Care Home: Reeves Court

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What the care home does well The service is under considerable pressure, as it is currently under a safeguarding investigation, is without a registered manager and the service is due to be relocate into three separate purpose build homes. Despite this staff appear to be working hard to maintain a "business as usual" approach to minimise any negative impact for residents. Some examples of good practises were noted in the development of communication books and specific behavioural guidance for staff, which had been completed by individual members of staff. What the care home could do better: Although the specific shortfalls noted at the previous inspection relating to care planning and risk assessments had been addressed other shortfalls were identified which demonstrated an overall lack of monitoring and review of care planning by management and competent persons to ensure consistent standards and that the assessed needs of residents were being addressed. To ensure that residents are enable and supported to make informed decisions about the care and support they receive any restrictions on their freedoms must be considered under the appropriate legislation (Mental Capacity Act ). Staff including management must be more appropriately supervised by the management at the home and by the organisation to ensure that residents assessed needs are being met, good practises including the organisations own polices and procedures and that individuals roles and responsibilities are being fulfilled. The current management provision for the service must be more proactive and cohesive in order to be able to address the shortfalls in practises noted, consistently manage the service at this challenging time and ensure residents safety. Random inspection report Care homes for adults (18-65 years) Name: Address: Reeves Court Reigate Road Leatherhead Surrey KT22 8NR two star good service 09/10/2009 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: Jane Jewell Date: 2 6 0 3 2 0 1 0 Information about the care home Name of care home: Address: Reeves Court Reigate Road Leatherhead Surrey KT22 8NR 01372389446 01372389416 v.seewoolall@seeability.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Vishul Seewoolall Type of registration: Number of places registered: Conditions of registration: Category(ies) : SeeAbility care home 25 Number of places (if applicable): Under 65 Over 65 0 learning disability Conditions of registration: 25 The maximum number of service users who can be accommodated is 25. 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 Reeves Court is registered to provide residential care for up to twenty five people who have a learning disability and specialises in supporting people who have a visual impairment. The home is owned and managed by SeeAbility, a registered charity who work with adults who have a visual impairment and additional disabilities. 0 9 1 0 2 0 0 9 Care Homes for Adults (18-65 years) Page 2 of 12 Brief description of the care home The premises were purpose built in the early 1980s and is presented across two floors with access provided to the first floor via a shaft lift or stairs. The home is split into three units called Flats 1,2 and 4. Each flat has its own lounges and dining area. There are small patio areas surrounding the home. All bedrooms are for single occupancy. The home is located near local amenities, with the home also having access to its own transport. The home is located in the Seeability complex in leatherhead, which also provides a large day care services and supported living units. The whole complex is currently under massive redevelopment with the building of three houses on the site, which residents over the next few months will be relocated to. The original premises will then be redeveloped to provide private housing. The homes literature states that it aims to offer a service that encourages individuals with a visual impairment and additional complex needs to participate in all aspects of daily living. The manager reports that the fees for residential care are currently from £89000 per year, depending on the services and facilities provided. Extra such as newspapers, hairdressing, chiropody, holidays, toiletries are additional costs. The providers website is: www.seeability.org Care Homes for Adults (18-65 years) Page 3 of 12 What we found: This random inspection was undertaken in order to identify the actions taken to address the shortfalls in practises noted at the previous key inspection that resulted in requirements being made. This was in response to similar areas of concern noted during a safeguarding investigation. The inspection was undertaken between 11:30am to 19:00pm and was facilitated by a regional support service manager and the responsible individual ( Steve Drew). The inspection involved discussion with those facilitating the inspection, senior staff on duty and the sampling of care plans on each of the three units. There were twenty four residents residing at the home at the time of the inspection. it was reported that there has been one emergency admission to the home since the previous inspection. Documentation relating to this admission showed that the resident was only accommodated following an assessment of their needs. Information about the residents needs was gathered from a variety of sources including the resident, their representative and health care professionals. The needs assessment then formed the basis of an initial care plan which helped inform staff of the residents recorded needs before they moved into the home. The senior staff member undertaking the needs assessment on behalf of the service was aware of the admission criteria for the home and knowledgeable about good practises that would ensure a smooth transition to the home. It was therefore assessed that the previous requirement of the needs of residents to be assessed by suitably qualified persons prior to any admission had now been addressed. Six support plans were examined from across the three units. Senior staff on each of the units noted that they are in the process of reviewing