Inspection on 29/04/09 for Christ The King

This is the latest available inspection report for this service, carried out on 29th April 2009.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Christ The King 02/11/07

Christ The King 15/11/06

Christ The King 05/12/05

Christ The King 10/08/05

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Christ The King 68 Tankerville Road Streatham London SW16 5LP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lynne Field     Date: 3 0 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Christ The King 68 Tankerville Road Streatham London SW16 5LP 02084805028 02084805031 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Healthcare Professionals Services Ltd care home 6 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home Christ the King is a small residential care home that aims to provide 24-hour care and support in an independent living setting in the community. It can take up to six residents, men or women aged 18 -65, who are experiencing mental health difficulties and need continual rehabilitation in the community following their discharge from hospitals or from other care institutions. There are six single bedrooms, four with en Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 6 Brief description of the care home suite facilities. The registered manager said the current fees payable for each resident range from #1050-00 to #1500-00 according to the assessment of needs of the resident. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The unannounced inspection was carried out over one day in April 2009. The registered manager facilitated the inspection. The inspection included a tour of the home and examination of records on care plans, medication records and the complaints book. The home had no vacancies at the time of the inspection. We met all six residents including one new resident. We spoke to three staff and the new deputy manager during the course of the inspection and all were very positive. The new staff told us about their experience of recruitment and working for the service. We checked relevant policies and procedures as well as the residents files, the care plans and building maintenance records. During the visit we were able to observe how staff interacted with residents and how residents responded to staff. Two staff and two residents responded to CSCI survey and comments from these have been included in the report. The registered manager returned a standard form, the Annual Quality Assurance Care Homes for Adults (18-65 years) Page 6 of 32 Assessment (AQAA)to CSCI. This was taken into consideration and used as part of the inspection process. There is a good level of commitment displayed by the registered manager and staff to ensure they were meeting the needs of the residents and complying with the standards. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Adults (18-65 years) Page 8 of 32 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information in the Statement of Purpose and Resident Guide needs to be revised to include details of the changes in the organisation. Residents have their needs assessed by senior staff before they move to the home and know that staff have decided that the home can meet their needs before they move there. Prospective residents and their relatives can come and look around the home and meet staff before they decide to move there. Evidence: There has been one resident admitted since the previous inspection in April 2008. The manager said they always go to see a prospective resident to do an assessment at the place the prospective resident was living and gather information about the resident. The resident would then be invited to come to spend time in the home and meet all the residents living there. If they liked it they would come for a day with any friends or family. If this is successful there would be a discharge meeting when the whole Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: care package is put together. We met the resident who had been recently admitted. They said they had visited the home before making a decision about whether to come to live at the home and had all the information they needed to make a decision about whether to live there or not. They had stayed over night as well as coming for a meal and had a chance to meet the residents who were living at the home as well as the staff of the home. Another resident said they had visited the home several times beforre moving in. They said it is a lovely house. A really nice home. We checked the statement of purpose and resident guide and noted these had been reviewed and updated to include all the information relating to the changes in the management of the home. We were told and saw each resident had a copy of the statement of purpose and resident guide in their bedroom. We looked at three residents files including the new residents and noted they all contained a community care assessment and the relevant assessments and summary of needs that were completed by the home before the resident came to live there were seen on file. Care plans that were developed from these gave a thorough description of resident behaviours, reactions and preferences and how the resident was to be treated. There were immediate, medium term and long-term goals and these are reviewed monthly and recorded. Risks were identified and how these would be minimised, with actions agreed and recorded. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Families and other professionals are involved when reviews are held. Residents are consulted and supported to make decisions about their lives by staff and appropriate independent professionals. Care plans are thorough and reflect residents needs and goals and are reviewed within the allotted time scale or before if needed. Evidence: We checked three resident files including the new residents file and noted that the care plans gave a thorough description of resident behaviours, reactions and preferences and how the resident was to be treated. The residents care plans and risk assessments are individualized that are developed with the resident participating fully and in consultation with the residents family, care co-coordinator and other professionals. We were told the risk assessments from the previous placement would be checked and then the home would develop their own risk assessments to suit the Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: residents