Inspection on 16/04/07 for Glebe House

This is the latest available inspection report for this service, carried out on 16th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Glebe House 10/10/05

Glebe House 18/05/04

Glebe House 04/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Glebe House Glebe Road Rainham Essex RM13 9LH Lead Inspector Ms Gwen Lording Key Unannounced Inspection 16th April 2007 10:00 Glebe House DS0000015591.V336205.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Glebe House DS0000015591.V336205.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Glebe House DS0000015591.V336205.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Glebe House Address Glebe Road Rainham Essex RM13 9LH 01708 554 711 01708 526 469 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) glebe.house@theavenuestrust.co.uk The Avenues Trust Limited Brian James Smith MR BARRY SMITH Care Home 12 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (12), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (12) Glebe House DS0000015591.V336205.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No service users under 40 years of age. Date of last inspection 26th January 2006 Brief Description of the Service: Glebe House is a care home with nursing. The home provides accommodation for up to 12 people of either gender with enduring mental health problems. All residents are over the age of 40. The Registered Provider is The Avenues Trust. The home is purpose built and consists of two storeys with lift access to the first floor. All the rooms are single with en-suite. There is a large wellmaintained garden. The home is situated in a residential area of Rainham and is close to local community facilities. The home is easily accessible by public transport and by car via the A13 and M25. The home also has its own transport. All beds in the home are contracted to Havering Primary Care Trust, and there are clear admission criteria defined by the Trust. On the day of the inspection the fees for the home were £1,000.24 per week. A copy of the Statement of Purpose and Service User Guide are available in the home, together with a copy of the most recent inspection report. Glebe House DS0000015591.V336205.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which started at 10am and took place over five hours. The registered manager was available throughout the visit to aid the inspection process. This was a key inspection visit in the inspection programme for 2006/2007. Discussion took place with the manager, members of nursing and care staff; the domestic and the cook. Nursing and care staff were asked about the care that service users receive, and were also observed carrying out their duties. The inspector spoke to a number of service users who were asked to give their views on the service and their experience of living in the home. A tour of the premises, including the kitchen was undertaken and all rooms were clean with no offensive odours present throughout. A random sample of service user files were case tracked, together with the examination of other staff and home records. This included medication administration, staff rotas, training schedules, maintenance records, menus, complaints, fire safety, accident/incident records and staff recruitment procedures and files. Information was also taken from a pre-inspection questionnaire, which was completed and returned by the manager. The inspector had a discussion with the manager and people living in the home about how they wished to be referred to during the inspection and in the report. They expressed a wish to be referred to as service user. This is reflected accordingly in the report The inspector would like to thank the service users’ and staff for their input during the inspection. What the service does well: It was very evident that the home is operated for the benefit of service users. Every effort is made to retain a level of independence for those people living in the home and for them to continue to exercise choice and control over their lives. The home has an experienced manager who sets high standards for the home. He works with a strong staff team who are committed to further improve the quality of care for people living in the home. This is reflected in the provision of care to service users. Some service users require a higher level of support in meeting their personal care needs. However, staff are aware of the need to balance service users independence and choice with flexible and responsive personal support. Glebe House DS0000015591.V336205.R01.S.doc Version 5.2 Page 6 The manager ensures that the home works in partnership with all agencies to ensure that there is effective and well co-ordinated mental health care provision for people living in the home. The attitude and practice of the service and that of the staff team promote opportunities for service users to remain independent, exercise choice and express their wishes and needs. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Glebe House DS0000015591.V336205.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Glebe House DS0000015591.V336205.