Inspection on 28/10/06 for Dimensions 47-48 Chichester Court

This inspection was carried out on 28th October 2006.

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 found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Dimensions 47-48 Chichester Court 09/11/07

Dimensions 47-48 Chichester Court 23/02/06

Dimensions 47-48 Chichester Court 14/09/05

Dimensions 47-48 Chichester Court 01/02/05

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 08/07/2008.

CARE HOME ADULTS 18-65 Adepta 47-48 Chichester Court 47-48 Chichester Court Stanmore Middlesex HA7 1DX Lead Inspector Clive Heidrich Key Unannounced Inspection 28 October and 7th November 2006 10:50 th Adepta 47-48 Chichester Court DS0000062639.V317346.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 Adepta 47-48 Chichester Court DS0000062639.V317346.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. Adepta 47-48 Chichester Court DS0000062639.V317346.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Adepta 47-48 Chichester Court Address 47-48 Chichester Court Stanmore Middlesex HA7 1DX 020 8905 0442/0310 020 8343 8876 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) www.Adepta.org.uk Adepta Miss Eugenia Delgado Palacios Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Adepta 47-48 Chichester Court DS0000062639.V317346.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd February 2006 Brief Description of the Service: 47 and 48 Chichester Court are two homes within a purpose-built complex managed by Adepta (previously named Pentahact). The homes are managed by one person, but otherwise generally function individually. The homes provide long-term care and accommodation for up to 8 adults who have learning disabilities. The building is maintained by the Metropolitan Housing Association. All service users have their own bedroom. The bedrooms are spread across two floors. Each house has its own lounge and dining area as well as bathrooms on each floor. There is a garden to the rear of each house. The homes are fully wheelchair accessible downstairs. Access to the first floor is by stairs only. The homes are quite close to shops, leisure facilities and local transport. A minibus is shared with the other houses in the same complex. Unrestricted parking is available on the road leading to the house. The home’s Service User Guide is available on request. The weekly fees for services are £1186.87, based on the current block contract in operation at the home. Adepta 47-48 Chichester Court DS0000062639.V317346.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Since the last inspection, the organisation has advised the CSCI that it has changed its name from Pentahact to Adepta. This inspection took place across two days, including one Saturday. It lasted just over thirteen hours in total. The focus was on inspecting all of the key standards, and with checking on compliance with requirements from the last inspection report. The inspection process included the discussing with service users, where possible, about their experiences of the service. This was supplemented by passing on surveys during the first day of visiting, for the home to pass onto each service user and their representative. Three surveys were returned. The inspection process also involved observations of how staff provide support to service users, discussions with staff about the work, checks of the environment, and the viewing of a number of records. The manager was present during the second day of the inspection, and was provided with overall feedback at the end of the visit. The inspector thanks all involved in the home for the patience and helpfulness before, during, and after the inspection. What the service does well: Overall this home is managed well by an experienced manager and a dedicated group of staff. Staff have a good understanding of the service users’ needs. The ethos of the home very much supports service users’ rights and independence. The home continues to uphold an excellent standard of supporting service users to uphold relationships with family and friends. This includes with visiting, having people visit, and in one case going on holiday with a friend. Staff capably supported service users with preparing for visits, and appeared familiar with family members. The home continues also to enable service users to pursue leisure activities in the home and in the community. For instance, at the time of the inspection, service users talked with the inspector about the Halloween decorations that they had been involved in, and about the club that they would be visiting in the evening. The home continues to accept, consider, and address shortfalls in respect of complaints raised by both service users and family members. Adepta 47-48 Chichester Court DS0000062639.V317346.