changing needs. The care plans are written based on the residents assessed needs and information gained during the assessment. There is a lone working risk assessment for each resident. Care plans reviewed regularly within the allotted time scale or sooner if things have changed or there have been developments in the residents behaviour and life. We saw copies of the care plans that indvidulised and different for each resident. We saw a copy of the initial six week review, the three monthly review and from then on the monthly reviews. The care plans we checked were signed by the residents, We were shown copies of the minutes of residents meetings and staff meetings where the choice of activities has been discussed by staff and residents. These are held every two months. Residents fully participate in home meeting and one resident said they could say what they wanted to and they were listened Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are encouraged to develop independent skills and interests as well as access the community with the support of staff when required. Families and friends are encouraged to keep in touch with the residents and participate in social activities. Residents engage in appropriate, enjoyable and fulfilling activities and mix with the general community. Residents rights and responsibilities are respected. A healthy diet is provided, which the residents enjoy. Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: Each resident has an individual activities programme designed to meet their needs. Some of the weekly activities were related to independent living skills, such as cooking, laundry and keeping their room clean. Care plans are very well developed and include clear details of residents needs and how they can be met. Residents are also encouraged to take part in activities commissioned by outside specialists such as reflexology, aromatherapy and healthy eating and this continues to be developed. In this way residents are supported and encouraged to take part in activities that are enjoyable, beneficial to their mental and physical health and which give them the opportunity to develop skills within their abilities. Residents said they felt free to say what type of activity they wanted to take part in. We noticed one resident seemed to be particularly reluctant to get up out of bed and it was quite late in the day before they came downstairs although they had been up for breakfast. The manager and staff said the resident will come down to make themselves a meal and they do try to motivate them to do more in the home. We were told by the registered manager the residents are encouraged to take part in activities they enjoy instead of being told which ones to participate in. One resident told us in the survey they returned to us as part of the inspection, I spent a lot of time in my bedroom by choice. I am a loner and find it hard to mix with people, which has added to my depression and other problems. The home adopted the Rehabilitation Recovery Model of social inclusion that was introduced by the present manager who has encouraged residents use the community amenities like anybody else. They do their own shopping for their food, attend local events and eat out in various restaurants. We were told they continue to go to one particular favorite Pakistan restaurant which is near the home that they all enjoy going to. The resident who has independently formed friendships with storekeepers from his own country, shares new with him from his home country. The home has checked that this is acceptable by the shopkeepers and was assured it was. Two residents go to the local church or sometimes as a change with staff to their church. The ladies go to the local hairdressers saloon and the males to local barber. The manager and staff said residents were taking more responsibility for self managing the number of cigarettes they smoke. Residents are being supported to do this and this has been written into their care plan and helps them become more independent. Birthdays are celebrated, and family members always attend. Relatives and care coordinators are invited to attend social activities and religious celebrations. The staff and residents said the home celebrated all faiths of the residents. Residents told us about a recent birthday party which residents family had come with gifts and a cake. Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: The residents have said although they are of different faiths and cultures, one from India, one from Mauritius, one from Sri Lanka and two from Britain they all wanted to celebrate Christmas. One resident said they spoke to their family every week. Another resident goes to visit their family and their relatives are always visiting and keeping in touch. Relatives are encouraged to visit the home and keep in contact with the resident. Relatives said the home keeps them informed about what is going on in the home and the only way they knew about a review meeting was by the home telling them it was to take place. Residents said they enjoy the meals served at the home. We were told by the residents and the manager that residents choose and prepare their own breakfast and evening meal. This means residents are able to cook their preferred dishes with some supervision from staff. They told us they enjoyed their meals and they are able to choose what they want to eat instead of rigidly sticking to the weekly menus. The staff said this is easy to implement because of the smallness of the home. One resident takes pride in cooking their ethnic meals on a regular basis and another does so once in a while. The resident goes out with a member of staff to shop for the type of food they wanted to eat and cook. They have a midday meal prepared for them by staff but are encouraged to help prepare this. One resident has several large bowls of homemade soup made for them that has helped them cut down on their alcohol intake. They said they really enjoy the soup and it is very fresh and tasty. We were told each resident has been given a mobile phone and a badge with the homes details on it that they can pin somewhere discreet, to enable them to contact the home in an emergency. This has been agreed with their families and is written in their care plan along with the risk assessment. Care Homes for Adults (18-65 years) Page 17 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive personal support, in the way they prefer and their