Inspection on 25/05/05 for Angel Home

This inspection was carried out on 25th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Angel Home 12/06/07

Angel Home 21/06/06

Angel Home 20/10/05

Angel Home 07/01/05

Angel Home 04/11/04

Similar services:

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Edenvale

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Chatsworth Care - Dawson House

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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 Angel Home 43 Stayton Road Sutton Surrey SM1 1QY Lead Inspector Rin Saimbi Announced 25 May 2005 th 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 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 Stationary 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. Angel Home G53-G53 S7204 Angel Home V211372 250505 Stage 0.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Angel Home Address 43 Stayton Road, Sutton, Surrey, SM1 1QY Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8715 6940 020 8647 2548 Angel Home Limited Mrs Christine Mouralidarane Care Home 5 Category(ies) of Learning Disability (5) registration, with number of places Angel Home G53-G53 S7204 Angel Home V211372 250505 Stage 0.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 7th January 2005 Brief Description of the Service: Angel Home is a residential care home for five younger adults who have learning disabilities. The home itself is a end of terrace house situated on a residential road in Sutton. The accommodation compromises of a two storey building; on the first floor there is a lounge/diner, kitchen, toilet, small office, laundry room and one bedroom. There is access via the kitchen and lounge/dining room to a small garden, which is dominated by a ramp. On the second floor, there is a further four bedrooms and a bathroom. To the front of the building there is a small garden. There is restricted car parking near the home, although the home itself has parking for one vehicle at the back of the property. The home is within easy walking distance of Sutton town centre, where there are shops, post office and pubs. Sutton has good transport links as it is on many bus routes and there is also a railway station that goes into London and the coast. Angel Home G53-G53 S7204 Angel Home V211372 250505 Stage 0.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was Angel Homes first inspection for the year 2005/6. It was an announced inspection, which started at 9.15 am. This part of the inspection involved looking through the documentation including the policies and procedures, a tour of the building and talking to staff and the manager. This took four hours. The second part of the inspection started at 3.15pm for approximately two hours. This was an opportunity to meet and talk to the service users directly and to observe the staffs interaction with the service users. What the service does well: What has improved since the last inspection? Requirements made in the last inspection, if in the control of the manager, have been acted upon. Angel Home G53-G53 S7204 Angel Home V211372 250505 Stage 0.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Angel Home G53-G53 S7204 Angel Home V211372 250505 Stage 0.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Angel Home G53-G53 S7204 Angel Home V211372 250505 Stage 0.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 and 3 The manager gets as much information from variety of sources, including the service user, family and other professionals before a decision is made about any new service user coming into the home. This is done to make sure that it is the right place for the service user and that everyone is happy with the arrangement and the staff are able to meet their care needs. EVIDENCE: No new service users have been admitted to the home in the last year. For all the existing service users there was an initial assessment, which had been completed by the manager after gathering information from a variety of sources. There is then a process of introductions, when the perspective new service user comes for tea visits, then overnights and then for a trail period. A meeting is then held to make sure that everyone, and particularly the service user is happy for the placement to start. The manager gave an example of how they had sort the advise of a professional regarding the recent changes in behaviour of one of the service users. This advice had been sort privately. Angel Home G53-G53 S7204 Angel Home V211372 250505 Stage 0.doc Version 1.30 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8 and 9 Service users are given opportunities to make everyday choices in their lives. However, there is a premise within the home to minimise activities, which may be risky to the individual, which also inadvertently restricts independence and dignity. EVIDENCE: The key worker and the service users on a three monthly basis complete individual plans. These summaries are then the framework for the annual reviews. It was positive to note that these summaries were completed regularly. However, they lacked focus and seemed to be a summary of events, rather than highlighting the changing needs, aspirations of service users and how these goals they could be achieved. Consequently, there was no record of whether the goals had been achieved or not. Service users are given the opportunity to make some decisions in their lives; they choose what to wear and what to eat. There are monthly meetings held for service users, the last one was the 8.5.05 where from the minutes it is clear that service users are able to say what they feel about living in shared accommodation and about the service they receive, particularly the food they eat. Angel Home G53-G53 S7204 Angel Home V211372 250505 Stage 0.doc Version 1.30 Page 10 The manager completes an audit twice a year, where service users are given the opportunity to say what things could be improved. It was positive to note that the completion of this survey and the questionnaire sent by the Commission is completed with the service user, and their friends and advocates ensuring that there is some independence. Risk assessments are in place and are reviewed regularly. Staff gave many reasons why some activities could not take place, which often equated with the fact that service users may be putting themselves at risk. Rather than an attitude that my enable service users to participate to a greater extent. Angel Home G53-G53 S7204 Angel Home V211372 250505 Stage 0.doc Version 1.30 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,14,16 and 17 There