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 2, 3 & 5 People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Comprehensive assessments are undertaken for all service users prior to them moving into the home. Care plans are drawn up from the information in this assessment, ensuring the needs of the service user are identified, understood and met. EVIDENCE: There are currently no vacancies at the home. Six of the service users have lived in the home since it opened in 2000. The most recent service user was admitted to the home in 2006. Through discussion with the manager and viewing pre-admission assessments/ documentation held on file, it was evident that no admissions would be made to the home unless a full needs assessment had been undertaken. Each service user has a Service Agreement/ Contract, which details the responsibilities of the provider and the rights and obligations of the individual. All contracts seen had been signed by the individual service user. The Care Homes Regulations 2001 have been amended with effect from the 1st September 2006 for new service users, and for existing service users with effect from 1st October 2006, so that more comprehensive information is to be Glebe House DS0000015591.V336205.R01.S.doc Version 5.2 Page 9 included in the service user guide. Details of information to be included are contained within the amended regulations. Therefore, the service user guide must be reviewed and amended by the stated timescales. The manager was also provided with a copy of the Commission’s ‘Policy and Guidance on Provision of Fees Information by Care Homes’. Glebe House DS0000015591.V336205.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7, 8, 9 & 10 People using the service experience excellent quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Service users’ health, personal and social care needs are set out in individual care plans and provide staff with the information they need to satisfactorily identify, understand and meet service users’ needs. Care plans are being used as working tools and service users benefit from the attention to detail paid by staff at the home in meeting their needs. The home maximises independence wherever possible and staff provide service users with information, assistance and support to make decisions about their own lives. The attitude and practice of the service and that of the staff team, promote opportunities for residents to remain independent, exercise choice and express their wishes and needs. Service users know that staff handle information about them appropriately and their confidences are kept. EVIDENCE: Glebe House DS0000015591.V336205.R01.S.doc Version 5.2 Page 11 Individual files were available for each service user and the care plans and related documentation of five service users’ were case tracked. Care plans are very comprehensive and are being used as working tools. They are sufficiently detailed as to be understood by all staff and to others who may not be as familiar with the individual service user. Each service user has a key worker who is able to provide one to one support and ensures that care plans are being kept up to date through regular evaluation and review. All service users’ plans of care are in line with the Care Programme Approach (CPA) and are reviewed in accordance with CPA procedures by the service users’ Consultant Psychiatrist. The manager ensures that the home works in partnership with all agencies to ensure there is effective and well co-ordinated mental health care for people living in the home. Key workers contribute to CPA reviews by completing a detailed nursing report for inclusion at the reviews. Service users are actively encouraged and supported to be involved in the development of their care plan. Engaging and motivating individuals is sometimes a challenge for staff due to the enduring and severe mental health problems experienced by people living in the home. However, staff have the training, experience and skills to engage the individual at varying levels to enable them to have a degree of meaningful involvement. Comprehensive risk assessments were in place for each service user and were subject to regular review and updated accordingly. They identified elements of risk for individuals and detailed strategies and actions to keep any such identified risks to a minimum. This included risks associated with physical/ verbal aggression and for individuals where the risk of relapse in their mental health was considered to be quite high. Service users are supported to take risks as part of promoting their independence and where there are limitations in place, such decisions are made involving the individual and were recorded. One service user enjoys regular visits to the cinema, but had recently encountered a problem whilst away from the home and the police had been involved. The inspector evidenced a very positive discussion by staff around the problems the individual had encountered and how they could support him to continue to enjoy this activity independently. There is a policy in place in the event of a person going missing from the home, which all staff were aware of. All service users have access to independent advocacy services and at the time of the inspection one individual had involvement of an advocate through HUBB –Barking, Havering and Brentwood Mental Health User Group. There is a wellresourced notice board containing information about local activities and events in the borough, both mainstream and specific to people with mental health needs and support. There is a strong focus on maintaining and promoting independence. Staff understand the importance of supporting residents to have control of their lives and make their own decisions. Individual staff were observed providing service users with information, assistance and support, and were respectful of their Glebe House DS0000015591.V336205.R01.S.doc Version 5.2 Page 12 right to make decisions. The routines of daily living and activities were flexible and varied to suit the differing needs of service users in the home. Glebe House DS0000015591.V336205.