each care plan and its documentation with a view to introducing a more person centred approach to care planning documentation. It was reported at the previous key inspection that new care planning documentation was in the process of being implemented but little process had been made towards achieving this across all the units. Several examples were noted of good pieces of work relating to improving support plans. This included the development of a pictorial communication book, and behavioural guidelines for another resident. This provided clear up to date guidance for staff on how to support an individual. These had been independently developed and initiated by members of staff and was not part of a cohesive approach to ensuring that these practises were implement for other residents. The person overseeing the home agreed to look into incorporating these documents as part of other residents support plans where appropriate. There remains some variation between units on the standard of information provided in support plans, however areas in which the inspector noted at the previous inspection were poor had recently been addressed to an acceptable standard. However many support plans remain bulky with information fragmented across numerous folders making it difficult for staff to easily retrieve essential information. Changes to support plans were typed by administrators who worked for part of the week. This resulted in some information not being available for staff to reference while it was removed awaiting typing. The responsible individual agreed to address this immediately to ensure that at all times staff had the guidance they needed on the assessed needs of residents. Care Homes for Adults (18-65 years) Page 4 of 12 Some residents receive social inclusion input from the organisations rehabilitation team which is based at the home. This included specialist one to one work and developing detailed needs assessments. Some good examples were noted of the guidance provided to staff to help improve individual residents communication skills and interaction. However there appeared to be little cohesion between the work being initiated and completed in support plans by the rehabilitation team and support plans being completed by staff on each unit. This resulted in some inconsistent standards in the information provided for staff across the units and between residents support plans. The responsible individual was aware of the need to integrate more the work of the rehabilitation team into support plans and spoke of the current review of the rehabilitation team in light of the immanent relocation of the service. Although it was reported from senior staff that all support plans have recently been reviewed this could not always be confirmed, as there was not always recorded evidence that any changes in residents needs were being noted and the appropriate guidance provided to staff. This has now been required to ensure that any changes in residents needs are able to be identified promptly. An example was noted whereby not all staff were following the specific recorded instructions regarding the frequency of night checks for a resident in order to promote their safety. This resulted in staff undertaking the checks at different intervals which placed the resident at potential risk. It has been required that proper provision is made for this resident to receive the appropriate and consistent support in accordance with their assessed needs. This example also demonstrated that support plans were not being monitored by senior staff or management. It is recommended that there is greater monitoring of support plans by management to ensure consistent standards of review and recording. A significant example was noted whereby professional health care guidance which had been developed many years ago and which staff still followed did not appear to have been reviewed in the interim. This was of particular concern as it appeared to restrict a residents rights and had also not been considered under changes in legislation (Mental Capacity Act), which effects residents rights to make decisions in their lives. The responsible individual agreed to look into this matter as a matter of priority and it has been required that any restrictions placed on residents freedoms are fully considered under the appropriate legislation (Mental Capacity Act ) and good practise guidance to enable them to be supported to make decisions about their health and welfare The home maintains a daily record for each resident on events and occurrences. The tone of language used was not always respectful and in some cases was largely repetitive and did not cross reference to the needs noted in care plans. For example where individual goals and care needs had been identified there was little reference to how these were being addressed in the daily notes. Concern was noted regarding the lack of transparency in several support plans as most documents had not been signed or dated to authenticate them or evidence when they had been developed. A recommendation has been made to commence this. It was previously required that personal risk assessments are completed for all residents which are reviewed regularly and records significant findings and the actions taken to minimise risks or mange any risks. The areas of risk noted at the previous inspection Care Homes for Adults (18-65 years) Page 5 of 12 which had not been identified had now been addressed. The responsible individual reported that the organisation has recently reviewed the risk management documentation and is slowly introducing a standardised documentation to help promote consistency. A member of staff when interviewed as part of a safeguarding investigation undertaken by the organisation noted that they had not received an induction into the service. The responsible individual clarified that the member of staff had completed a local induction into the service but their comments referred to the organisational induction, which they had not undertaken at the time of their feedback. The organisations policy is that both inductions are completed within the first three months of employment. The