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Two issues about better respecting service users arose. Staff omitted to support service users to change soiled clothing on two occasions during the inspection, which compromises service users’ dignity. There was also personal information about service users on the notice-boards in the kitchens, which could consequently be viewed by inappropriate people. The manager agreed to address both issues. Blood-sugar skin-prick testing is recently taking place for one service user without staff being suitably trained by an appropriate professional. This puts the service user at risk of the procedure being poorly managed. The manager agreed to address this. There was some evidence of staffing levels being sometimes insufficient to meet current service users’ combined needs. For instance, some service users displayed behaviour that challenged the service in one home when their requests to go out were put on hold due to staffing numbers. The manager must formally review and address staffing levels based on service users’ collective needs. There are a few other requirements in the list at the end of this report, relating to some maintenance issues, monthly monitoring visits, and as-needed medication. Adepta 47-48 Chichester Court DS0000062639.V317346.R01.S.doc Version 5.2 Page 7 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. Adepta 47-48 Chichester Court DS0000062639.V317346.R01.S.doc Version 5.2 Page 8 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 Adepta 47-48 Chichester Court DS0000062639.V317346.R01.S.doc Version 5.2 Page 9 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): 1 and 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There have been no further admissions to the home since the last inspection. The home was previously judged as being capable of suitably assessing prospective service users’ needs. Prospective service users can expect to receive up-to-date information about the services at the home, to help with decision-making. EVIDENCE: The home has not admitted any new service users since the last inspection, and they have no vacancies. Since becoming part of the Adepta organisation, the manager has updated the Service User Guide. The guide was seen to suitably contain relevant and pictorial information about the service. The manager also provided evidence of working similarly on the Statement of Purpose. Adepta 47-48 Chichester Court DS0000062639.V317346.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): 6, 7, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are suitably supported to make and act on decisions about their lives. Where the decisions involve risk, this is suitably assessed so as to enable independence as much as possible. There are good standards of providing service users with suitable individual plans that reflect their needs. Information is generally securely stored. The only improvement needed is with ensuring that records on display on noticeboards in the kitchens do not compromise service users’ confidentiality. EVIDENCE: The care files of one randomly-chosen service user from each house were checked through. This included the care plan, health-assessment plan, comprehensive risk assessment, and the minutes of the last formal review meeting. There were generally good standards of person-centred planning based on the service user’s needs and wishes. The care plan was comprehensive but focussed on the key support needs. The risk assessment was also comprehensive and practical, focussing very much on what the risks Adepta 47-48 Chichester Court DS0000062639.V317346.R01.S.doc Version 5.2 Page 11 are and how these will be minimised. Where it is judged that the service user may be able to understand some parts of the documentation, the documentation includes many pictures to help with the understanding. The service user in this instance had also signed the documentation. The other service users’ file was actively being worked on, to update it following a recent formal review. All of this documentation is stored securely in the office. Formal review meeting minutes showed that these meetings are held sixmonthly. Relevant people are invited, including the service user, family, daycentre worker and social worker. There was feedback from staff about there being clear goals for service users, and about the majority of these having been achieved. It was overall found that guidance documents about the support each service user needs might be in the care files, in a staff induction file, or in the service user’s daily record file. A suggested improvement, for easy accessibility of relevant and current guidance, is for key guidance sheets to be stored in the daily record file. The inspector found for instance that staff are expected to fill in monitoring sheets in respect of following a program for a service user, but that the guidance connected to the sheet was not stored with the monitoring sheet. Similarly, some guidance in the daily records was out of date. The manager agreed to address this. There was good evidence of service users making decisions for themselves. One service user asked for support for a bath in the early afternoon, which staff organised. One service user was seen to be excited about the imminent arrival of her father. As she kept focussing on the door, staff supported her to have a look around the area outside of the house whilst awaiting the arrival. One service user acquired the support of staff to get their chosen seat at the dining table from the inspector. Service users were seen to have reasonable freedom to take snacks from the kitchen. However staff also explained that they monitor food intake for some service users due to the service user’s specific health needs regarding overeating, and as some service users may try to eat inappropriate items that could cause them harm. Consequently, the kitchen in one home is kept locked if staff are not available to provide support in the kitchen or lounge. At one stage during the first day of inspecting, one service user noisily expressed their dissatisfaction with not being able to go out. Staff reported that this was due to