Inspection on 10/06/08 for MI CASA

This is the latest available inspection report for this service, carried out on 10th June 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

MI CASA 06/10/06

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 MI CASA 15 Duckett Road London N4 1BJ Lead Inspector Jane Ray Unannounced Inspection 10th June 2008 9:30 MI CASA DS0000067230.V365564.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 MI CASA DS0000067230.V365564.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. MI CASA DS0000067230.V365564.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service MI CASA Address 15 Duckett Road London N4 1BJ 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) 020 8340 2447 020 8967 3021 briione@yahoo.com Precious Homes Ltd Care Home 5 Category(ies) of Learning disability (5) registration, with number of places MI CASA DS0000067230.V365564.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th October 2007 Brief Description of the Service: Mi Casa is owned by Precious Homes Ltd and is registered to provide residential care for five adults who have a learning disability. The home is situated next to another registered care home owned by Precious Homes Ltd. Both homes are self-contained and have their own separate staff groups. The homes share one manager. Mi Casa is a large three storey terraced house that has been converted for use as a residential care home. The communal space is accommodated on the ground and lower ground floors. The lower ground floor consists of a kitchen and dining area, laundry room, staff office. The basement has been converted to create a large activity room. There is a small rear garden accessible from this floor. The ground floor consists of the main entrance hall, lounge and manager’s office that also contains the medication storage cupboard and a separate toilet with wash hand basin. The five residents bedrooms all have ensuite facilities and are spread across four sub landings along with an additional toilet and shower room. The home is within easy access to local shops, restaurants, pubs, and public transport and near to Wood Green shopping city, Finsbury Park and Alexandra Park. Depending on the service users’ assessed needs, the fees for the current three residents range from £1000 to £1785 per week. The home’s stated mission is to be dedicated to creating a safe enabling environment in which individuals can experience respect, dignity and positive valuing and thereby sustain meaningful and fulfilled lives. The home also states that it seeks to provide high quality support in a residential care setting to adults with learning difficulties and challenging behaviour. This support reflects the individual residents unique needs and aspirations and cultural values, promotes autonomy and self-determination and enables the residents to lead their preferred way of life. A copy of this report can be obtained direct from the provider or via the CSCI website (web address can be found at page two of this report). MI CASA DS0000067230.V365564.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The inspection took place on the 10 June 2008 and was unannounced. The inspection lasted for six hours and was the key annual inspection. The inspection looked at how the home was performing in terms of the key National Minimum Standards for Younger Adults and the associated regulations. The inspector was able to observe the support given to the current residents and to talk individually to one of the residents. The inspector was also able to spend time talking to the manager as well as the two care staff who were working. The inspector did a tour of the premises and also looked at a range of records including resident records, staff files and health and safety documentation. The home had provided the inspector with a completed self-assessment questionnaire (AQAA) prior to the inspection. The inspector also received two completed surveys, one from a relative and another from a care professional. What the service does well: What has improved since the last inspection? There have been a number of significant improvements since the last inspection in October 2007 where it was felt that the service was providing adequate outcomes for the people living in the home. Most significantly the MI CASA DS0000067230.V365564.R01.S.doc Version 5.2 Page 6 home has a permanent manager who is applying to be registered and she is supported by a recently appointed area manager who has experience of managing services for people with a learning disability. Both the manager and area manager have worked very hard to improve standards in the home. The staff team has remained reasonably stable and the staff have got a good relationship with the residents that is enhanced by an effective key-worker system. Staffing levels allow residents to participate in a programme of activities. Staff performance is now developed through the completion of an induction, a programme of ongoing training and regular supervision. The care plans have been reviewed and person centred plans introduced for the residents. These care plans are being reviewed at regular intervals. Risk assessments have also been put into place to help safeguard the residents. Healthcare input is now recorded including the outcomes of appointments so that any ongoing support can be monitored. The activity room is now safer as old and broken pieces of equipment have been removed. The home now has an updated statement of purpose that provides accurate information to care professionals and other people who want to know about the service. Any complaints are now correctly recorded and include the action and the time taken to address the complaint. 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. MI CASA DS0000067230.V365564.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 MI CASA DS0000067230.V365564.