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 11, 12, 13, 14, 15, 16 & 17 People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Service users are actively encouraged and supported to be involved in social and leisure activities appropriate to the individual, and are able to maintain and develop personal relationships of their choosing. They are supported to exercise their rights, which are respected and promoted by staff and enables them to participate in the community in which they live. The nutritional needs of the residents are well considered so that food and mealtimes are seen as being important and enjoyable for all residents. Service users are provided with meals that are reflective of their choice, cultural and dietary needs. EVIDENCE: People living in the home are individually and collectively involved in determining the type of activities they wish to participate in, when and with Glebe House DS0000015591.V336205.R01.S.doc Version 5.2 Page 14 whom they choose. Service user meetings are held once a week and typed minutes are displayed in the communal lounges. From viewing minutes of these regular meetings it was apparent that activities and other house matters are discussed in this forum. Six of the service users have lived in the home since it opened in 2000 and the age range of the current people living in the home is between 76 and and 46 years of age. There is a wide range of leisure activities for service users to engage in both in the home and the community. This included attendance at MIND, drop in centres; and other specialist mental health centres; individual formal sessions with Support, Time and Recovery Workers (STR); trips to the cinema and theatre; local cafes and pubs. Other service users enjoy bingo, quiz nights and bowling. One service user spoken to said: ‘I enjoy my own company and like listening to my radio’. Another service user is a keen football fan and is supported by staff to attend local matches. It was clear that the type and variety of activities were reflective of their individual choice, ability, age and culture. On the day of the visit staff were observed to be supporting individuals to pursue their individual interests and hobbies. The home has its own transport, which is used for shopping trips, outings and out patient appointments supported by staff. Other service users are well orientated and integrated in the community and make use of public transport. One service user has a bicycle, which he makes regular use of. Where there are family links and friendships, service users are encouraged and supported by staff to maintain these links. One service user goes home every weekend to visit her husband and this is clearly important to them both. A retired neighbour voluntarily works in the garden and was there on the day of the visit. He has a good rapport with the service users and is respectful of their wish to be involved and have discussions with him about the garden, or not. He clearly enjoys his involvement and said: “The people living in Glebe House are very good neighbours”. All service users are on the electoral register and some have requested support to make postal votes. The routines of daily living and activities were flexible and varied to suit the differing needs of service users in the home. All staff, including the cook and domestic are very aware that Glebe House is the home of the service users, they respect this and try to make this as pleasant as is possible. During the inspection, service users were observed accessing all areas of the home independently, apart from the main kitchen. However, some service users are involved in cooking and appropriate risk assessments are in place. The home employs a full time cook who has worked at the home for seven years. She is a valued member of the staff team and knows what the service users like to eat. The menu for the week is discussed and planned one week in Glebe House DS0000015591.V336205.R01.S.doc Version 5.2 Page 15 advance; menus are in place and records maintained. Service users spoken to confirmed that they are involved in choosing them. In line with promoting equality and diversity menus were reflective of the diverse needs and preferences of individuals. Food and mealtimes are seen as being important and enjoyable for everyone in the home and staff eat with service users. The main meal of the day is served in the evening and service users spoken to confirmed that this is their choice, as it suits individual service users’ activities and daily schedules. The lunchtime meal was observed to be very flexible and relaxed with service users choosing what they wanted to eat on the day. There was a good variety of dishes to choose from including a selection of freshly prepared salads; bread/ rolls; cold meats/ cheeses; ice cream, yoghurt and fresh fruits. Service users were observed helping themselves to tea, coffee and fruit juices. A visit was made to the kitchen and the inspector discussed the storage and preparation of food and menus with the cook. She demonstrated a good knowledge and understanding of the importance of well balanced and well presented meals. Food was being adequately stored, with a good variety of food available, which included meat, fish, dairy produce; and a fresh supply of fresh fruit and vegetables. There is little reliance on tinned, processed or frozen foods. Glebe House DS0000015591.V336205.