiar with the place in which they live. What the care home could do better: Two new requirements have been made regarding the registered managers current Criminal Record Disclosure and the reporting, to the commission of events which affect the well being and welfare of the service user. In conclusion it was evidenced that eight out of ten requirements, in areas which are fundamental to the well being of the service user had not been complied with which indicates that the registered providers are unable or unwilling to comply with the regulations. Random inspection report Care homes for adults (18-65 years) Name: Address: Ethel Road (7) 7 Ethel Road Ashford Middlesex TW15 3RB zero star poor service 21/04/2010 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Suzanne Magnier Date: 0 3 0 9 2 0 1 0 Information about the care home Name of care home: Address: Ethel Road (7) 7 Ethel Road Ashford Middlesex TW15 3RB 07854509273 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Victoria Charlton Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Vaughan Charlton,Mrs Victoria Charlton care home 1 Number of places (if applicable): Under 65 Over 65 0 learning disability Conditions of registration: 1 The maximum number of service users to be accommodated is 1 The registered person may provide the following category of service only: Care home only(PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category : Learning disability ( LD) Date of last inspection Brief description of the care home The home is privately owned and is registered as a care home which currently supports one adult with a learning disability. The resident has their own single bedroom and has sole use of a bathroom and toilet Care Homes for Adults (18-65 years) Page 2 of 16 2 1 0 4 2 0 1 0 Brief description of the care home situated in close proximity to their bedroom. Care and support is provided by the registered providers. The resident has a choice to share the communal lounge, dining room, conservatory and part of an enclosed garden and domestic style kitchen with members of the family. Care Homes for Adults (18-65 years) Page 3 of 16 What we found: The compliance inspection was carried out by Sarah Seaholme Compliance Manager and Suzanne Magnier Compliance Inspector on the 3rd September 2010 who arrived at the service at 09.00 and left at 13.00. The reason for the inspection was to follow up the compliance, by the service, as a result of the requirements made during the unannounced Key Inspections on the 28th October 2009 and the 21st April 2010. The service was represented by the registered manager. A requirement had been made during the Key Inspection in April 2010 that arrangements must be made that detailed records are kept which determine the residents income and outgoings and receipts are kept of all expenditure in order that records are able to be monitored to safeguard and promote the service users right to involvement in their financial affairs. The registered manager showed the inspector a computerised summary of the service users expenditure which detailed a variety of incoming and outgoing expenditure. The records summarised details up until July 2010. The registered manager showed the inspectors two receipts, one of which was a receipt seen at the previous Key Inspection in April 2010. No other receipts were made available during the inspection to cover the service users expenditure over the last five months. The Registered Manager confirmed that the service user purchases their own toiletries, attends social clubs and the barbers yet no receipts were made available to support the statement. The service users financial risk assessment was sampled. The risk assessment was dated 1.3.10 and was not up to date as it included details that the service user had a Post Office Account and a cash tin which the registered manager told the inspectors the service user did not have. Additionally the risk assessment section regarding the potential severity, likelihood and risk rating regarding the service users finance had not been completed. It was concluded that the registered persons had not complied with Regulation 13 of the Care Homes Regulations 2001 to safeguard the service users financial affairs. A requirement made during the Key Inspection in October 2009 was identified as not met during the April 2010 Key Inspection. The requirement detailed that the standard and format of the risk assessments be revised and improved to ensure that the current hazards in the service users life were fully documented, the measures and actions taken to reduce the hazards were clearly recorded and that review dates were recorded. In order that the risk assessments could be audited to promote the service users best interests, safety and ensure their well being as far as reasonably practicable. The registered manager confirmed that the risk assessment format had not been changed as she said a social services representative had approved the risk assessment format and Care Homes for Adults (18-65 years) Page 4 of 16 therefore she did not think it necessary to change the format. The risk assessment process was discussed with the registered manager and, as noted during previous inspections, the registered manager demonstrated limited understanding of the process of evaluating risk assessments to promote the safety and well being of the service user as far as reasonably practicable. It was acknowledged that the registered manager had developed a new risk assessment, as recommended during the previous inspection regarding the service users potential dehydration yet the risk assessment was incomplete and there was no indication that the risk assessment had been reviewed. A requirement had been made during the Key Inspection in April 2010 that arrangements be made that a risk assessment be developed to assess the hazards and measures in place regarding the service user being left on their own and documented evidence to detail that safe vetting procedures have been undertaken to ensure the safety and protection of the service user when they were being supported alone by persons other that the registered providers. The inspectors sampled six risk assessments all of which included identified shortfalls. It was concluded that the registered persons had not complied with Regulation 13 of the Care Homes Regulations 2001 to ensure that the standard and format of the risk assessments are revised and improved to ensure that the current hazards in the service users life are fully documented, the measures and actions taken to reduce the hazards are clearly recorded and that review dates are recorded to promote the service users best interests, safety and well being as far as reasonably practicable. The registered manager showed the inspectors a policy and procedure regarding safe vetting practises which had been developed following the previous inspection. The registered manager told the inspectors that the service user was never left on their own and that friends and neighbours would always stay with the service user if the registered providers were not available. The registered manager gave a verbal detailed account of the measures that would be in place if the service user were left on their own yet no documented risk assessment