Inspection on 14/04/10 for London Mental Health Care Centre

This is the latest available inspection report for this service, carried out on 14th April 2010.

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

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

London Mental Health Care Centre 06/05/08

London Mental Health Care Centre 01/10/07

London Mental Health Care Centre 13/11/06

London Mental Health Care Centre 19/12/05

London Mental Health Care Centre 09/06/05

London Mental Health Care Centre 19/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Key inspection report Care homes for adults (18-65 years) Name: Address: London Mental Health Care Centre 78-80 Arran Road Catford London SE6 2NN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Rosemary Blenkinsopp     Date: 1 4 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: London Mental Health Care Centre 78-80 Arran Road Catford London SE6 2NN 02086988770 02086988770 Arranhouse@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Dhaneswar Dooraree Name of registered manager (if applicable) Type of registration: Number of places registered: care home 15 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: 15 The registered person may provide the following category of service only: Care Home Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home The London Mental Health Care Centre is a care home registered to provide accommodation and care for up to 15 adults with mental health problems. It is situated in a quiet side road off the Bromley Road approximately 15 minutes walk from the shopping centre and civic amenities in Catford. The home has 13 single rooms, and one shared room. There is a communal area for dining, and an activities area where there is a television and a pool table. There is a good-sized garden with patio area with Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 15 Brief description of the care home outside seating. There is also a quiet room for private meetings of staff and residents. The home aims to provide support and accommodation to residents who are undergoing rehabilitative care programmes. The skills that they acquire will enable them to move on to more independent living situations where possible. Accessing local services and integration with the wider community are an implicit part of the rehabilitation programme. Staff in the home work in collaboration with the multi disciplinary team to provide a consistent approach to achieving their needs and managing their mental health conditions. The staff team includes a number of RMNs and staff with NVQ qualifications. The weekly fees are between £950 - £1,500. Care Homes for Adults (18-65 years) Page 5 of 31 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: This was an unannounced inspection visit and was carried out over one day, by one inspector. The inspection covered all the key standards in the National Minimum Standards. No enforcement activity has occurred since the last inspection. The manager facilitated the inspection. Periods of observation were undertaken in the communal areas where residents were located. Prior to the inspection the manager had completed the AQAA and forwarded this to the CQC. No comment cards were received prior to the inspection. During the site visit the inspector met with several residents and one multi disciplinary team member. No other visitors attended during the site visit. Care Homes for Adults (18-65 years) Page 6 of 31 Staff were interviewed as part of the site visit. All of the information obtained from the sources identified above has been incorporated into this report. Documents were inspected during the site visit including care plans, staff personnel files as well as health and safety records. Feedback was provided to the manager at the end of the inspection. Other information, which was considered when producing this report and rating, consisted of information supplied and obtained throughout the year including Regulation 37 reports and complaints. Feedback on our findings was given verbally to the manager at the end of the inspection visit. The managers and all the staff were very helpful and they are to be thanked for their assistance over the course of this inspection visit. The agencies Registration Certificate with the Commission was seen displayed appropriately in the hallway. There have not been any changes in the ownership of this home since the last inspection. Care Homes for Adults (18-65 years) Page 7 of 31 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 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 31 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 9 of 31 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. Prospective residents needs are assessed before a decision is made to move into the service. The pre-admissions procedures provide residents with the information they require prior to any decision regarding placement being made, to establish whether the service is right for them. The information provided to staff enables them to set up an initial care plan to meet the needs of the resident. Evidence: On the day of the inspection there were eight residents on site and one in hospital. All residents are under Care Programme Approach which is a system of aftercare whereby reviews on the residents health are carried out by members of the multi disciplinary team Residents subject to this system of aftercare have a named care co ordinaor who works collaboratively with all other professionals in the best interest of the resident. Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: Admission information and assessment reports were retained on file. We inspected 3 of the residents files over the course of this inspection and found that for all these people their needs had been assessed before moving into the home. The assessments, we were told, are usually carried out by the manager or another senior member of staff. Standard assessment formats had been used that identify the persons physical, mental and social care needs and any other useful information such as their current medication programme. London Mental Health Centre conduct their own assessment once a referral has been received. A pre admission questionnaire is also completed. Additional information including the previous care plan information and reports from Care Programme Approach reviews are obtained. All of the information provided a good picture of the resident and their presenting needs. Staff told us that residents were provided with opportunities to visit the service and stay over night. The number of introductory visits may vary depending on the individuals needs. In reality residents have limited choice in where they live, as there are few facilities that provide support for this category of resident. The terms and conditions of residency were on file. The Statement of Purpose and Service User Guide need to be updated to reflect the current staff group, their skills, management structure and the new Regulatory body. Care Homes for Adults (18-65 years) Page 11 of 31 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. Care plans and risk assessments are comprehensive in content and detailed enough to ensure the individual residents are met. Residents are consulted on and have choices in their daily lives. Evidence: We randomly selected care plans. Care plans are developed in line with the identified needs included in the CPA. Care plans are discussed with residents at the individual key worker sessions that are held frequently. Those care plans viewed had photographs of the residents attached which is essential should the resident go missing, as police may require a description and photograph. The care plan included issues around presenting mental health, rehabilitation and physical health needs. The interventions were to a good standard and would provide staff with the information they need to provide the support and assistance needed. Residents signatures are obtained as confirmation they have been involved in the Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: development of the care plan. Documents provided evidence of regular weight, pulse and blood pressure checks, and where issues were identified, care plans were in place for the problems. Risk assessment tools were in use. Those areas identified as potential risks were incorporated into a risk overview document. In cases where residents had specific risks associated with their behavior or condition, these were recorded with the information and actions needed to minimise the risk. Risk profiles need reviewing frequently as by the very nature of the presenting problems risks may change, increase or decrease. We saw records of the reviews that had taken place and those relating to key worker sessions. Records are securely stored in the staff office. The AQAA told us the following : All service users have individualized care plans, and are treated as individuals. As much as possible service users are encouraged and supported to adhere to their recovery plan programs. Care Homes for Adults (18-65 years) Page 13 of 31 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. The home has increased the rehabilitation activities both within the home as well as those in the community, which provides residents with opportunities to develop independent living skills. Evidence: Periods of observation were undertaken during the site visit. Residents were watching TV, others were going out, some were reading newspapers magazines and one was playing pool. Residents we spoke to said they decided what they did during the day and generally no restrictions were placed upon them. Rising and retiring times we flexible within reason. They were able to have visitors and go out unaccompanied. Integration into the community is encouraged and residents are supported to use public transport, go Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: out shopping and visit friends and family. The manager has tried to introduce a greater range of therapeutic activities to enhance residents leisure time as well as help with rehabilitation. During the lunch time several resident had different meals which had been prepared by a member of the support staff. All staff complete the basic food hygiene training, as they are expected to prepare the breakfast and lunchtime meal, as the cook is only employed for the evening meal. Juice a well as tea an coffee are freely available. Fresh fruit and biscuits were available in communal areas. The kitchen was inspected. The area was clean and well organized. The Environmental Health Officer had visited the premises September 2009 and awarded the home a four star rating ( very good standards). The kitchen was stocked with a selection of fresh, frozen and tinned food. One resident said that she does some cooking and makes her own tea, several of the residents are able to make their own drinks and facilities are provided in a tea making area. The menu is reviewed with the residents input and this is often a topic raised during residents meetings. Residents indicated that they looked after their own bedrooms with staff support and said that they also did some of their laundry. In each care plan there is a weekly activities sheet to detail what the residents took part in. The AQAA told us the following:Residents are encouraged to actively participate in activities in the house. These would be of their own choice. In terms of meal there is a good choice given and there is a menu list which is amended and reviewed on a monthly basis in the clients meeting. Any new meals are included on the menu list. The home plans to introduce the following : All residents will be referred to external community activities delivered by local agencies. These would include leisure and educational as well as jobs experience whether voluntary or remunerated. All activities will be discussed on a monthly basis during the Key worker session as well as communally in the service users meeting. Care Homes for Adults (18-65 years) Page 15 of 31 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 have all of their health care needs met by staff in the home supported by members of the multi disciplinary team. Medications are safely managed. Evidence: During the site visit we talked to residents and staff about the level of support and assistance provided in the home. Whilst on site we met with one visiting health professional and asked their opinion of the service and support provided. They told us this is the best service we use , and added that the home managed some very difficult residents . They went on to give examples of residents that had progressed well within this service, whilst having failed in other homes. They continued by saying that the residents were closely monitored by their Care Co ordinators and because of this they had frequent contact with the home, therefore he felt able to give an informed opinion on the service. Records relating to visits by the multidisciplinary team were on file, as were those relating to CPA reviews as well as other health appointments. Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: One area which needs to be carefully monitored, is in relation to residents nutrition and weight. There was evidence that some residents were gaining weight and on occasions eating an unhealthy diet. Whilst this can be a difficult situation to manage, as residents are encouraged to be independent, staff must endeavor to address it. We were advised that dietitians and nutritional help had been sought on previous occasions, although there was little in the way of records relating to this. Residents are usually able to address their own personal care although most require some level of prompting and reminding. Some of the residents do have personal care incorporated into their care plans to indicate to staff what support they would require in this area. Residents have their preferences in relation to gender care addressed as the staff team has male and female staff. All residents must be mobile as there is no lift facility and the stairs are steep. The medications were inspected including the storage of the actual medications and the supporting records. Medications are stored in the ground floor staff office, which is where residents, attend to take their medication. The medication charts had photographs of individual residents for identity purposes. The individual allergies that residents suffer were recorded. Medications received into the home as well as those returned to pharmacy were recorded, this provides information when auditing medications to check correct administration procedures. There was a list of homely remedies, which indicated the drugs to be used and for what purpose. Records for homely remedies administered to residents were completed. Homely remedies had directions for use and charts were well completed. One resident self medicates. Self medication is a staged process leading up to full management of medication. There is a risk assessment in place for those residents who are self medicating. The last pharmacy inspection took place January 2010 and the findings were satisfactory. These inspections take place every three months. Staff are trained on medications, and this training is provided through SLAM ( South London and Maudsly). Staff receive refresher training although proficiency training has not yet been developed. This should be investigated. Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: Care Homes for Adults (18-65 years) Page 18 of 31 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. Residents can be confident that the home will deal with complaints appropriately. The complaints procedure is readily available to all who may wish to express an opinion about the service. Residents can be assured that the processes in the home will protect them from potential abuse by staff or others. Evidence: The procedures relating to complaints and protection were viewed. The complaints procedures were available and on display. They were included in the Statement of Purpose. This policy covers all the essential areas required for a complaints policy including a staged process with timescales and information for other agencies to contact in the event of dissatisfaction with the internal process of investigation. The manager maintains a record of complaints book and we saw this. There were five concerns raised in the last year that had been resolved. These ranged from maintenance issues others were food related matters. Residents told us that they would refer complaints ad concerns to staff in the home as well as their care managers and one said their boyfriend. Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: The AQAA told us the following :Residents have the opportunity to raise their opinion during the residents meeting on a monthly basis. Any concerns can also be explored in other settings such as the Key worker session. As indicated above all complaints are recorded dealt with speedily. A part of the site visit staff were interviewed. Staff were asked about their training and knowledge on dealing with abuse and whistle blowing. Overall the staff who we asked were able to demonstrate sufficient knowledge of the policies and procedures to afford proper protection to the residents. Staff were asked about what action they would take if they witnessed an incident of verbal abuse towards a resident from a senior staff member. Staff interviewed indicated that they would report it and they had some knowledge of external organisations whom they would contact. There was an understanding about whistle blowing issues and the need to report these, although external agencies were not in general felt to be appropraite for this type of incident. The manager needs to ensure that all staff including ancillary staff are fully conversant with whistle blowing and all that it entails as most staff felt this only related to abuse cases. Care Homes for Adults (18-65 years) Page 20 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides adequate accommodation and the home needs continual redecoration and maintenance to ensure that residents live in a homely environment. Evidence: During this inspection we undertook a tour of the premises and reviewed all the areas of the home to assess the quality of the environment and decor. It was evident that a lot of refurbishment had been undertaken since the last key inspection. The ground floor lounge had new carpets and two new modern sofas. The first floor smoking area had also benefited from redecoration and re painting of the furniture. Redecoration of corridors and communal areas had been addressed. Bedrooms are redecorated and upgraded as they become vacant. The manager is trying to ensure pictures are matching and items of furniture co ordinated to give a less hap hazard look to bedrooms. Soap and hand towels were available at wash hand basins. Staff told us that gloves and protective clothing were available. Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: To the exterior of the building improvements had been made to the garden with a new pathways and lawn. The manager plans to introduce a sensory garden which he hopes will encourage residents to participate in the maintainence of it. The majority of residents bedrooms were inspected with the permission of the residents concerned. It was noted that bedrooms were of a variable standard, some being quite personalized and nicely decorated others less so. Bedroom doors are lockable for privacy, although they can be accessed in an emergency. The home has a maintenance man who carries out routine maintenance for the property on a regular basis. He is employed three days a week and works hard to maintain the premises in a good state of repair. This is an older style house which has been adapted for the purposes of a care home and therefore it needs constant attention. At the time of this inspection he was seen by us to be busy painting the smoking area. We found the premises to be in a reasonable state of repair and well maintained. Generally the home was found to be mainly clean and hygienic. The home does not employ its own domestic staff this job is contracted out . One of the domestic was in the home cleaning as we arrived. She confirmed that she attended the home for 2 hours daily ; five days a week. Extra hours were available for deep cleaning. Care Homes for Adults (18-65 years) Page 22 of 31 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. Residents can be assured that the numbers of staff and the skill mix will meet their needs. The recruitment policy and procedure fully supports and protects residents. Staff are supported and trained so they can be effective and competent in their role. Evidence: The home has a team of staff headed up by the manager and the deputy manager. Several of the senior staff in this service are qualified mental health nurses. The care staff team are supported by an external domestic team, a handyman, and a cook who starts at 4pm daily. Male and female staff are employed to ensure residents have a choice when personal care is being addressed which happens occasionally. The ethnicity of the staff is mainly Indian or Caribbean /African, although the residents group is multi racial. Some of the staff group are related. The manager stated that no white British staff were employed as the applicants were not up to a suitable standard to work in the service. The manger should endeavor to employ a staff group that reflect the residents population. In addition care must be taken when employing relatives to ensure that no conflict of interest or detriment to residents or other staff Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: occurs. Staff are provided throughout the 24 hour period and include waking night staff. Staff in this home have remained consistent for several years and very few vacancies occur, however two new staff had been appointed in the last year. We inspected some of the staff personnel files to check that staff had been safely recruited. The personnel files are securely stored in the main office. The documentation seen in the staffing files indicated that applicants are interviewed, application forms completed; appropriate forms of identification sought; two written references obtained and authenticated by way of a company stamp or headed paper, and enhanced Criminal Record Bureau (CRB) checks undertaken. Applicants complete a self health declaration regarding their current health. The home has a programme of induction in place for all newly appointed staff. On asking staff what this consisted of i.e. duration etc, variable information was provided. The duration was said to be from half a day to two weeks. All staff must be safely inducted into the home and its workings, with sufficient time allowed for this process. The manager said that staff were perhaps confused over what constituted induction and that all staff were provided with comprehensive induction. All new staff are on a three month probation period. Terms and conditions and job descriptions are issued. The home has a reciprocal arrangement with SLAM and it is they that provide training to staff in this home. A lot of training is provided by SLAM covering mandatory topics and others specific to mental health. Recent topics had included the Mental Capacity Act, recovery training and social exclusion. In return the manager delivers training for staff employed by SLAM. Training information was provided to us by a senior support worker, who co ordinates the training. All but 2 of the staff group have achieved their NVQ qualifications at level 2, whilst two others were in the process of completing their NVQ level 4. Some certificated evidence was seen in the staffing files inspected that supported staff attended training courses. It was difficult to establish that staff had been regularly updated on the mandatory topics, and that these had been addressed at the stated intervals. It is required that the manager ensures certificated evidence is held on staffing files that supports staff attendances at training events and that an accurate Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: staff training matrix be completed. The manager told us that over the last nine months the frequency of staff supervision had improved and staff had received the required levels of supervision. In the staff files supervision documentation was retained. These