physical and emotional needs are met. Medication is handled safely. Evidence: We looked at three residents personal files including the new residents file. The home has developed Holistic Individualised care plans to ensure that the residents needs are thoroughly assessed with their participation and the appropriate care and support given. These contained all the information staff need to support the residents in their preferred personal care routines and details of how much help an individual requires with different personal care tasks. We spoke to all the residents during the inspection who said they were pleased with the support they were being given by the home. Each resident has their own folder they have access to. Residents are registered by the local GP and have the initial baseline medical check appointment when they come to live at the home. There were records on file of Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: routine checks to the dentist, chiropodist, and appointments. Emergency appointments are made with the GP, if the need arises. All the appointments are entered in the diary, so that they will not be missed. The record of health appointments attended indicated that staff supports each resident to attend an appropriate range of healthcare appointments in line with their individual healthcare needs. Records include the outcome of the appointment. The home works with the Diabetic Nurse and Incontinence Nurse to meet the needs of individual residents. The new resident has been a diabetic for many years and is able to control this independently. They check their blood each morning and record it in their book. This is monitored by the home and the Diabetic Nurse who support the resident and home. One resident attended the smoke cessation clinic run by the local pharmacist and now controls their cigarettes with the support of staff. Another resident is a recovering alcoholic and has been helped by the home to cut down on his consumption of alcohol by eating bowls of homemade soup several times a day. Residents weight, blood pressure, temperature and pulse are monitored and recorded weekly, so that potential health problems can identified and dealt with at early stage. The home also works closely with the Community Mental Health Teams for the mental, psychological, social and financial factors of the residents. The residents attend regular appointments with Psychiatrist where their mental state is assessed and medication reviewed. Community Programme Approach meetings are carried out every six months either in the home or at the CMHT. The resident, their family, the staff of the home, their care coordinator and other professionals involved in their care, attend these comprehensive meetings where the whole care package is reviewed. The home now places more emphasis on educating, developing and promoting the independence of residents. To help residents become more independent and give them more control in their lives, two residents are being encouraged to manage their own cigarettes and tobacco-smoking regime. Another resident is managing his alcohol drinking in a socially accepted manner. We checked three residents medication and all were correct. We found the medication procedures have continued to improve and they now use blister packs. Three residents are being helped to self medicate. This was risk assesssed. Each resident has a medication book where medication coming into the home or is returned to the pharmacy is recorded and this is written on a new page each month. We checked were told the storage and handling of medication is managed according to the home policy and this had been reviewed to ensure there were safer procedures in place. The bottle Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: of eye drops had the date of opening and when it should be discarded. Rigorous medication checks have been put in place in order to ensure the correct administration of the medication and to highlight any errors immediately. Medication charts are written more clearly and different strengths of the same medication are recorded on separate lines. Only the trained nurses dispense medication. The local pharmacist audits the medication every six months and has recorded there were no problems. The manager told the inspector she does a medication spot check every week and records this on the medication charts. The manager said if a mistake was made the manager would immediately contact the member of staff involved and dealt with in supervision and through refresher training. Medication issues are discussed at staff meetings and in supervision. The manager says she feels the more medication is discussed the more it raises staff awareness. None of the residents are self-medicating at the moment. If there are concerned about the effects of medication on a resident, they inform their GP and Psychiatrist and ask for medication review. The home thought one resident could be ready to self medicate, but after some discussion with the care coordinator and other professionals at the residents review meeting, it was decided not to introduce this yet. Care Homes for Adults (18-65 years) Page 20 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Practices and training at the home ensure that residents are protected from abuse. Residents confirmed that they felt their views were listened to and acted upon. Evidence: The complaints book is on display in the hall for residents or visitors to look at or write in and there is a copy of the complaints procedure on the notice board in the hall. There have been a number of complaints by neighbour about noise who had also contacted CSCI as well as being in touch with the home and their local MP. The complainant has sent us a a number of documents and records relating to their complaint which are very comprehensive. This was referred back to the home who dealt with appropriately by contacting the complainant. During the inspection we spoke to the manager about the complaint. At this time the home feels it has dealt with it fully and addressed all the concerns by putting procedures in place to ensure noise levels are kept down. The manager said she continues to monitor the situation and speaks to residents and staff about appropriate noise levels and behaviour. Appropriate professionals have been informed. The manager said they take all complaints seriously and aim to deal with them promptly and within the time scales. Every