had been completed as required. A requirement had been made during the Key Inspection in April 2010 that arrangements must be made for appropriate health care referrals to be arranged in order that the service users nutritional and health care needs related to their diet are fully assessed to ensure the services users well being and welfare. During the compliance visit the registered manager confirmed that she had not sought advice regarding the service users nutritional and health care needs related to their diet as the service user had been a day patient at hospital and had ongoing contact with their general practitioner and concerns regarding the service users nutrition and health had not been highlighted. It was observed that the service user had a bag of crisps and had a drink of water at around midday as they had not had any breakfast. Care Homes for Adults (18-65 years) Page 5 of 16 It remains a concern that the registered providers have not sought advice or requested a referral regarding the service users current nutritional and health care needs relating to their diet. It was concluded that the registered persons had not complied with Regulation 13 of the Care Homes Regulations 2001 to ensure that the service users nutritional and health care needs related to their diet had been fully assessed to ensure the service users well being and welfare. A requirement had been made during the Key Inspection in April 2010 that arrangements must be made that current documentation is sought from health care specialists relating to the service users exercises following their meals, records to evidence the service users weight and documented evidence from hospital appointments and admissions to hospital. The registered manager confirmed that there were no current records regarding the service users exercises following their meals and no records of the service users body weight, although their body mass index had been recorded recently during a hospital consultation. Current documentation from the service users general practitioner and hospital consultants confirmed that the service user had recently been seen by these health care professionals. It remains a concern that the registered providers have not sought current advice and documentation regarding the exercises which the service user is expected to do following a meal and have not sought records of the service users body weight. It is concluded that the registered persons had not complied with Regulation 17 of the Care Homes Regulations 2001 to ensure the service users well being and welfare. A requirement had been made during the Key Inspection in April 2010 that arrangements must be made that the registered manager and registered provider undertake accredited medication training in order to ensure that the service user is protected by the homes policies and procedures for dealing with medicines. The registered manager stated she had not undertaken any medication training as she did not believe it to be a relevant requirement in the care home. Records were sampled of the registered providers training in 2007 which were sampled during the previous inspection in April 2010. The registered manager confirmed that the service user does not take any medication including homely remedies and when asked who would administer any medicines the registered provider confirmed it would be her husband as the other registered provider. Following the inspection the commission were provided with a training nomination form for the registered provider application to undertake medication training in October 2009. It was concluded that the registered persons had not complied with Regulation 13 of the Care Homes Regulations 2001 to ensure that the service user is protected by the homes policies and procedures for dealing with medicines. Care Homes for Adults (18-65 years) Page 6 of 16 A requirement had been made during the Key Inspection in April 2010 that arrangements must be made that the registered manager must undertake a Criminal Records Bureaus check and retain the documented evidence to support that the check has been undertaken in order to promote the service users rights to safety and protection. The registered manager confirmed that a Criminal Records Bureaus check had been sought from a Surrey County Council Shared Lives Scheme and had not been fully processed. This information was clarified with the Shared Lives Scheme following the inspection. It was concluded that the registered manager had complied with Regulation 13 of the Care Homes Regulations 2001 to obtain an up to date Criminal Records Bureau check yet had failed, on questioning, to advise the commission of a recent incident involving a police caution. A requirement has been made that the registered manager inform the commission, within the timescales set, of the matter in which they have been recently cautioned by a police constable and which, at the time the caution was given in order to promote the service users rights to safety and protection. A requirement had been made during the Key Inspection in April 2010 that arrangements be made that documented protocols be developed to provide evidence that the service users vehicle is at their disposal when they require it in order to ensure that the use of the vehicle is for the service users purposes to improve their quality of life and social engagement. The registered manager confirmed that no documented protocols had been developed regarding the use of the service users vehicle. An explanation was given that the vehicle is not only the service users as the registered providers paid the deposit for the vehicle and another car is always available for the service user to use. The registered manager advised that she did not understand the requirement and therefore had not written any protocols. The requirement was explained to the registered manager and they were advised that they had the opportunity to raise any queries or seek clarification regarding the content of the last report and the requirements before it was finalised yet had not done so. It was concluded that the registered persons had not complied with Regulation 13 of the Care Homes Regulations 2001 to ensure that the use of the vehicle is for the service users purposes to improve their quality of life and social engagement. A requirement had been made during the Key Inspection in April 2010 that arrangements must be made that the registered provider undertake safeguarding vulnerable adults training in order to ensure that the residents rights to safety and protection against abuse or harm are promoted. The Compliance Manager spoke to the registered provider on the telephone during the inspection and it was confirmed that they had attended a safeguarding vulnerable adults training session in April 2010. The registered manager confirmed that as part of the application to the Shared Lives Care Homes for Adults (18-65 years) Page 7 of 16 Scheme and as recommended as best practise, she had booked a refresher safeguarding training course in the coming months. It was concluded that the registered persons had complied with Regulation 13 of the Care Homes Regulations 2001 to ensure that the service users rights to safety and protection against abuse or harm are