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19, 20 & 21. People using the service experience excellent quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Service users’ personal and healthcare needs are closely monitored by a skilled, trained and knowledgeable staff team. This ensures that their needs are recognised, understood and met. Personal support is provided in a manner, which suits their individual needs and preferences. There are clear medication policies and procedures for staff to follow and this ensures that residents are safeguarded with regard to the administration of medication and their health care matters are efficiently managed. EVIDENCE: Four of the service users spoken to confirmed that they were happy with the support they receive around their personal care needs. Service users have a choice in relation to same gender care preferences when receiving personal care, and their care plans set out how their personal support is to be provided. Some service users require a higher level of staff support in meeting their personal care needs. However, staff are aware of the need to balance service users’ independence and choice with flexible and responsive personal support. Glebe House DS0000015591.V336205.R01.S.doc Version 5.2 Page 17 All of the care plans examined clearly recorded referrals to specialist health care professionals for example, diabetic nurse specialist, continence advisor; and that appointments were being kept. There were well-detailed care plans relating to specific health care needs such as management of diabetes; care and support for a service user with an indwelling catheter; and weight management. Records indicated that service users attend routine health appointments including GP; dietician, dentist, optician, chiropodist and routine cervical and breast screening. As far as possible service users are given the opportunity and support to independently attend their own appointments, and are seen as individuals taking responsibility for their own health care. Staff are very observant and alert to changes in individuals behaviour and mood and fully understand how they should respond and the action required. Care plans detail specific behavioural interventions. There are policies and procedures for the handling and recording of medication. An audit was undertaken of the management of medicines in the home, and a random sample of Medication Administration Record (MAR) charts were examined. Medication storage was satisfactory and medication records were being fully completed. Regular checks are undertaken to ensure that staff comply with the organisations policy/ procedure. Currently there are no service users who are self medicating. They have regular reviews of their medication, which is closely monitored by nursing staff. Service users receive good support with their medication, which for all is an important element of maintaining their mental health and well-being. The manager has undertaken comprehensive training around “Medication Management for the Seriously Mentally Ill”. The wishes of some service users around dying and the arrangements they want after death had been sensitively discussed during the development of care plans. These wishes are clearly recorded in the individual’s care plan so as to be respected and known to staff in the home. However, in view of the variance in the age range of service users, it is strongly recommended that ‘End of Life’ care plans be developed for all service users. This should include clear information about the individual’s wishes, choices and decisions. One service user who had lived in the home since 2000, sadly died recently. There were letters of thanks from relatives thanking staff for their support at his funeral. Glebe House DS0000015591.V336205.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 & 23 People using the service experience excellent quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. The manager and staff make every effort to sort any problems or concerns. Service users and their relatives/ representatives can be confident that their complaints and concerns will be listened and acted upon. Staff working in the home have received training in safeguarding adults to ensure that there is a proper response to any suspicion or allegation of abuse. Service users are safeguarded from abuse and harm through the use of staff training, regular supervision and monitoring. EVIDENCE: There is an in house training programme for all staff in safeguarding adults and recognising and reporting abuse. All staff working in the home have received this training and this is included in induction training for any new staff. Those staff spoken to during the inspection were aware of the action to be taken if they had concerns about the safety and welfare of service users and were also vigilant to the potential for abuse between service user and service user(s). This knowledge is regularly reinforced and discussed through supervision and staff meetings. There are policies and procedures in the home which are accessible and understood by staff regarding safeguarding adults and staff are clear about local reporting protocols and referral to the local authority. Service users have access to external agencies and professionals through advocacy services and CPA reviews. Glebe House DS0000015591.V336205.R01.S.doc Version 5.2 Page 19 There is a written complaints policy and procedure, which is clearly displayed and included in the Statement of Purpose and Service User Guide. The complaints procedure is also available as an audiocassette or CD. No complaints had been recorded since the last inspection. In discussion with the manager and staff it was evident that they take residents’ concerns and views seriously and were clear on the service users’ right to complain and that they would encourage and support them to do so. Those service users spoken to felt able and confident to complain, should they feel the need to. One service user said: “I would tell them at the service users’ meeting” Other service users commented that they would speak to the manager; their named key worker or at their meetings. There is a policy and procedure in place and known by staff for the management of physical or verbal aggression by a service user. Glebe House DS0000015591.V336205.