them seeing another service user go out. The teams in both homes arranged to support the service user to go out a little later, when suitable cover for those still at home could be provided. The inspector was informed that service users have fortnightly tenants’ meetings, within which planning as for menus and activities take place amongst other issues. The minutes of one meeting noted about one service user raising a complaint about not receiving support to pursue a decision. The Adepta 47-48 Chichester Court DS0000062639.V317346.R01.S.doc Version 5.2 Page 12 issue was recorded in the complaint file as being upheld and was consequently addressed. This all shows good standards of enabling service users to make decisions about their lifestyles in the home. Risk assessment documentation showed that service users are enabled to take reasonable risks, and that actions are taken to minimise the hazards where risks are considered too much. There was feedback about service users being supported for instance with going on holiday both abroad and more locally. There was consideration of risks against benefits, with independence being clearly valued. There was a generally strong focus on independence for service users, such as with skills developments in the home, and on rights such as with recognition and valuing of bedrooms as belonging to individual service users. The overall judgement on the risk management for service users is seen as at a suitable and enabling standard. The inspector noticed some personal information about certain service users on display on notice-boards in both kitchens. This is not sufficiently confidential, as anyone including for instance visitors may be able to view this. The manager agreed to address this as required, making key information for staff available within a folder that will be stored within the secure filing area in the kitchen. This will also enable the kitchens to be more homely. The inspector noted that information stored in the offices is kept suitably secure. Adepta 47-48 Chichester Court DS0000062639.V317346.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): All of them. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There are excellent standards of supporting service users to be part of the community, and with maintaining and developing relationships with friends and family. This is all undertaken with particular reference to each service user’s individual needs and wishes. There are also good standards of supporting with appropriate occupation and leisure, enabling skills, maintaining service users’ rights, and providing appropriate meals. EVIDENCE: There was a reasonable focus on service users developing and upholding skills and responsibilities around the home. Depending on individual abilities, service users were asked to do such things as tidy their room with staff support, or to help make cups of tea for themselves. Staff also made efforts to get service users to be independent where possible, such as with getting a coat or Adepta 47-48 Chichester Court DS0000062639.V317346.R01.S.doc Version 5.2 Page 14 preparing a snack themselves. There were also reasonable references to skills developments within care plans and other records. There was some good evidence of service users’ rights being valued. There is for instance an attitude of the rooms being private, and hence they are generally not accessed by staff unless with the service user’s permission. Some bedroom doors lock automatically when shut, to help keep personal property secure. Fire-safe door release mechanisms have been purchased where service users do not want the door shut, to allow the door to be kept open safely. Some other service users have keys that they can use to access their rooms. Service users can also lock bedroom doors from the inside. Staff treated service users respectfully, including through responding to service users’ communications, and in the way that service users were generally spoken about. Staff were seen to respect decisions made by service users. For instance, one service user refused to get changed for going out to an appointment. The involved staff member handled this by gently reminding the service user every five minutes or so, until the service user was ready. Staff and service users reported that each service user has an individual package of occupational arrangements during the week. Most people attend a day care service for most of the week. However, individuals also have days to attend college classes, work at a local shop, have family or friends visit, and follow an activities program provided by the home. Service users generally spoke positively about these set-ups. Staff noted that for day centres, they communicate key issues via books and phone calls, and that service users can and do choose occasionally not to attend the service. Service users talked positively about the community activities that they undertake. There was much excitement in one home about the upcoming ‘Apple Club’ party and general Halloween related activities such as the pumpkin that had been carved out in the kitchen. There was also feedback from service users and staff about going shopping, going to a local football club, going to a local recreational club, going to music & singing sessions, and eating out. Records showed that some internal activities are pursued, including puzzles and music. A couple of service users in one house were also seen to laugh along at points to a film on