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 1,2,3,4 and 5 were inspected. People using this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home can be assured that their individual needs will be assessed and that the staff have the skills and ability to meet these needs. New people moving to the service will have access to information in an appropriate format to tell them about the home. The contracts between the home and the resident are not yet completed fully. EVIDENCE: We inspected the statement of purpose and this document had been updated to provide specific information about the home and the resident group they care for. This document is clear and would be useful for care professionals and relatives who could need information about the service. In each residents case notes we were able to see that they had been given a service user guide in an appropriate pictorial format. We looked at the case notes for the three people who live in the home. They all had assessments that formed part of their individual care plans that covered MI CASA DS0000067230.V365564.R01.S.doc Version 5.2 Page 9 their current individual needs and provided a good basis for the care plan goals. We discussed the current needs of the people who live in the home with the manager and care staff. They have very specific individual needs linked to their learning disability, complex behaviours, autism and epilepsy. The staff spoken to had a very good understanding of the individual needs of the residents. In addition it was observed that the staff were supporting the residents with great skill and sensitivity. The training programme till the end of the year was also inspected and it was positive to note that training sessions are planned on mental health and autism as well as supporting people who have complex challenging behaviours. There have been no new people moving to the home since the last inspection although the manager explained that interest has been expressed in one of their vacant rooms. The manager also explained that residents with their relatives and other care professionals are supported to visit the home as part of the process of deciding if they want to move to the service. The AQAA prepared by the home stated that all the residents had a completed contract between themselves and the home clearly stating what the service will provide. The three case notes that were inspected all included copies of the contract but these had not been signed by a representative acting on behalf of the resident, no fee was included and any specific input such as one to one staffing had not been recorded. The organisation had produced a user-friendly document explaining the rights and responsibilities of the residents and the care provider. MI CASA DS0000067230.V365564.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 and 9 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home can be confident that they will be supported to have an individual care plan and risk assessments. This will facilitate the residents to make choices in their daily lives. EVIDENCE: We inspected care plans for three people currently living in the home. We also spoke to the manager and care staff about the care plans. All of the people whose records were inspected had comprehensive care plans in place. These were clearly laid out and covered all aspects of each persons needs and were written using appropriate language. The care plans had all been reviewed on a monthly basis by the key-worker. Two of the residents had been supported to have an annual care plan review meeting with their care manager and the third resident had met regularly with his care manager and had a review meeting MI CASA DS0000067230.V365564.R01.S.doc Version 5.2 Page 11 arranged. One resident was asked about his care plan and said he “understood what it was about” and had been “involved” in preparing the person centred plan. Each resident had a named key worker and co-key worker. The staff were asked about their role as a key-worker and this showed that the support they provided was very comprehensive including helping with personal shopping, attending healthcare appointments, ensuring all the residents personal care needs were met, organising leisure activities and updating care plans. The staff spoken to said, that they felt they were well matched as key-workers and shared interests or a cultural background with the residents. The staff also showed a good understanding of each resident’s individual care plan goals. Since the last inspection the home has also developed a user-friendly person centred care planning process for the resident’s. The manager explained that there is still more work to take place to make these documents accessible through the use of photos. We read the risk assessments for the same three people who live in the home. It was possible to see that an effort had been made to identify areas of personal risk and look at how this can be managed without placing unnecessary restrictions on people. The risk assessments had been prepared using one main format that was clear and easy to follow. It was also possible to observe the actions from the risk assessments being implemented in the home, such as supporting people in the kitchen and these clearly helped to maintain the safety of the residents. Each person living in the home had individual behavioural guidelines as part of their individual profile, assessment and care plan and these were clearly written and gave appropriate guidance to the staff. The three residents assessments and care plans clearly stated what arrangements were in place to support them to manage their personal finances including who acts as their appointee and how they can access their monies. We observed the three people living in the home and their interaction with the staff. It was positive to note that they were being facilitated to make choices including when they wished to get up or move around the home, when they were ready to eat and in some cases what they wanted to eat or drink. The staff were observed to be very aware of both verbal and non-verbal communication. They were also able to describe how they facilitate choices by for example offering a choice and observing the residents response. MI CASA DS0000067230.V365564.R01.S.doc Version 5.2 Page 12 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 and 17 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home are supported to develop their daily living skills and are also enabled to follow their own routine. The home has made progress in supporting the residents to enjoy a range of activities during the daytime based on their individual interests. Residents are offered a healthy and varied diet. EVIDENCE: The staff spoken to explained that the people living in the home were being supported by staff to develop their independent living skills in line with their individual needs. For example one person enjoys hovering and mopping the floor. Another resident helps staff in the kitchen with cooking. The third resident was able to tell the inspector how he enjoys cooking and also keeps MI