showed supervision sessions had been conducted and records kept. Staff confirmed that they were receiving supervision on a regular basis and that these these were open discussion about their work, training needs and any other issues. The AQAA told us the following :The turn over of staff is very low. Staff receive regular supervision. The service users are in receipt of care from skilled staff who are competent in their respective area of care Care Homes for Adults (18-65 years) Page 25 of 31 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. The home is effectively managed. Quality assurance measures include the views of those in the service. Health and safety service certificates were up to date ensuring the premises are safe. Evidence: The home has a new manager Mr Salim Atchia, who was appointed July 2009. The manager is a trained mental health nurse and well qualified in many fields. He has attained certificates in Psychotherapy and Counseling, a Bachelors Degree in Health Promotion as well as Post Graduate Certificates in Management and Human Resources. Additional training has included courses covering Drug and Alcohol Abuse and Clinical Supervision. Mr Atchia also holds a paid position with the Mental Health Act Commissioners ,which he does on a part time basis.It is through this work that he has gained considerable experience knowledge and skills particularly in relation to the Mental Health Act, Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: records and documentation. He has applied through CQC for registration, although to date this has not been completed. It was evident throughout the visit that he had made a positive impact on the service and this was related to us on many occasions. The manager told us that residents and relatives satisfaction surveys are sent out every three months. Once the surveys are received the comments are collated into a report and action taken on areas of need. Those completed surveys seen indicated a high percentage of satisfaction with the service. Mr Atchia holds residents meetings every two months and at other times when circumstances dictate, such as the recent incident whereby a resident died suddenly. This meeting was to provide support to residents after this tragic event . Other residents meetings are focused on the day to day business of living in the service, where issues such as refurbishment and upgrading are discussed along with any activities which may be taking place. Meetings are organized for Saturdays as this is when there are the most people in the service and it prevents clashing with hospital appointments etc. The service has very few relatives who visit, and it is for this reason that staff offer one to one sessions. Staff meetings are held every two months for all staff. These meetings are minuted and then circulated. Staff need to sign the minutes to say they have seen them. Other quality related meetings are in the form of the regular review meetings, usually held in the home, where members of the multi disciplinary team assess the progress made in the residents rehabilitation and mental health condition. We met with one health professional who was a budget holder and placed residents in this service. Whilst he accepted that the service was not cheap, as the top tier of fees are £1500.00 per week he felt it was value for money. He evidenced this by saying residents were well supported by the staff and many residents were now living in more independent accommodation, hence in the long term it was cost effective. Each resident in this service has a bank account. There is also a book retained on site, Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: which is a record of residents expenditure. Residents are able to sign for their money and if this is not possible staff sign the transactions. Receipts for expenditure are retained only if residents produce them. The home has policies to cover health and safety and these are available to staff. A number of service and maintenance certificates were inspected to check that the home is safe for residents to live in. The records were well organized and easy to access. Stickers confirmed PAT testing was current as was the five year electrical certificate. The gas service had taken place February 2010. The employers liability insurance certificate was current. There are no lifting aids or lift in this home Fire safety records were inspected. The fire alarm is tested weekly and different zones activated. The fire alarm panel call points and smoke detectors had all been serviced. Regular checks are made on fire door closures. Fire records showed fire drills had been conducted for day and nights staff. The home is reminded that the recommendation is that night staff have four fire drills, and day staff have two annually. The fire drills must include all those working on the premises including temporary staff and where possible residents. The environment was maintained hazard free and all COSHH products securely stored. Some of the hot water outlets felt hot and these must be checks made to ensure these are safe for residents to use. Care Homes for Adults (18-65 years) Page 28 of 31 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 29 of 31 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 35 18 It is required that the manager ensures certificated evidence is held on staffing files that supports staff attendances at training events and that the training matrix is current. To provide evidence that staff receive the appropriate and updated training to do their jobs. 31/08/2010 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 2 3 18 21 32 Residents should be monitored to ensure that they maintain a healthy weight whilst eating a balanced diet. The staff should be subject to regular proficiency training in respect of medication procedures. The manager should endeavor to recruit a staff group reflective of the residents population in terms of ethnicity and race. Page 30 of 31 Care Homes for Adults (18-65 years) Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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