the television. Feedback, observations and records showed a clear attitude amongst staff of trying to support service users to have a community presence. Staffing is sometimes specifically rostered to enable community presence, such as for college support and to enable service users to attend local recreational clubs in the evenings. The manager explained that additional funding, for the community support of two service users from one house, had recently been ended by the funding Adepta 47-48 Chichester Court DS0000062639.V317346.R01.S.doc Version 5.2 Page 15 authority. There was documentation to show that this is being challenged, on the basis of its benefit to the service users. It was clear from risk assessments and records that such community presence is difficult to achieve with the minimum staffing levels. Service users spoke positively about their holidays this year. For instance, three people had been to a hotel in Spain. Another service user had flown to a separate foreign holiday. One was awaiting a holiday in France. Other service users had generally holidayed more locally. There was clear effort to meet service users’ needs and wishes in respect of holidays. There are excellent standards of enabling relationships with family and friends. Visits to and from people are supported. For example, two service users continue to meet weekly with colleagues from a home that they all used to live at. One service user has a set day off from their day centre to meet with their boyfriend; another to meet with their mother. One service user went on holiday with a service user from another residential home. One service user is being supported with a recent family bereavement through staff openly responding to their communications. A pictorial book about death has also been acquired for the service user and was seen to be beneficially used by them. During the inspection, one service user’s father popped in to say hello to them. Two sisters got dressed up to visit their family. One service user had already gone out for the weekend. Records, feedback and observations generally suggested good relationships between family members and staff. In terms of food provision, one service user was seen to be offered breakfast when they got up at around 10:30 in one home. Staff provided some choices, and worked with the service user to enable them to have their breakfast. In the other home, the lunch matched the menu. Records showed that service users can change their minds about what to eat. Staff explained that service users choose the menu for the week in advance, using picture books to assist. Staff noted that they work to enable everyone to have their favourite meals across the week. One service user from each house undertakes the weekly shopping from a local store as part of their weekly daytime occupations. Both houses were seen to have sufficient food available. One house was wellstocked, the other reasonably so considering that the food-shopping day was almost due. Fruit, biscuits and crackers were easily-available for snacks. Records of the food eaten are kept in each house. Each house has homecooked food based on its service users’ wishes. Some meals reflected the cultural diversity of the homes. The meals are suitably nutritious. Adepta 47-48 Chichester Court DS0000062639.V317346.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): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are excellent standards of meeting service users’ health needs. This comes through both support with accessing appropriate healthcare professionals, and with suitable planning and actions in-house. There are generally strong standards of medication and personal support in place. However improvements in specific areas, mainly to do with supporting service users with upholding suitable appearance, and to implement safer systems of handling blood-sugar testing for one service user, are needed. EVIDENCE: Service users were generally provided with appropriate support for personal care. For instance, one staff member was seen to spot the Makaton communication of a service user and offer toileting support immediately. Staff arranged for a service user to have a bath at the service user’s request. There were no offensive odours that could suggest poor personal care support. Service users had reasonable hair and nail care. Staff were clear on when they provide this support themselves, and where family or professionals undertake it. Service users had individually fitting clothing that was well-maintained. Adepta 47-48 Chichester Court DS0000062639.V317346.R01.S.doc Version 5.2 Page 17 However in both houses one service user each was able to spend over an hour walking around with food-staining on their clothing. Staff were not seen to provide support for this except for when supporting the service user to get changed for going out. The service users’ dignity was compromised by having stained clothing. The manager agreed to ensure that this is addressed. There was an impressive amount of Makaton communication between staff and some service users. All staff had some degree of ability and willingness to communicate this way, including new staff. One staff member said that they had recently had training in this respect. There was however a lack of individual guidance easily available on the individual signage used by service users. It is recommended that this be set up. Both homes have picture-rosters in place. These utilise pictures of staff and