CASA DS0000067230.V365564.R01.S.doc Version 5.2 Page 13 his room clean and does his laundry on a weekly basis. The development of independent living skills was also reflected in the residents care plans. Here it could be seen that there was a strong focus on developing greater independence by developing skills to manage their own personal hygiene or improve domestic skills. We spoke to the staff and looked at the resident’s activity programmes to get an understanding about the activities that are taking place. The manager explained that one of the residents goes to a specialist day centre five days a week. The other two residents are supported by staff to participate in a range of activities. One of the residents is very independent and wants to be able to make his own choices in terms of how he spends his time. He said that he enjoys exercising at home, watching television, going shopping and cooking. He is also working with his key-worker and care manager to explore supported employment. On the day of the inspection he went out cycling with a member of staff. He also said that he had a freedom pass and made good use of public transport. Another resident has a more structured programme that includes activities in the home as well as accessing community facilities in the local area. The key-worker said that they go out every day for a walk and the resident also enjoys drumming. One relative in the survey said that they felt more use could be made of public transport and of local sports facilities. We could see that due to the complex needs of the residents, these activities need to be carefully arranged considering risk management issues. In terms of staffing, there are two staff on duty during the day. The manager is also based at the home during the day. One resident needs two staff in order to go out and the staff said that this is possible almost every day, whilst one resident is at the day service or visiting relatives. In terms of holidays the manager explained that they are looking at different options for a holiday later in the year. One resident may go away with a group from another service. The AQAA identified that the residents have different ethnic and cultural backgrounds. One person is a practising Muslim and has a key-worker who is the same religion. The key-worker has liaised with the relatives and has arranged for him to eat halal meat and supports him to visit the mosque. One other resident said he did not wish to attend a place of worship. The other resident may wish to follow a religion and this could be explored in the future. The manager explained that the people living in the home have close contact with their relatives, who either come to visit them or they are supported to go home. One relative visits the home almost on a daily basis. One resident said he enjoyed seeing his friends and girlfriend when he visited his relatives. We were able to observe during the inspection that the people living in the home were able to follow a routine of their choice and that people get up at MI CASA DS0000067230.V365564.R01.S.doc Version 5.2 Page 14 different times according to their individual wishes and needs. It was very positive to note that the residents were supported in a very person centred and individual manner. We saw the new six-week menu that has just started being used in the home and this offered a nutritional choice. The manager explained that this would be evaluated once they could see what the residents enjoy. One person said he often chooses an alternative to the menu and that he was pleased because the meat, being used in the home was fresh from a local butchers. MI CASA DS0000067230.V365564.R01.S.doc Version 5.2 Page 15 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 and 20 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home are supported in a manner that protects their privacy and dignity. Each person is supported to access professional healthcare input based on their individual needs. The medication administration records are not completely accurate and need to be reviewed. EVIDENCE: We observed during the inspection that the staff were supporting the people living in the home to receive personal care in a manner that preserved their privacy and dignity. It was observed that all the residents were wearing clothing that was in good condition although one person was initially wearing a jumper that appeared to be too warm considering the sunny weather. The resident was supported to change the jumper later in the day before leaving the home. The manager and care staff explained about how relatives buy clothes for some of the residents. All the residents were also well groomed in MI CASA DS0000067230.V365564.R01.S.doc Version 5.2 Page 16 terms of their personal care including haircuts. One relative did however comment that she felt personal care could be done better as part of the survey. We looked at the healthcare records for the three people living in the home. They had all been supported to access a range of healthcare professionals including the GP, psychiatrist and other appointments according to their individual needs. One resident has recently been referred to a psychologist to address issues relating to his complex needs. The manager also explained that the residents who cannot access local dental and optical checks had been referred for specialist input. All the residents are being supported to have their weight checked on a monthly basis and any additional input is reflected in their individual care plans. We looked at the medication, administration records and staff training records. The home uses the Boots blister pack system. The medication is stored in a medication cupboard in the manager’s office. The medication administration records do not record when all the medication is delivered to the home and so a clear audit trail is not available. One medication administration record said that the medication should be administered in the morning, but this medication is now administered in the evening. Each resident had a profile and these appeared accurate and reflected the medication on the medication administration record. Each resident also has a list of homely remedies they can take and this has been approved with the GP. Since the last inspection the manager has revised the information for each resident giving clear guidelines on how medication should be managed during regular home visits. The training records were inspected and all of the staff had