responsible individual fedback that all staff commencing employment since October 2009 have completed both induction training. Documentation to confirm this was not available at the time of inspection, due to them being securely stored with only the absent registered manager able to access. The responsible individual was asked to confirm in writing within four working days that all new staff had completed the appropriate induction and that the evidence would be made available for any future inspection of the service. The home has been without a registered manager since 9th March 2010. Although required to, the organisation had not notified the Commission of the registered managers absence until prompted by the inspector. Monthly visits by the organisations representatives had now been undertaken on a more regular basis by other managers across the organisations. The last written report of these monthly visits (March 2010) was comprehensive and highlighted similar concerns to the shortfalls in practises noted at the last inspection, relating to care planning. This was a concern as action should have been taken to address these shortfalls within the dates required by the Commission. However, in response to this written report action was then taken to address these shortfalls and meet the previous requirements as noted earlier in this report. The management arrangement is that each of the units has a deputy manager who manages the running of that unit, with the registered manager overseeing all of the units. In light of the immanent relocation of the service into three separate homes, three managers had recently been recruited with a view to them shortly applying for registration with the Commission for each of the new homes. Two managers are new to the organisation and one is currently the deputy manager of a unit within the home. The managers had been in post for four days at the time of the inspection and were in the process of undertaking a formal induction into the home and organisation. The managers had varying experiences in management and were being supported by a service manager from the organisation who had been deployed to the home to oversee the running of the service in the registered managers absence. They had been based at the home for seven days prior to the inspection. Although they demonstrated a sound understanding of the day to day running of the home their secondment was temporary. Throughout the inspection it was evident through the continuing varying standards across the units that there was a lack of management cohesion and supervision of the staff in charge of the units and of the registered manager by the responsible individual and the organisation. Concern was therefore noted regarding the current management provision for the service as highlighted by the number of concerns noted at this inspection and the need for a more proactive and cohesive management to address the shortfalls and manage the service at this time. The ability of the responsible individual to provide the Care Homes for Adults (18-65 years) Page 6 of 12 required level of supervision necessary of the service at this time was challenged by the inspector due to the level of their other work commitments. An immediate requirement was made that the responsible individual ensures that the home is managed competently in to ensure residents safety. In addition it is required that staff are appropriately supervised at all times by competent persons. This is with particular reference to the persons appointed to oversee the running of the home and of support staff to ensure that residents needs are being met in accordance with their assessed needs. What the care home does well: 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 7 of 12 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Adults (18-65 years) Page 8 of 12 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 1 39 10 That the registered provider 30/03/2010 shall having regard to the size of care home, statement of purpose and number and needs of service users carry on managing the care home with sufficient care competence and skill. To ensure that residents are not placed at potential risk from the lack of leadership and direction. 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 6 15 That care plans are reviewed 29/04/2010 regularly to reflect changes in the needs and preferences of service users and recorded as having been reviewed. To ensure that any changes in service users needs are identified promptly and the appropriate guidance provided for staff. 2 7 12 That any restrictions placed on service users freedoms are fully considered under the appropriate legislation (Mental Capacity Act ) and good practise guidance to enable service users to be 29/04/2010 Care Homes for Adults (18-65 years) Page 9 of 12 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 able to make decisions about their health and welfare. To ensure that service users are able to make informed decisions about the care and support they receive. 3 9 12 That proper provision is made for service users to receive the appropriate care and support in accordance with their assessed needs. To ensure that service users receive consistent care and support. needs. 4 36 18 That all persons working at the home are appropriately supervised at all times by competent persons. To ensure that service users are safe, their wellbeing is promoted and assessed needs being met. 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 15/04/2010 29/04/2010 1 2 6 6 That the quality of support plans are regularly monitored by management to ensure consistent standards That staff undergo training in recording techniques, which takes into account the tone of the language used and the relevancy of the data. That documentation is signed and dated by the contributors of that document to confirm authenticity and when it was Page 10 of 12 3 6 Care Homes for Adults (18-65 years) 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 completed. Care Homes for Adults (18-65 years) Page 11 of 12 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. 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