Inspection on 09/11/07 for Dimensions 47-48 Chichester Court

This inspection was carried out on 9th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Dimensions 47-48 Chichester Court 28/10/06

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 9th November 2007 8:00 Adepta 47-48 Chichester Court DS0000062639.V353943.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.V353943.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.V353943.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.pentahact.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.V353943.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th October 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, for instance in terms of staffing. The homes provide long-term care and accommodation for up to eight adults who have learning disabilities, four people in each home. The building is maintained by the Metropolitan Housing Association. Everyone using the service has 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 £1375, based on the current block contracts in operation at the homes. Adepta 47-48 Chichester Court DS0000062639.V353943.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The only formal regulatory work with this service since the last inspection was CSCI attendance at a strategy meeting involving the home. See standard 23 for more details. CSCI surveys were sent to the home for distribution in advance of this inspection. Replies were received from four tenants, sometimes with the help of relatives, and also from four staff members. Their comments are included throughout this report. An Annual Quality-Assurance Assessment (AQAA) document was also sent in advance of this unannounced inspection, but it was not received by the manager. A replacement was sent after the inspection. The inspection visit took place across one autumn day. It lasted just over nine hours in total. It included discussions with tenants, separate discussions with staff, observations of the environment, observing care practices, and checking records. The manager was present for most of the visit, including for feedback and discussion 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: All four tenants who answered surveys stated that they like living at the home. Feedback from tenants during the inspection was similarly positive. There is good support for tenants to go out, and to keep in touch with friends and family. As one staff member said in response to the question of what the home does well, “making the tenants feel good about themselves and being part of their community.” Healthy diets are provided for tenants, who report that they enjoy the meals. The home is kept clean and homely. Tenants can personalise their bedrooms. Staff support tenants well with getting help from doctors and other health professionals. There are excellent standards of safely supporting tenants with their medication. Complaints by tenants or their relatives are listened to and acted on very well. Complaints can be made both verbally and by using signs. Adepta 47-48 Chichester Court DS0000062639.V353943.R01.S.doc Version 5.2 Page 6 Tenants are involved in decisions about who is to work in the home. There are excellent overall standards of checking on new people, to make sure they are the best people for the job. Tenants’ individual care files are kept up-to-date and reflect their needs and preferences. The staff who work in the home are well-trained, including in terms of NVQ qualifications. The home is run by an experienced manager who is focussed on tenants. There are strong systems of reviewing the quality of care, and of health & safety, in the home, to help improve services. What has improved since the last inspection? What they could do better: Improvements are needed with: • Staffing levels in house #47. The complex care needs of tenants in that house are not sufficiently met through the current levels of two staff members per shift. • The recognition and appropriate notification of incidents of physical aggression of one tenant towards another in one house. Whilst the home has a good record of notifying the CSCI and other relevant bodies about incidents, some historic cases since the last inspection involving specific tenants were only dealt with internally and not reported externally as required. This could lead to a lack of protection for the tenants in question. All cases of physical aggression of one tenant to another must be notified. • Ensuring that all staff have up-to-date training on protection of tenants from abuse. Whilst there has been training in the past on this, it has not been recently updated nor provided to new staff, which could result in staff responding inappropriately to an abuse scenario. Adepta 47-48 Chichester Court DS0000062639.V353943.R01.S.doc Version 5.2 Page 7 A full list of requirements and recommendations is available at the end of this report. 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.V353943.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.V353943.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): 2 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service continues to appropriately assess the needs and wishes of people who are considering whether to move into the home, to help ensure that any placements made are successful. EVIDENCE: The manager explained that, since one person moved out of the home at the end of 2006, no-one has moved in. There is hence one ongoing vacancy. A couple of people have been considered for the placement, including one person who visited, but neither has ended up taking it. For instance, one person was ultimately assessed as having needs which the home could not meet. As assessment and moving-in processes have been previously assessed as suitable, the key standard here is considered to remain ‘met’. Adepta 47-48 Chichester Court DS0000062639.V353943.