resident has the complaint procedure in their information booklet. All communication relating to complaints are well documented. The manager said they have continued to maintain a reflective log on all complaints received to enable them to pro actively deal with situations before they arise, by observing a trend. There are Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: diagnostic discussions among staff, which always follow any complaints received, in order to elicit the cause of the complaint and plan ways to resolve the complaints amicably. We spoke to all the residents and who said they were happy living at the home. We spoke to one resident who said it is good here and would speak to the manager or staff if they had any complaints. There is an adult protection policy and procedure in place including whistle blowing. In addition, there is an appropriate restraint policy, stating that restraint should be used only as a last resort. We spoke to the manager and care staff during the inspection about adult protection and they said there were different types of abuse, not just physical abuse, such as verbal abuse and financial abuse. They said if they suspected abuse was happening they would reassure the resident and report what they suspected to the manager. We saw each resident had a care plan on adult safeguarding deprivation of liberty and the mental capacity act. This stated the residents identified need, goals, types of abuse and how the resident will be protected. Staff said they had access to all the policies and procedures in the home and if they were not sure of anything they could look it up. Staff said they had training on POVA and whistle blowing and said they felt confident that they would know what to do. The manager said they have never had to use any restrain on the residents but if they had to they would follow their restraint policy. She said staff are aware that this should be used as a last resort and this is reinforced during any training they have. We saw copies of the minutes of the residents meetings and noted that residents are encouraged to speak out about any concerns they may have. In the past residents were put in touch with the Croydon Advocacy Service, an independent advocacy service. The manager said if the need arose they could contact them again for any help they might need. The home said they were aware that because of the mental health issues the residents have, relying on written documents to facilitate complaints can be dis empowering and they endeavored to find other ways of empowering them. They said they always remind residents about the complaints procedure and their right to complain and to keep them up to date with the latest complaints procedures from their providers. The manager has been empowering residents to look after their own money. One resident has managed to save a large sum of money by not drinking so much and this has pleased them. One resident manages their own money and has a bank account. Four other residents have their own bank account and staff supports them to the bank and make transactions. All money is recorded in separate named residents books and Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: is checked by two staff at the daily handover. One residents support plan is learning to take responsibility of the budgeting of their money. Care Homes for Adults (18-65 years) Page 23 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience 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 with adequate private and shared space, toilets and bathrooms. Residents bedrooms promote their independence. The home is generally well maintained and furnished apart from the radiator covers in residents bedrooms that need to be repaired to make them safe. Evidence: The manager showed us around the home. Most of the home was well decorated and homely. but there were a number of areas that requires attention. Such as the kitchen unit doors needed to be repaired and at least two radiator covers were broken. This was pointed out to the manage who said they would get the handy man to mend them. This needs to be done as it could be a health and safety risk. There is a good range of communal spaces, including large lounge / dining room. The garden has a raised patio area that has been extended to include a walkway to the large heated outhouse that is used for some of the homes activities. Residents are encouraged to smoke outside but in the colder weather they use the heated out house when it is not being used for activities. There is a personal computer available in the lounge area for use by the residents. One resident in particularly enjoys using this and was using it during the inspection. There is large kitchen that leads off the dinning area. As stated above some of the kitchen units need to be repaired or replaced. The door between Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: the kitchen and the living area, which is a fire door, has been fitted with a fire door guard that was recommended at a previous inspection. From the kitchen is a door leading to a small passage. To the left is a laundry that has a washing machine and a dryer. Opposite this is a small toilet with a wash hand basin. There is a sink installed for clothes that need to be hand washed. Residents said they were supported by the staff to do their washing and ironing and this was written in their care plans. There are six single bedrooms over three floors. There is one bedroom on the ground floor and all bedrooms are of adequate size with four having en-suite facilities. We were shown and visited four residents bedrooms. The residents who spoke to us said they were happy with their bedrooms and they had been able to make them homely by bringing personal possessions. All the residents have a television in their bedroom. The home is clean and well maintained apart from the previously mentioned radiator covers and kitchen cupboards. It is decorated and furnished in a comfortable style. The staff and residents continue to do a good job keeping the house clean. Care Homes for Adults (18-65 years) Page 25 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff files and the homes recruitment policy and practices continue to improve and are robust. Staff are having regular appropriate training and supervision to enable them to meet the needs of the residents. Evidence: The home has recruited a number of perminent staff and now has eight staff