promoted. A requirement had been made during the Key Inspection in April 2010 that arrangements be made that the registered providers must forward to the commission, upon receipt of the final report, an improvement plan detailing how the home intends to improve the service provided. The registered manager confirmed that she sent a letter to the commission which was in their view the homes improvement plan. The document contained a response from the previous report and advise to the commission of the homes intention to apply to the Surrey County Council Shared Lives Scheme. The document corrupted and remained unaccessible. The Commission contacted the registered manager in August 2010 and requested another copy which has not been received by the commission. During the inspection the registered manager tried to retrieve the document from the homes computer yet was unable to do so. It was concluded that the registered persons had complied with Regulation 24A of the Care Homes Regulations 2001 in sending an improvement plan yet following this compliance inspection it was evidenced that the home have not met the majority of the requirements from the Key Inspection in April 2010 to detail how the home intends to improve the service provided to ensure the safety and well being of the service user. During the October 2009 Key Inspection the registered providers were reminded, and a requirement made, that the registered providers must report any incidences to the commission without delay of any event that affects the well being and welfare of the service user. The registered manager confirmed, during the compliance inspection, that the service user had been admitted to hospital in recent months and when asked why a Regulation 37 notification had not been forwarded to the Commission the registered manager told the inspectors that she thought this was not necessary as the service user was admitted as a day patient. A requirement has been made that the registered providers must report any incidents to the commission without delay of any event that affects the well being and welfare of the service user in order to ensure that the commission are aware of any incident of note in the Registered Care Home that affects the welfare and well being of the service user. It was concluded that the registered persons had not complied with Regulation 13 of the Care Homes Regulations 2001 to ensure the promotion of the service users best interests, safety, well being and protection as far as reasonably practicable. What the care home does well: Care Homes for Adults (18-65 years) Page 8 of 16 The service user is familiar with the place in which they live. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Adults (18-65 years) Page 9 of 16 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 13 Arrangements must be made 31/07/2010 that detailed records are kept which determine the residents income and outgoings and receipts are kept of all expenditure. In order that records are able to be monitored and audited to safeguard and promote the residents right to involvement in their financial affairs. 2 9 13 Arrangements must be made 19/02/2010 that the standard and format of the risk assessments are revised and improved. In order to ensure that the current hazards in the residents life are fully documented, the measures and actions taken to reduce the hazards are clearly recorded and that review dates are recorded in order that the risk assessments can be audited to promote the residents best interests and safety and ensure the residents well being as far as reasonably practicable. 3 17 13 Arrangements must be made 31/08/2010 for appropriate health care Page 10 of 16 Care Homes for Adults (18-65 years) Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action referrals to be arranged. In order that the residents nutritional and health care needs related to their diet are fully assessed to ensure the residents well being and welfare. 4 19 17 Arrangements must be made 31/08/2010 that current documentation is sought from health care specialists relating to the residents exercises following their meals, records to evidence the residents weight, documented evidence from hospital appointments and admissions to hospital. The records must be available to support and evidence that the current health care needs of the resident are being appropriately met. In order to ensure the residents well being and welfare. 5 20 13 Arrangements must be made 31/08/2010 that the registered manager and provider undertake accredited medication training. In order to ensure that the resident is protected by the homes policies and procedures for dealing with medicines. 6 23 13 Arrangements must be made 31/07/2010 that a risk assessment is Page 11 of 16 Care Homes for Adults (18-65 years) Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action developed to assess the hazards and measures in place regarding the resident being left on their own and documented evidence to detail that safe vetting procedures have been undertaken to ensure the safety and protection of the resident when they are being supported alone by persons other that the registered providers. In order to promote the resident rights to safety and protection. 7 23 13 Arrangements must be made 31/07/2010 that documented protocols are developed to provide evidence that the residents vehicle is at their disposal when they require it. In order to ensure that the use of the vehicle is for the residents purposes to improve their quality of life and social engagement. 8 42 24A Arrangements must be made 30/09/2010 that the registered providers must forward to the commission, upon receipt of the final report, an improvement plan detailing how the home intends to improve the service provided. In the home to ensure the safety and well being of the Care Homes for Adults (18-65 years) Page 12 of 16 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action resident in the home. Care Homes for Adults (18-65 years) Page 13 of 16 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 23 9 Arrangements must be made 30/09/2010 that the registered manager inform the commission, within the timescales set, of the matter in which they have been recently cautioned by a constable and which, at the time the caution was given. In order to ensure the integrity and good character of the registered manager and safeguard and promote the service users rights to safety and protection. 2 42 37 Arrangements must be made 30/09/2010 that the registered providers report any incidents to the commission, without delay, of any event that affects the well being and welfare of the service user. In order to ensure that the commission are aware of any incident of note in the Registered Care Home that affects the welfare and well Care Homes for Adults (18-65 years) Page 14 of 16 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action being of the service user. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 15 of 16 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got 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 Helpline: 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 16 of 16 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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