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24, 25, 27 & 29 People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. The premises are homely and the atmosphere in the home is very welcoming. The living environment is appropriate for the particular lifestyle and needs of the service users and is clean, safe and comfortable. EVIDENCE: The home was toured at the start of the inspection, accompanied by the manager, and all areas were visited later during the visit. There is a lounge on each floor and the first floor lounge is designated as a smoking area. The dining room is situated on the ground floor and there is a servery hatch through to the main kitchen. The dining room is a pleasant and airy room but can sometimes appear a little cramped when all the service users and the staff are eating together. All areas of the home were clean, tidy and free from odour throughout. The furnishings and fittings in all the communal areas were of good quality and well maintained. Glebe House DS0000015591.V336205.R01.S.doc Version 5.2 Page 21 All the bedrooms are single and en suite. The inspector visited the rooms of two service users by invitation. These were furnished and decorated to suit the individual’s preferences and particular needs. The rooms were very personalised and reflective of the occupant’s cultural, religious, personal interests and lifestyle. There is a call alarm system fitted in each bedroom; all rooms are lockable but can be overridden by staff in an emergency. The building is owned by the Guinness Trust and there is a general programme of ongoing refurbishment for the home. A part time domestic is employed who has responsibility for cleaning of the communal areas of the home. Service users are involved in taking responsibility for their own rooms with support from staff. There is a well-equipped utility room, which service users use, some with the support of staff as part of maintaining their independent living skills. The home is close to community facilities and local services, with good transport links. The grounds are well maintained, spacious and secluded. Glebe House DS0000015591.V336205.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 33, 34, 35 & 36 People using the service experience excellent quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Staffing levels are satisfactory and service users benefit from a committed and motivated staff team who have the skills, training and competence to meet the individual assessed needs of service users. The procedures for the recruitment of staff are robust and provide safeguards for the protection of people living in the home. EVIDENCE: Staff rotas were inspected and staffing levels and skill mix of qualified nurse and care staff was sufficient to meet the assessed nursing and other care needs of service users. Glebe House has a very stable workforce and effective team working was observed and evidenced throughout the inspection. Staff interacted well, both with each other and the service users, and this was in line with each individual’s programme of care. There is no use of agency staff and any gaps Glebe House DS0000015591.V336205.R01.S.doc Version 5.2 Page 23 in the rota are covered by permanent staff. This is clearly to the benefit of residents since it provides consistency of care, which is extremely important for people with mental health care needs. In discussion with the manager and staff, at all levels, is was apparent that staff morale is high and they are enthusiastic and positive about wanting to improve the quality of life for service users. The registered providers, The Avenues Trust, have a robust recruitment and selection procedure in accordance with the requirements of legislation, equal opportunities and anti-discriminatory practice, which ensures the protection of service users. Only one member of staff has been recruited since the last inspection and the personnel file was inspected and found to be in good order with necessary references, Criminal Records Bureau (CRB) disclosures, and application forms duly completed. Avenues Trust as an organisation, employs a workforce from diverse cultures and backgrounds. It was apparent at the time of the inspection that the ethnicity of the majority of the staff team was different to that of the people living in the home. However, all staff working in the home undertake training in “Valuing Diversity”. This ensures that the spiritual, dietary, cultural, sexual and any other diverse need of service users at Glebe House is understood by staff and appropriately met, wherever possible. Staff are able to demonstrate a thorough understanding of the particular needs of individual service users and can therefore deliver meaningful person centred care. From talking to staff, inspecting training records and observation, it was evident that staff have the opportunities to undertake a variety of training courses, and that such training is then put into practice within the home to the benefit of residents. All the staff have undertaken training specific to caring for people with mental health needs. This has included understanding communication, cognitive behavioural therapy and mental health awareness. The effectiveness of such training was evident in the attitude and practices of staff when interacting and caring for service users. An individual record is maintained of staff training and records showed that staff have undertaken training in essential areas such as fire safety, health and safety, first aid, moving and handling, control of infection and food hygiene. The home has an agreement with South Bank University to take student nurses on 8-week placements whilst undergoing their branch training in mental health. There is a reciprocal agreement with the University that qualified nursing staff working in Glebe House have access to the University training programme. As a consequence of this the manager had undertaken a very comprehensive training course in Medication Management for the Seriously Mentally Ill. The pre-inspection questionnaire completed by the manager states that 70 of staff have been trained to National Vocational Level 2 or above. Glebe House DS0000015591.V336205.