members. There is an ongoing action plan for the development of the home. We were told this was one of the key areas the manager has looked at and wanted to to develop the staffing. This included looking at recruitment procedures and the recruitment of permanent staff, staff induction process, skills and knowledge of the staff. She said she wanted to make sure she gets the right staff and has recently employed a deputy manager who started to work at the home the week before the inspection as well a member of staff who will be the activity co ordinator. We checked three staff files. Two were new members of staff and we met both staff during the inspection. All staff files viewed there were two written references, a signed copy of their contract stating terms and conditions and Criminal Records Bureau checks as required including confirmation of training that has been undertaken. There Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: were copies of the certificates of training the staff had received held on their files. This included induction training and mandatory training, diversity and equality training. The manager said all staff including agency staff is given mandatory training when they first come to the home. The manager said when a new member of staff started they would have weekly supervision sessions then these would be monthly to six weekly after the initial induction period had taken place. During the probational period the home will monitor the staff attitude, abilities and skills in terms of residents care. All staff have training and development plans. We could see from these they have completed their mandatory training. Staff are given information about the National Minimum Standards so they have an understanding of the expectation of the service provided to the residents. We were told all staff have had training in adult protection issues. The home has a qualified nurse on each shift and care assistants who hold the NVQ qualification or are in the process of doing so. Staff have regular clinical supervision and their performance is reviewed through use of annual appraisals. Other professional development offered through in house training as well as training offered by various organisations or arranged by the management of the home. We were shown copies of the staff meetings and these indicated that the home had a high level of commitment to raising the standards of care the residents were receiving. The manager emphasised the importance of staff training and encouraged staff to come up with new ideas that will improve the quality of the service. The manager had arranged for support workers to attend medication training and is arranging for support workers to attend Croydon College to take NVQ level 3. We were able to speak to two staff who had recently started work at the home. Staff said the induction was done with the manager and things were explained clearly if they had any questions. One nurse who responded to the CSCI survey said the home provided on going training for staff such as medication, care plans and any other relevant up to date issues. Staff said they had regular supervision every six weeks and it was noted there were copies for the supervision notes on file, which were signed by the manager and the member of staff. Care Homes for Adults (18-65 years) Page 27 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. . Evidence: The manager started to work in the home in February 2008 and applied and has been accepted by CSCI as the registered manager of the home. She is a trained registered mental health nurse. She is a teaching award and is an NVQ assessor D32 / D33. She has past experience in managing a rehabilitation unit and has experience and knowledge having worked in the various fields of general nursing and various aspects of mental health nursing. She puts the residents first but doesnt loose sight of the needs of the staff. The residents and staff spoke highly of her and said she has continued to improve the home. Staff said they have regular contact with the manager who gives support and clarification on any issues that are of concern to them. Another member of staff said she always gives her support. One resident said they thought the manager is superb and the team are amazing. They said I am amazed how I have improved since I arrived at the home. The manager said she thinks in the terms of Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: rehabilitation and of residents developing their skills to their meet their full potential rather than being looked after by staff as well as believing staff need to develop their skills too. Staff continued to say since the manager took over there has been a lot of improvements and to provide holistic care for each resident and there continues to be more outing for residents and with staff learning about more about rehabilitation. Residents said they are given the opportunity to give their views of the home at residents meetings, which were recorded in the minutes of the meeting that are held every two months. We saw copies of the minutes of the meetings. The home showed us copies of the completed residents surveys and they were all very positive. We found there is a relaxed feel about the home and when we had to speak to the manager about the complaint made about the noise the manager dealt with it immediately. Residents said they felt that their views were listened to and at residents meetings they felt they could speak up. One new resident said they felt able to speak to staff about any concern they had and they would get an answer. The home has policies and procedures in place around health and safety. We checked the records relating to health and safety measures and servicing of the equipment and these were correct and up to date. Care Homes for Adults (18-65 years) Page 29 of 32 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 24 23 Radiator covers in the 01/06/2009 residents bedrooms must be repaired and kitchen cupboard doors repaired. Radiator covers need to be repaired to ensure residents are not able to fall against a hot radiator and burn themselves. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 14 The home could look at different ways of getting the resident who is reluctant to participate in activities and daily living skills by involving other professionals. Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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