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 and 9. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments reflect the individual needs and wishes of the tenant, and are updated as needed, to help support individualized care. The service strives to provide and support choice for tenants, and generally achieves this. EVIDENCE: Feedback from the surveys of tenants found that everyone felt that they are involved in making decisions in the home. Staff surveys found that the service usually supports individuals to live the life they choose. Observations by the inspector during the visit confirmed these viewpoints, that decisions are generally made by tenants, with staff assistance where needed. A photo-book communication aid was used by staff with one person, to assist them to get ready in time for going to their day service. Adepta 47-48 Chichester Court DS0000062639.V353943.R01.S.doc Version 5.2 Page 11 Another person was appropriately asked by staff about going to college. When they said ‘no’, staff accepted this. Nonetheless, the person later went to college, confirming to the inspector that this was ok, which suggests staff provided further support. One tenant refused the inspector’s request for a chat. Another refused a request to be able to view their room, but accepted a chat. This further evidences that tenants are able to make decisions about their daily lives. Three care plans were checked to various degrees of detail. It was apparent that all had been updated, following recent formal review meetings, albeit that that manager and staff made points that some plans were being still being finalised. The plans were appropriately detailed, and clearly person-centred in that they reflected the needs and wishes of the person. The plans are backed by detailed and up-to-date individual risk assessments. These include about safety of the person should there be a fire, should they go missing, other community presence considerations, and safety issues within the home. The CSCI were notified about the recent occasions of two people who live at the home going missing. One was from the home, the other from their day service. Appropriate actions were taken by management to aim to minimise the risks of repeats, including the decision to remove the person from their day service on two occasions pending assurances of sufficient precautions being in place. It was also noted that the individual risk assessments for these people had been updated. Adepta 47-48 Chichester Court DS0000062639.V353943.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): 11, 12, 13, 15, 16 and 17. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. There are good standards of providing occupational and recreational support for tenants, relative to their individual needs and wishes. There is excellent support for tenants to uphold and develop relationships with family and friends. The service supports the personal development of tenants. Healthy diets are provided for tenants, who report that they enjoy the meals. EVIDENCE: Staff used photo-books, and Makaton signs and pictures, to help some tenants to get ready in the morning. Staff had sufficient knowledge to understand the communications signs of tenants. One person was seen to be encouraged by staff to answer the phone in the lounge. Staff supported the tenant as far as they could handle the call, which was encouraging. There were records of another person being supported to learn to use a mobile phone. Adepta 47-48 Chichester Court DS0000062639.V353943.R01.S.doc Version 5.2 Page 13 A few tenants have keys to their rooms. Rooms are also designed to be able to lock upon closing, to protect the occupant’s property from the presence of others. One tenant was involved in the interviews and assessment of three potential staff members during the inspection visit. One staff member commented that strengths of the service include, “Enabling the service users to reach their full potential.” These practical examples, alongside such formal processes such as care-planning and service-reviews, provide good evidence of the service supporting the personal development of tenants. It was apparent that all of the tenants have independent day-service placements that they can attend for most of the week. Communication books between home staff and the day centres are in use, to enable consistent support of the individual, and day services are asked for input at tenants’ review meetings. Tenants also have college courses, work placements, and personal support days as applicable. Feedback from surveys of tenants found that almost everyone says that there are good activities in the home. Staff feedback, and findings from the service review (standard 39), concurred with this. Discussions with some of the tenants found that people can go to music concerts, visit their family, and attend organised football coaching. The manager and staff also noted that community support is providing for such things as trips to watch car racing, to the cinema, to the Albert Hall, to local recreational clubs, to shopping centres such as Brent Cross, for swimming, and