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 38, 39, 40, 41 & 42 People using the service experience excellent quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. The manager of the home is a well qualified and experienced person and service users benefit as the home is run in their best interests. Monitoring visits are undertaken regularly by the responsible individual to monitor and report on the quality of the service being provided in the home. Staff are appropriately supervised and the health, safety and welfare of service users and staff are promoted and protected. EVIDENCE: It was evident during the inspection that the home is being well managed and the manager is keen to work in collaboration with external agencies and the Commission. Through staff training, supervision and good management, staff Glebe House DS0000015591.V336205.R01.S.doc Version 5.2 Page 25 are ensuring that residents receive a high standard of care and that the home is run in their best interests. All staff spoken to throughout the visit spoke very positively about how well supported they felt by the manager. Staff receive regular 1:1 supervision, direct observation of care practices, annual appraisals and regular staff group meetings. Mr Smith has an open and inclusive style of management and staff feel valued. He is very service user focused and works continuously to improve the service and provide an increased quality of care for people living in the home with the support of a strong staff team and in partnership with other agencies and health care professionals. All staff work as a team and value each other’s contributions. The organisation and the manager ensure that policies and procedures are reviewed on a regular basis and he keeps up to date with new and changing legislation. Audits, spot checks and quality monitoring systems provide evidence that practice reflects the homes policies and procedures. The inspector had a discussion with the manager around the introduction of the Mental Capacity Act 2005, which becomes effective from April 2007. The manager was aware of this new legislation and is scheduled to attend training around this. He will then be discussing this with staff and people living in the home. The home benefits from the quality assurance procedures adopted by the registered organisation, Avenues Trust. An Annual Quality audit is undertaken by the registered organisation as well as a Health and Safety audit approximately every 12-18months. As part of the quality audit, questionnaires are sent to service users and other stakeholders. All this information is collated and a report is sent to the home. Regulation 26 visits are undertaken regularly by the responsible individual to monitor and report on the quality of the service being provided. A copy of the report is sent to the Commission. These reports include the views of service users and staff, which demonstrate that both are listened to, and their views valued and acted upon. Information gained from service user meetings; complaints, concerns and compliments; and quality assurance questionnaires are all used to make improvements and influence service delivery. The home has responsibility for the personal allowances of some of the service users and secure facilities are provided for their safekeeping, with records being maintained. One service user manages his own finances and one service user’s finances are managed by her husband. A wide range of records were looked at including fire safety, emergency lighting, health and safety checks and accident/ incident reports. These records were found to be detailed, up to date and accurate. A copy of the Certificate of Insurance displayed in the home showed an expiry dated of 31/03/07. The manager had not received the current certificate from the organisation, but Glebe House DS0000015591.V336205.R01.S.doc Version 5.2 Page 26 was able to fax a copy of the current valid certificate to the inspector the following day. Glebe House DS0000015591.V336205.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 3 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 4 33 4 34 3 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 4 4 3 LIFESTYLES Standard No Score 11 3 12 3 13 4 14 4 15 3 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 3 4 4 4 3 3 3 X Glebe House DS0000015591.V336205.R01.S.doc Version 5.2 Page 28 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA21 Good Practice Recommendations It is strongly recommended that ‘End of Life’ care plans be developed for all service users. This should include clear information about the individual’s wishes, choices and decisions. Glebe House DS0000015591.V336205.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Glebe House DS0000015591.V336205.R01.S.doc Version 5.2 Page 30 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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