of activities, to help some service users to plan ahead and be more in control of what is planned for the day. Staff for instance noted that one service user uses them to communicate further about their day. The standard of healthcare recording was generally excellent. A wide range of appropriate healthcare professionals are accessed, including GPs, psychiatrists, audiologists and dieticians, based on individual needs. Each service user has a healthcare assessment, to help to plan what support they need. There was good evidence, from feedback and records, that these plans are addressed. One service user was made aware of an impending visit to the GP on the second day of inspecting, which took place successfully despite the service user showing some clear signs of anxiety about it. Significantly, staff were seen to communicate respectfully and reassuringly to the service user in response to the service user’s verbal expressions of anxiety. Some service users were able to say that they get support from staff to attend health professional meetings. There was also positive feedback received from a health professional about the standards in the home. The evidence overall points towards excellent standards of support with healthcare. The manager stated that one service user has frequent blood-sugar level tests as an outcome of their health action plan. She explained that staff undertake this prick to the service user’s finger, following the instructions from the kit provided and from a previously-trained staff member. This is not in line with CSCI guidance, as the lack of direct formal training and accountability for what is a nursing procedure puts the service user and staff at risk of the procedure being poorly carried out. Appropriate professional training and accountability is required, along with confirmation that the procedure is covered within the home’s insurance policies. If not, the procedure must be carried out by an appropriately trained health professional. The manager agreed to address this. The medication systems and practices were checked. No service users in the home are assessed as capable of self-medicating. Medication was seen to be Adepta 47-48 Chichester Court DS0000062639.V317346.R01.S.doc Version 5.2 Page 18 securely stored. A 28-day blister-pack system is used. Records of administration are now signed by two staff, and there are checks of the medications at staff handovers. This improves on previous practices, and helps to minimise the chances of medication errors. Administration records were upto-date, the medication cupboard was tidy and clean, and there were no expired medications found. The pharmacists last check identified only the need to keep temperature records, and these were now taking place. There were impressive standards of documenting about the PRN (as-needed) medications of service users, including about when the medication can be offered and in what form. Administration records included about PRN paracetamol but this was not included within the PRN records. No such medication was available in the medication cupboard. The manager explained that it is no longer intended for use, in which case it must be removed from the administration records. Adepta 47-48 Chichester Court DS0000062639.V317346.R01.S.doc Version 5.2 Page 19 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): Both of them. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good standard of enabling service users’ views to be listened to and acted on. Complaints are dealt with appropriately. There is an excellent standard of protecting service users from abuse. This includes through the provision of relevant training, and through the implementation of appropriately client-centred support in respect of behaviours from service users that challenge the service. EVIDENCE: Survey feedback found that all service users know who to speak with if they are not happy. Two of the three noted that they know how to make a complaint. This matched the feedback and observations found during the visits. There were five entries with the homes’ complaint books since the last inspection, including from a service user, family members, and a member of the public who contacted the CSCI directly. Records showed suitable actions to address the issues raised, and generally indicated an acceptance of where the service was not sufficient. Complaints that are more recent included that the complainant was asked about satisfaction with the actions taken, which is good practice. The complaint to the CSCI related to how the service handles punctuality and respectfulness towards service users in respect of a particular community activity. The complaint was passed onto the provider, Adepta, to investigate Adepta 47-48 Chichester Court DS0000062639.V317346.R01.S.doc Version 5.2 Page 20 using their complaints procedures. They found there to be some shortfalls with the punctuality issue, which was consequently being monitored. There were no other complaints raised with the CSCI. One other complaint was found within a service users file. Whilst it should also have been recorded about in the complaint book, it was seen to have been clearly documented about and included an action plan. There is a strong commitment from the home to ensure that staff have had relevant formal training to help protect service users from abuse. This includes wider training, such as for behaviours that challenge and Makaton signing communication. Staff were seen to