for local walks. A couple of tenants also continue to meet in the community weekly with former housemates. Staff could explain arrangements for many of the tenants to visit family at the weekend, and occasionally during the week for some. One tenant told the inspector, using signs, about visiting their family shortly. They were clearly looking forward to this. The manager also explained about the continuing support for one person to visit their boyfriend. Family are generally involved in care review meetings, and are supported by the service to attend other meeting such as with health professionals. Staff are aware of responsibilities to keep next-of-kin updated where appropriate. Surveys from tenants found that everyone likes the food provided. There was enough food available, including fresh food. Menus are discussed in house meetings with tenants. Sampled weight records showed no significant change in weight over time. Menu records were also checked through. These all suggest appropriate nutrition. Adepta 47-48 Chichester Court DS0000062639.V353943.R01.S.doc Version 5.2 Page 14 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. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Tenants receive good support with heath needs, including liaison with community health professionals. They receive appropriate personal support through staff assistance where needed. Tenants’ dignity is appropriately considered. There are very strong standards of safe and effective medication support to tenants, which very much minimise the chances of mistakes occurring. EVIDENCE: Tenants were generally seen to be appropriately-dressed in individual clothing from the start of the inspection. Where clothing was inappropriate, staff encouraged and supported the tenant to change. There were also no concerns about nail and hair care from the inspector’s observations. Surveys received from tenants found that they all feel well-cared for, and that their privacy is respected. Staff feedback also noted that the service always respects individuals’ privacy and dignity, one person stating, “Staff always close the bathroom and bedroom doors when individuals are using it for changing or bathing” Adepta 47-48 Chichester Court DS0000062639.V353943.R01.S.doc Version 5.2 Page 15 Appropriate individual health records were in place for tenants. This includes for blood tests, medication reviews, psychiatrist reviews, GP support for minor injuries and illnesses, opticians, and the chiropodist. The records contained sufficient details and actions. There were also ongoing weight records in place. Those checked on found no significant changes over time, which suggests appropriate health support. Notifications to the CSCI about injuries to people using the service generally included details about using the timely support of community health professionals. Staff surveys support this, for instance noting that the health needs of individuals are always met by the service. One staff member noted, “We have a good relationship with our local GP surgery and they help us to monitor the health of our service users.” One staff member explained during the visit that one tenant would be asked to go out later to collect a prescription following a very recent meeting with their psychiatrist. The tenant’s medication had just been reviewed. Care files of other tenants found appropriately-recent medication reviews with health professionals in all cases. There were now appropriate arrangements in place for the support of one tenant with weekly blood-sugar level checks. Named staff have been trained by a community nurse to undertake the tests and dispose of needles correctly. Clear guidelines were in place, and weekly results were being recorded about. Recent concerns with results of the checks were being addressed through liaison with community health professionals. The manager noted that further staff would be trained, as the team was starting to become short of specifically-trained people. Checks of the medication processes in the home found very appropriate standards in place overall. None of the tenants currently self-administer. Medication was being securely and tidily stored. A local pharmacy supplies medications in 28-day blister packs. There were appropriate records of medications being received. Records of administration were up-to-date with no gaps. Two staff were signing where possible. Exceptions were for instance for prescribed creams, which only one staff witnesses for reasons of the tenant’s dignity. Staff handovers include the recorded checks of medication being given, and of tablet counts where deemed appropriate. It was noted that where shortfalls with these checks occurred, the manager reminded staff through the communication book. Guidelines within the medication files were of a very high standard. Each tenant’s medication profile included reasons for the medication and sideeffects to observe for, an individual statement of how the tenant likes their medication support, and detailed guidance around any as-needed medications. Adepta 47-48 Chichester Court DS0000062639.V353943.R01.S.doc Version 5.2 Page 16 Medication was seen to be distributed to tenants appropriately. The medication was distributed directly from the container into a pot, and handed directly to the tenant with a glass of water. Medication refusals are recorded about, with medications disposed of appropriately. One staff member explained that new staff are not permitted to distribute medication to tenants until they have attended a formal training course. They also have to be assessed on three occasions to ensure that they can distribute correctly and safely. This includes for temporary staff. This is appropriate training. There was one notification to the CSCI of a minor medication error, shortly after the last inspection, which was appropriately investigated by the manager. Adepta 47-48 Chichester Court DS0000062639.V353943.