completed the medication training. MI CASA DS0000067230.V365564.R01.S.doc Version 5.2 Page 17 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 and 23 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home have access to an appropriate complaints procedure. Procedures and training on safeguarding vulnerable adults are in place to protect the residents. New systems have been implemented to ensure residents personal monies are being managed appropriately. Insufficient training places are currently available to ensure all the staff receive training on how to appropriately support people who have complex and challenging behaviours. EVIDENCE: The AQAA stated that there have been no written complaints since the last inspection, however since this assessment was completed there has been one complaint. The organisation has two complaints procedures, one designed for the service users and the other for relatives and care professionals. Both these documents are clear and can be found in the service user guide. The home has a format available to record any complaints and this had been completed for the complaint received and included details of all the actions taken and the timescale of the response. We were able to see that the Area Manager had tried to respond in a thorough manner to all the issues raised. The staff spoken to during the inspection understood how to respond appropriately to any complaints received. MI CASA DS0000067230.V365564.R01.S.doc Version 5.2 Page 18 There have been no adult protection issues since the last inspection. Copies of the organisations procedures and social service procedures are available in the home. A user-friendly policy has also been prepared for the residents to help them think about how they can keep safe. I looked at the staff training records and these show that some of the staff had received safeguarding vulnerable adult training and further training is booked for the rest of the team. We spoke to the care staff about the safeguarding adults procedure and they all displayed a good knowledge of the procedures and the importance of speaking to the manager about issues that arise. In addition safeguarding is discussed as part of the staff induction and in ongoing supervisions. We also looked at the training records to see if the staff had been trained on how to appropriately support people who have complex challenging behaviours. These show that two staff have received this training and further training is booked on breakaway techniques and three staff will be attending. Four further staff still need to receive the training and this is a priority to ensure that staff respond appropriately to residents if they are distressed. We checked the personal finances for two residents including their cash record, cash and receipts. The third resident manages his own personal monies. The two residents who are supported by the home to manage their monies, both have relatives who act as their appointees. In the home there is an individual finance record for each person and their cash is held in a lockable filing cabinet. All expenditure is recorded and receipts are available. The record of expenditure was inspected and money had been spent appropriately and receipts were available. The only person with access to the monies is the manager or area manager. A small float is made available for the care staff to access as required. There was clarity about use of resident’s monies when going out for meals. The staff explained that the company pays for the residents’ lunch and first drink as well as a small allowance so staff can also eat something. MI CASA DS0000067230.V365564.R01.S.doc Version 5.2 Page 19 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 and 30 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people who use this service can usually feel confident that they are living in a well maintained home. The home is kept clean and hygienic and is a pleasant environment for the people who live here. EVIDENCE: The home is a converted four storey domestic premises that remains well decorated, well maintained and which continues to provide an overall pleasant environment to meet the current residents needs. We did a tour of the premises and each resident has their own bedroom with an en-suite bathroom. There is also a separate toilet and shower room. The communal spaces consist of the kitchen and dining area, lounge and activity MI CASA DS0000067230.V365564.R01.S.doc Version 5.2 Page 20 room in the basement. The home also has a small enclosed garden and the residents were observed enjoying sitting in the garden. One resident showed us his bedroom and he said he was very “pleased with his room” and liked to keep it clean and tidy. He also explained that he had his own key and could lock his room if he wanted to do so. We looked at the bedding on the resident’s bed and it was observed that one person did not have an under-sheet on their bed and this meant that their bottom sheet was directly on top of a plastic covered mattress, which would be very uncomfortable. It is recommended that an under-sheet is provided at all times. The house has satisfactory laundry facilities and storage for chemical cleaning materials. The home was seen to be clean and tidy during the inspection. MI CASA DS0000067230.V365564.R01.S.doc Version 5.2 Page 21 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 32,33,34,35 and 36 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The residents are supported by a committed and stable team of staff. The staff are receiving a range of training and are supported by regular supervision sessions. This enables them to work to a high standard and deliver good care. Not enough staff are being enabled to undertake the NVQ in care training to ensure staff skills are updated. EVIDENCE: We checked the rota for the home and this showed that there is a team of nine staff working in the service. The staffing structure consists of the manager, one senior carer and a team of carers. During the day there are two staff on duty and at night there is one waking member of staff. The manager is shown as being supernumerary on the rota but is based in the home. The staff turnover has been low and most of the staff spoken to during the inspection had worked in the service for over a year. MI CASA DS0000067230.V365564.R01.S.doc Version 5.2 Page 22 The manager and care staff explained that staff team meetings take place on a monthly basis. The record of these meetings was inspected