address challenges appropriately, such as through engaging with the service user, and with organizing themselves well to help minimize disruptions to service users. The manager has acquired a significant amount of support from the local psychiatrists and Adepta’s behaviour therapists in respect of behaviours from service users that challenge. There are consequently detailed staff guidelines in respect of some service users. These document the likely communications behind the behaviours, and provide guidance to help with meeting the service user’s needs. The manager and staff also explained that they all had to pass a written test to show sufficient understanding of one program, on the behaviour therapist’s request, to help to ensure that the program is consistently and effectively followed. This is highly encouraging. The inspector was impressed that the guidelines focus very clearly on positive reinforcements and the understanding of the behaviours that challenge. The manager explained that the use of appropriate language in this respect is highly valued, and gave examples of how shortfalls in this respect are addressed. Records and feedback suggest that the behaviours of service users that challenge, are in some cases much improved on and for others have been at least stabilized. There is additional funding for one service user to assist with this process, and for which relevant people from Adepta provide regular feedback to show how the funding is being used effectively. The overall commitment to working positively with the behaviours of service users that challenge, and with providing a service that helps to protect service users from abuse, is judged overall as exceeding the standard. Adepta 47-48 Chichester Court DS0000062639.V317346.R01.S.doc Version 5.2 Page 21 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): 24, 26, 27, 28 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This purpose-built home provides service users with a safe and clean environment. Some redecoration has taken place. Each service user has their own individualised bedroom. Minor improvements to facilities in one bedroom were identified as needed. Bathroom and toilet facilities are suitably provided, except for a safety and privacy issue in respect of the door for one downstairs bathroom. The home has suitable communal facilities to meet standards; however, consideration is suggested for how well this meets current service users’ combined needs. EVIDENCE: The home was warm, clean and hygienic from the start of the inspection. Staff attended to cleaning duties when there was time. Particular cleaning needs were communicated at the handover. Each home has a working washing machine and tumble-drier within a designated room. Adepta 47-48 Chichester Court DS0000062639.V317346.R01.S.doc Version 5.2 Page 22 All service user surveys noted that the home is always fresh and clean, one noting very much so. This matched feedback received during the inspection. On the second day of inspecting, it was noted that the corridor in one home was being professionally repainted. Records showed that there has been other redecoration work since the last inspection, including within some service users’ bedrooms. One lounge now has a wall-mounted, wide-screen television. Service users generally reported when asked that nothing needed fixing, and that they were fine with their rooms. However, when a few service users kindly agreed to show the inspector their rooms, one was found to have a TV that didn’t work and poor lighting. The manager agreed to address this as required. Checks of the bathrooms and toilets raised no concerns about the equipment. Staff noted that there is a new adjustable bath and new flooring in house #47. There were safety and dignity concerns with the bathroom door in house #48. It was not possibly to fully shut the door, it slid poorly, and there were significant cracks within the plasterwork in the top right-hand corner of the doorframe. These issues must be addressed. Feedback was received about there being insufficient space within each home to provide fully effective services to service users whose behaviours can challenge. Each house has one communal lounge that meets space standards. However each lounge must be passed through to access the kitchen, and the dining area is within the kitchen. There are no other communal rooms. Given that the service handles many behavioural challenges, consideration should be given to finding ways to enable service users to have additional communal living space. Adepta 47-48 Chichester Court DS0000062639.V317346.R01.S.doc Version 5.2 Page 23 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): 32, 33, 34, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported by a very competent staff team who have good standards of overall training. Staff are capably supervised. Minimum staffing levels are properly maintained. However there is evidence of service users’ combined needs not being fully met by current staffing levels. A review of this is needed, to address any identified shortfalls. There are generally excellent standards of recruitment checks, both for permanent and agency staff. However a shortfall in respect of acquiring a second reference must be addressed. EVIDENCE: All three service user surveys noted that staff always treat the service users well. Two said that staff always listen to and act on what they say, the other that this usually happens. This matched the feedback