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): 22 and 23. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Tenant’s views are listened to and acted on by the service, whether communicated verbally or otherwise. Complaints are appropriately considered and acted on. The home has reasonable standards of protecting tenants from abuse, including through the use of relevant policies, making safeguarding referrals, and cooperating with investigations, however some weaknesses are also identified. EVIDENCE: Most tenant surveys included that they know who to speak with if they are unhappy. Staff surveys all noted that the service always responds appropriately if concerns are raised. The complaint books from each house were seen. There were eleven entries in total since the last inspection of a year ago. These were generally from tenants’ family members, but included three from tenants including from a person who uses signs and body language as their primary forms of communication. This is encouraging. There were appropriate details about each complaint, and about actions taken to address the issues. The majority of complaints were upheld. The overall impression is that the service is very open to receiving complaints, and addressing shortfalls where possible. There was one complaint to the CSCI since the last inspection, made anonymously in writing. It raised concerns about the safety of some tenants, and was hence referred to the local borough’s safeguarding team. The CSCI Adepta 47-48 Chichester Court DS0000062639.V353943.R01.S.doc Version 5.2 Page 18 attended the consequent strategy meeting. The issues were investigated both internally and externally, with no evidence ultimately found to uphold the issues. The Adepta organization cooperated fully with the process. There have been three other incidents in the home since the last inspection that have been referred to the relevant local council safeguarding team. All were referred by the manager. One related to a case of whistleblowing, the other two from unexplained bruising to tenants. After following relevant processes, the former was not upheld, and the other two noted not to be cases of abuse. One strategy meeting from the above cases gave a recommendation that staff be provided with refresher training in protecting tenants from abuse. This had not been addressed, some six months after the recommendation. The manager explained that Adepta had not provided that course during this time, and that many staff had previously had such training. However, as new staff had not yet had this training, nor others a refresher, there are increased chances of staff responding inappropriately to an abuse scenario. Update training for the staff team must be promptly acquired. The service has a policy in place on the prevention of abuse, along with the local borough’s current safeguarding guidelines. It is also positive to note that all tenant surveys included the response that they feel safe at the home. There were detailed support guidelines in place for a number of tenants, to aim to minimise and support with any behaviours of theirs that challenge the service, for instance against aggression or to keep safe. Adepta’s behavioural support team were found to be commonly involved, for instance undertaking a functional assessment of one tenant earlier in the year and hence producing a report and detailed guidance on an afternoon and evening routine. It was pertinent to note that these guidelines included clear statements that tenants are not to be reprimanded in respect of behaviours that challenge, but supported where possible to rectify the issue. The manager also explained that the behaviour therapist checked each staff member’s knowledge of the guidelines that were drawn up, to ensure consistency and understanding. This is encouraging. The manager noted that incidents and accidents are checked by herself, and also by the operations manager, monthly. They are also copied to the Health & Safety consultants, and can be passed to the behavioural support team. Significant incidents are copied to the CSCI and the commissioning team. She also gave as example appropriate actions, the recent increase in aggression from one tenant that has resulted in a psychiatrist’s appointment being brought forward with consequent changes in medication. It was identified that the were three recorded and historic instances of one particular tenant hitting another particular tenant since the last inspection, and that these had not been notified to the CSCI or the relevant local authority Adepta 47-48 Chichester Court DS0000062639.V353943.R01.S.doc Version 5.2 Page 19 safeguarding units. These instances were recorded on ABC monitoring charts, as opposed to incident forms. The involved tenants’ monthly summaries did not refer to these instances beyond vague statements of the need for monitoring. Only the risk assessments made reference to the need for support. Staff and the manager were however clear of the possibility of aggression, noting that they monitor as best they can. The lack of external reporting could lead to a lack of protection for the tenants in question. All cases of physical aggression from one tenant to another must always be reported to relevant external agencies, so help ensure that tenants are appropriately safeguarded. Adepta 47-48 Chichester Court DS0000062639.V353943.