and it could be seen that they discuss a range of operational issues. The staff spoken to said, that the team felt it was now getting clear direction from the manager. The AQAA prepared by the home stated that two staff are working towards an NVQ. The manager explained that a number of team members were working towards other qualifications for example social work and nursing. There are less than 50 of the staff team who are studying towards an NVQ in care. We looked at the recruitment records for the whole staff team including staff who had started working at the home since the previous inspection. It was found that all the staff had two references, ID, POVA check and a CRB disclosure. The staff had completed and signed contracts of employment. One person did not have evidence of current permission to work in the UK. We inspected the training records. We looked at the induction records for all the staff and they all had completed the skills for care induction programme and a record was available. Each member of staff had an individual training record and most had been supported to complete a training needs assessment. An ongoing programme of training had been booked till the end of the year covering most mandatory training as well as specific training to support staff to work effectively with the residents they support. The staff said that the training they had received was a good standard and very useful for their work. We looked at the supervision records. All the staff had received regular individual supervision, including the night staff. The format used for supervision is appropriate and includes a record of any action agreed. MI CASA DS0000067230.V365564.R01.S.doc Version 5.2 Page 23 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 37,39 and 42 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. A permanent manager who can provide effective leadership is now in place and is completing the registration process. Health and safety measures are in place to safeguard the people living in the home, although some staff still need to receive some training. The quality improvement system seeks the views of people involved in the service. EVIDENCE: In the last year there have been five different managers for this service and this has caused instability and anxiety for all involved. The current manager MI CASA DS0000067230.V365564.R01.S.doc Version 5.2 Page 24 who has considerable skills and experience has made many improvements since she came into post in January 2008. She has applied for registration and is completing a CRB disclosure as part of this process. A new area manager has also come into post and is providing support to the manager. The inspector also met this person during the inspection. Whilst the standard of management in the home was good at the time of the inspection the inspector is also keen to ensure that improvements in this area are maintained consistently for the future. The manager explained that a quality assurance system is in place including regulation 26 monitoring visits to the home undertaken by the area manager and the manager completing a weekly audit. We looked at the records of both these audits and they are completed to a high standard. The company has questionnaires to seek the views of residents, relatives and other care professionals as part of a quality improvement exercise and these have been distributed but they are waiting for responses. In terms of fire safety we looked at the fire safety risk assessment and emergency plan and this was complete. The fire alarm and fire extinguishers had been serviced. The fire alarm records show the alarm is checked weekly and the fire drills have been taking place monthly. The manager explained that fire safety refresher training has been booked for the following week for the whole staff team. The AQAA showed that all the health and safety maintenance checks had taken place. The staff training records show that some staff need to complete some health and safety training including nine for food hygiene, three for first aid and seven for infection control and there is no record of them being offered places. The organisation must ensure all mandatory training is available on a regular basis and offers sufficient places for the staff who need the training. MI CASA DS0000067230.V365564.R01.S.doc Version 5.2 Page 25 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 3 2 3 3 3 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 x 3 x x 2 x MI CASA DS0000067230.V365564.R01.S.doc Version 5.2 Page 26 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. 1. Standard YA5 Regulation 5(3) Requirement Timescale for action 31/07/08 2. YA20 13(2) 3. YA23 13(6) 4. YA32 18(1)(c) The registered persons must ensure signed contracts are in place for each resident in the home that include details of their fees and any specific arrangements. This requirement is amended and restated as previous timescale of 31/12/07 was unmet. The registered persons must 15/07/08 ensure medication is safely managed in the home and record all medication being delivered to the home and ensure the instructions on the medication administration records are correct. The registered person must 30/09/08 ensure all staff are offered training on how to safely support residents with complex and challenging behaviours. The registered persons must 30/09/08 ensure that staff have the appropriate skills by arranging for a minimum of 50 of the staff in the home to have completed or be studying towards an NVQ in care. DS0000067230.V365564.R01.S.doc Version 5.2 MI CASA Page 27 5. YA42 18(1)(c) The registered persons must ensure all staff have been trained in safe working practice topics as detailed in standard 42 of the national minimum standards for care homes for younger adults. This includes first aid, food hygiene and infection control. This requirement is amended and restated as previous timescale of 31/01/08 was unmet. 30/09/08 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. 2. Refer to Standard YA24 YA34 Good Practice Recommendations The registered person should ensure the residents have an under-sheet on their bed to ensure they are comfortable when sleeping. The registered person should ensure the staff all have current permission to work in the UK. MI CASA DS0000067230.V365564.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 MI CASA DS0000067230.V365564.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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