received from service users and one relative during the inspection visits. The inspector observed generally very good standards of staff interaction with service users. For instance, staff listened to service users’ communications, Adepta 47-48 Chichester Court DS0000062639.V317346.R01.S.doc Version 5.2 Page 24 respected and addressed their decisions, and worked together to support service users. Records and feedback found that eight permanent staff and one relief staff have qualifications at NVQ level 2 or equivalent. Two others are currently undertaking such courses. There were thirteen permanent staff at the time of the inspection, with relief and agency staff providing support in both homes. In terms of meeting NVQ standards, this is sufficient overall, with the potential for excellence when the three vacancies for the permanent staff team are filled. There were generally very good standards of training provision amongst the staff team. Most workers have had for example recent training in manual handling, abuse awareness, challenging behaviour, and autism. The manager monitors training needs for all staff, including refresher training for such areas as emergency first aid and fire safety. The manager stated that Adepta are developing a new induction package for new staff based on changed national guidance. The manager noted that new staff are supernumerary for at least a week, to ensure that they are suitably capable before working alone. They do not lead the shift until they have completed key training courses. There was evidence that new staff receive such training in a timely manner. The home currently has an induction folder that includes a detailed checklist for new agency staff. This includes guidelines about how the home operates and individual information on each service user. There was verbal and written evidence that staff are provided with individual supervision sessions at least monthly. The manager noted that this includes for regular agency staff, which is good practice. Records are kept. Appraisals of established staff have started. The manager noted that she has recently received training in respect of providing supervisions. Rosters for two weeks around the times of the inspection were analysed. They showed that both homes provide a basic minimum staffing of two staff throughout the day, with a waking staff at night. House #48 was being funded additionally for a third staff member for one service user, for which a third person was working during the majority of evenings. Staff reported that some service users are less able to go out following the recent withdrawal of additional funding in one house. There was also feedback that in both houses, the significant amount of behaviours from service users that challenge can sometimes be difficult to handle when there are only two staff present to provide support. The inspector observed frustration, through both verbal aggression and withdrawal, from some service users in one house due to there being only two staff available for community activities. To ensure that staffing levels are sufficient, the manager must undertake a written Adepta 47-48 Chichester Court DS0000062639.V317346.R01.S.doc Version 5.2 Page 25 review of service users’ combined needs and analyse whether or not current staffing levels can meet these needs. Any shortfalls must then be addressed. The recruitment files of four newer staff were checked through. The organisation’s human resources department undertake the recruitment checks. However the manager keeps copies of most relevant documents. Hence it was found that Criminal Record Bureau (CRB) checks are suitably in place before staff, including relief workers, start work. Identification checks were mostly in place, however it is recommended to acquire passport copies as this also helps to comply with the need for a photo of the person and can help to establish whether a work permit is needed. One staff member was found to have only one reference, relating to their previous employer. There were good records of investigating the gaps in the person’s employment history. However, a second reference, which can be personal rather than work-related, is always needed to meet legislative requirements and protect service users. The registered provider must ensure that this is addressed for new staff. The manager noted that recruitment checks now include a written test for English, numeracy and report-writing abilities. This is very through, and is deemed necessary by the manager to ensure a better standard of staffing relevant to the service users’ complex needs. The manager explained that agency workers are not used unless the agency provides details of the CRB. This has helped to screen individuals where necessary. The manager noted that she also interviews new agency staff, to ensure that they can meet the service’s needs. Adepta 47-48 Chichester Court DS0000062639.V317346.R01.S.doc Version 5.2 Page 26 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): 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run to service users’ benefit by an established, experienced and competent manager. The health and safety of those in the home is suitably protected. Service users’ views have underpinned the formal development audit of the home. However the monthly visits by senior management on behalf of the registered provider are not suitably frequent, and hence monitoring of the home is insufficient. This must be addressed. EVIDENCE: The manager came across as very competent and service-user focussed during the inspection. This included in communications with service users, and with undertaking care tasks where needed. She has achieved the appropriate NVQ level-4 courses. Adepta 47-48 Chichester Court DS0000062639.V317346.R01.S.doc Version 5.2 Page 27 The manager provided a development plan for the home dating from September 2006. It explained that the plan is based on the independent auditing of service users’ and other stakeholders’ views, along with checks of systems and records in the home. The plan has goals set, and regular reviews to ensure progress. To enable feedback to those involved, a short summary of overall findings and planned actions is recommended. Proprietor visits had only happened on three occasions during 2006 according to records seen. This increases the risk of inappropriate activities taking place in the home without the registered provider being aware and is hence not seen as appropriate management of the scheme. The registered provider must ensure that this is addressed to the monthly frequency required in the legislation. Those reports seen showed suitable attention to the home. A health & safety consultant’s audit was undertaken in May 2006. There were some areas for improvement but the report had many positive findings. A sample of documentation about professional checks of equipment in the home raised no concerns. The checks were up-to-date for the gas systems, the electrical wiring, the fire systems, and against legionella. Internal fire checks, for weekly tests and regular drills, were in place. Weekly health & safety audits around the home are documented about. An up-to-date house risk assessment was also in place. There were appropriate accident records within the files of those service users checked on. Adepta 47-48 Chichester Court DS0000062639.V317346.R01.S.doc Version 5.2 Page 28 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 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 4 ENVIRONMENT Standard No Score 24 3 25 X 26 2 27 2 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 2 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 2 LIFESTYLES Standard No Score 11 3 12 3 13 4 14 3 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 4 2 X 3 X 2 X X 3 X Adepta 47-48 Chichester Court DS0000062639.V317346.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No 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 The manager must ensure that information on display in the kitchens does not include personal & confidential details about any service user. The manager must ensure that service users are always promptly offered support to change clothing that is foodstained. Appropriately-documented professional training and accountability is required for the blood-sugar testing of any service user, along with confirmation that the procedure is covered within the home’s insurance policies. Otherwise, arrangements must be made for the procedure to be carried out by an appropriately-trained health professional. The manager must ensure that PRN (as-needed) paracetamol is either removed from the medication administration sheet, or that there is individual guidance on the circumstances of its use for each applicable service user. DS0000062639.V317346.R01.S.doc Timescale for action 01/01/07 1 YA10 12(4) 2 YA18 12(4) 01/01/07 3 YA20 13(2) 15/01/07 4 YA20 13(2) 01/02/07 Adepta 47-48 Chichester Court Version 5.2 Page 30 5 YA26 23(2)(c, p) 6 YA27 23(2)(b) 7 YA33 18(1) 8 YA34 19 schedule 2 pt 3 9 YA39 26 The manager must ensure that the lighting and faulty-TV issues within one service user’s room are, with the service user’s consent, addressed. The registered provider must ensure that the safety and dignity concerns about the bathroom door in house #48 are addressed. To ensure that staffing levels are sufficient, the manager must undertake a written review of service users’ combined needs and analyse whether or not current staffing levels can meet these needs. Any shortfalls must then be addressed. The registered provider must ensure that a second written reference is always acquired for new staff. The registered provider must ensure that the required visits of the home, to audit service users’ views and monitor effective running of the home, take place monthly and are reported on. 01/01/07 01/02/07 01/02/07 01/01/07 01/02/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard YA6 Good Practice Recommendations A suggested improvement, for easy accessibility of relevant and current guidance about individual service users, is for key guidance sheets to always be stored in the daily record file regardless of where else the guidance sheets might be useful. It is recommended for there to be specific guidance easily available on the individual signs used by applicable service users. Consideration should be given to finding ways to enable DS0000062639.V317346.R01.S.doc Version 5.2 Page 31 1 2 3 YA18 YA28 Adepta 47-48 Chichester Court 4 YA34 service users to have additional communal living space. It is recommended to request for passports as recruitment identification checks, as this also helps to comply with the need for a photo of the person and can help to establish whether a work permit is needed. Adepta 47-48 Chichester Court DS0000062639.V317346.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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. 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