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27 and 30. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is appropriately kept for people to live in, in terms of homeliness, cleanliness and safety. Maintenance issues are addressed. Individual bedrooms have appropriate facilities. There are enough toilets and bathrooms to meet the needs of people living there. EVIDENCE: The home was warm, clean and hygienic from the start of the inspection. A few tenants kindly showed the inspector their rooms and other areas of the house. This raised no concerns about facilities, or about staff support to help keep rooms clean and tidy. One person had a drawer missing from a chest of drawers, which the manager noted was on the waiting list for repair. Tenants all reported that they are happy with their rooms, and that the rooms are kept warm enough. Previous requirements about the environment have been addressed. The most significant of these, about the downstairs bathroom doors, has been Adepta 47-48 Chichester Court DS0000062639.V353943.R01.S.doc Version 5.2 Page 21 permanently fixed through the replacement of the sliding doors with hinged doors. This allows doors to be opened easily, and for the rooms to be locked from the inside easily if tenants want. There was a relatively-recent case of a faulty boiler that caused some water damage to some areas of the home. There were no obvious concerns from this arising at the inspection, however the manager reported that redecoration is happening in some areas as a result of it. This included for carpets, for which there was a visitor during the inspection to provide a quote. Checks of the bathrooms and toilets raised no concerns about the equipment. The home has sufficient washing machines and tumble-driers in appropriate areas, along with protective clothing such as disposable gloves. Adepta 47-48 Chichester Court DS0000062639.V353943.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Tenants are provided with staff who have had very appropriate recruitment checks and who are hence safe to work with vulnerable people. Staff receive sufficient training, including NVQs, to better enable them to meet tenants’ needs. The limited staff numbers on shift sometimes prevent tenants’ needs from being collectively met. EVIDENCE: Rosters showed that, for each house, there are always two staff working. This is in the mornings, later afternoons through to evenings, and at weekends. Levels only drop if some of the tenants are out, such as at day centres during the week. Some staff mentioned in surveys that the service could improve by having more staff on duty, one pointing out that this is for tenants’ benefit. Records, feedback and observations highlighted the challenges of meeting the complex care needs of tenants in house #47. The manager has reviewed staffing levels since the last inspection. There were consequently a number of records of liaison with commissioners about staffing levels being inadequate to meet Adepta 47-48 Chichester Court DS0000062639.V353943.R01.S.doc Version 5.2 Page 23 tenants’ needs. One recent safeguarding meeting noted the recommendation for more funding for staff, to help meet the complex needs of particular tenants. The evidence suggests that for house #47, staffing levels do not sufficiently and consistently meet tenants’ overall needs. Staffing levels there must be improved on. Training records were generally in place for staff individually and collectively, including copies of certificates. It was found that the overall training grid for the staff team in one house was in the process of being updated, and hence the gaps in some training areas may not reflect the training provided. The manager noted that staff have to fill in an evaluation form for each training course, to receive a certificate, as most training is provided from within the Adepta organization. This also explains some gaps. It was evident that a range of training has been acquired in 2007 for individual staff, such as for diabetes, diversity, medication, and hygiene & infection. New staff were noted to have received a great deal of training, and individual records generally found that the expected training had been provided. It is therefore judged overall that appropriate training is provided to staff as needed. It is recommended that the training grids be promptly updated, so that any gaps or outdated training can be identified more easily for individual staff. All tenant surveys confirmed that staff treat them well. This matched feedback from tenants during the inspection visit. Observations of care practices showed staff treating tenants respectfully and individually. Staff survey feedback included that they feel that they usually have the skills and experience to meet tenants’ needs. Discussions with staff during the visit found them to have appropriate individual knowledge of tenants, and of how the home is expected to operate. The manager noted that most staff have qualifications at NVQ level 2 or equivalent, or are currently following a course in this respect. Hence it is overall judged that appropriately-skilled staff are provided to tenants. The manager reported some staffing vacancies within the home. However, a very successful day’s interviewing meant that the majority of these vacancies would shortly be filled. The home had been using a notable amount of agency and relief staff before this. There was evidence of familiar staff being usually used in this respect, and that there are detailed checks of the ability of any these staff before allowing them to work, to ensure that they can help to meet tenants’ needs. The recruitment records held on site, of two newer staff, were checked through. Each had an application form, an employment history including exploration of gaps where needed, and three appropriate references in place. Dates of receipt of the Criminal Record Bureau checks were also recorded. It was evident that sufficient checks had been made of people before allowing them to work in the home. Adepta 47-48 Chichester Court DS0000062639.V353943.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 and 42. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Tenants benefit from a home that is run in their best interests by an experienced manager. There are good standards of quality-auditing and planning. Records about tenants are generally kept appropriately. Health and safety processes protect people in the home very well. EVIDENCE: The manager has been registered with the CSCI in this role for a number of years. She has completed the NVQ level-4 qualification that is expected under the National Minimum Standards. She was seen to lead staff where pertinent, and guide them in meetings and via the communication book. She was receptive to tenants, but appropriately-boundarized when dealing with other issues. Adepta 47-48 Chichester Court DS0000062639.V353943.R01.S.doc Version 5.2 Page 25 Staff feedback about management at the home was positive. One staff survey, in respect of what the service does well, stated “Management are very supportive from all aspects, such as professional training, seeking professional support, and trying to do everything they can to give tenants a better life.” Records of recent staff meetings were available for staff consideration. The meetings focussed on relevant issues, such as updates, training provision, and tenant-specific issues. Whilst the general standard of record-keeping in the home protects tenants, improvements are needed with ensuring that individual daily records are always recorded for each tenant. There were occasional gaps found in these from checks of recent entries, along with for other ongoing records such as activities and continence. This can undermine the checking of relevant care should the need arise. The manager explained how Adepta’s quality audit team are involved at the home. The team sent questionnaires to all involved people such as tenants, their family, and staff, to acquire views about standards of care in the home. The team then provided a report to the home, based on the surveys and their own findings. Taking this service-review report into account, the manager and the staff team discussed plans for the service for the year, which became a documented action plan. The plan clearly relates to the findings of the report, and has at heart the empowerment of people who use the service. Regular senior management visits to the home continue to take place. Monthly reports of these visits are copied to the CSCI, and were seen to be available within the home during the visit. This also contributes to helping to uphold quality at the home. A very recent audit report by the service’s health and safety advisors found ‘excellent standards in place in all areas’. A fire-safety risk assessment was in place dating from September 2007. Observations of health and safety matters during the inspection visit raised no concerns. Adepta 47-48 Chichester Court DS0000062639.V353943.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 4 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 4 X 3 X 3 X 2 3 X Adepta 47-48 Chichester Court DS0000062639.V353943.R01.S.doc Version 5.2 Page 27 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. 1 Standard YA23 Regulation 13(6) Requirement Update training for the staff team, on abuse awareness and prevention, must be promptly acquired and appropriately upkept. All cases of physical aggression from one tenant to another must always be reported to relevant external agencies, so help ensure that tenants are appropriately safeguarded. Staffing levels must be improved on in house #47, as the current levels of two staff working per shift does not sufficiently and consistently meet tenants’ overall needs. Daily records for each tenant must be consistent kept. The occasional gaps can undermine the checking of relevant care should the need arise. Timescale for action 01/03/08 2 YA23 13(6) 15/12/07 3 YA33 18(1)(a) 15/01/08 4 YA41 17(1)(a) schedule 3 01/02/08 Adepta 47-48 Chichester Court DS0000062639.V353943.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA35 Good Practice Recommendations It is recommended that the staff training grids be promptly updated, so that any gaps or outdated training can be identified more easily for individual staff. Adepta 47-48 Chichester Court DS0000062639.V353943.R01.S.doc Version 5.2 Page 29 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. Extracts may not be used or reproduced without the express permission of CSCI Adepta 47-48 Chichester Court DS0000062639.V353943.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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