are some opportunities for service users to take part in the ordinary aspects of daily life. However, staff could do more to assist service users to live as fulfilling life as possible. EVIDENCE: Service users all attend Hallmead day centre five times a week. There they attend a range of activities including swimming, bowling and wood work at Oaks Park. The manager stated that attendance at a day centre was not a perquisite to living at the home. The activity plan at the day centre is determined at the annual review meetings. The manager stated that she did not envisage a time when any of the service users would be able to move onto any other daytime activities. Last year, none of the service users went away on holiday instead they chose to stay at the home and have day trips. This summer one of the service users has expressed an interest in going away to Devon for a week, although this has not as yet been booked. Other service users are choosing day trips to Angel Home G53-G53 S7204 Angel Home V211372 250505 Stage 0.doc Version 1.30 Page 12 Cadbury World, Brighton and Bournemouth. These day trips are part of organised excursions, whereby staff will accompany service users. Service users are all provided with a key to their bedrooms, although they choose not to use them. In addition, service users do have a lockable drawer in their bedrooms. The front door is not kept locked, service users would if they chose to able to leave or enter the home at their own will, the door is alarmed however, which would alert staff to someone using the front door. Mealtimes are important in the home; Service users are encouraged to choose their own menu for the week, there is a tendency to choose traditional meals. Service users all spoke positively about the meals that were on offer, which were on the whole all freshly prepared. Snacks and drinks were available on request. On Sunday some of the service users do cooking; this week it had been scotch eggs for their lunch boxes. Other than this, it does not appear that the service users use the kitchen. On return from the day centre, cakes and tea were available in the dining area; staff removed the dirty dishes. Angel Home G53-G53 S7204 Angel Home V211372 250505 Stage 0.doc Version 1.30 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19 and 20 Service users receive support, if they require, attending health appointments; the home ensures that health needs are reviewed and recorded on a regular basis. The systems for administration and disposal of medication are poor and potentially place service users at risk. The homes systems for the administration of medication and staff training are not robust and potentially place the service users at risk. Also additional training needs to be introduced for staff to ensure maximise service users privacy and dignity. EVIDENCE: Angel Home has a small staffing team of five individual staff, and bank staff who work as and when it is necessary. This provides consistency of care. Each individual service user has two designated key workers at any one time. The role of these key workers is to complete an individual plan every three months, which outlines the preferred routines of the service user. Staff could improve the way in which intimate care is offered to service users. A member of staff was observed leaving a bathroom door open whilst a service user was in the bathroom, and also entering another service users bedroom Angel Home G53-G53 S7204 Angel Home V211372 250505 Stage 0.doc Version 1.30 Page 14 without knocking. A requirement has therefore been made that staff must maximise privacy and dignity at all times. With regard to health needs, service users seem generally to have their needs met. There are records of health appointments including with the chiropodist and optician; one service user has monthly appointments regarding his epilepsy; everyone is offered an annual health check by their GP. Only one of the service users is able to self-administer medication, and this, he only does at weekends when he visits his girlfriend. The homes record of the administration of medication appeared accurate. The home receives medication on a weekly basis from the Pharmacist, which are in packs for ease of identification. The Pharmacist also completes an audit of medication, the last one being dated 19.11.04. Two requirements have been made in regard to medication. Firstly, that paracetmol that is prescribed should be labelled as such, and that it should be stored away in the medicine cabinet. In addition, that medication should only be administered by staff that have completed an accredited course. Angel Home G53-G53 S7204 Angel Home V211372 250505 Stage 0.doc Version 1.30 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 The home has all the policies and procedures in place to ensure the protection and well being of the service users. It is unclear if the service users feel that they are listened to and that any issues that may arise are taken seriously. EVIDENCE: The home has a clear complaints policy, which includes the timescales and the process of the investigation . Each service user had their own copy of the complaints policy in their bedrooms, which was written in plain English, and using Makaton symbols. The home has not received any complaints in the last twelve months, nor has the Commission. Service users said that they did not have any complaints, however, when asked what they would do if they had, three stated that they would talk to each other or a friend. Therefore, it may be advantageous for the home to revisit the issue again with service users making it clear whom they could complain to if they wanted to. A previous requirement that senior staff must attend a refresher course with regard to vulnerable adults has been removed, as the manager and deputy attended a course in July 2004. Angel Home G53-G53 S7204 Angel Home V211372 250505 Stage 0.doc Version 1.30 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,28,29 and 30 In general, the home is maintained to a reasonable standard, with adequate communal space and individual bedrooms allowing for some privacy. The home is adequately furnished and is clean and hygienic EVIDENCE: Bedrooms have been recently decorated in consultation with the service users. Each bedroom is a single room, with a bed, chair, wardrobe, chest of drawers, and a large easy chair. All bedrooms have a wash hand basin. Service users had televisions and various audio equipment in their bedrooms. There was some personalisation in the bedrooms, with posters and photographs of family and friends. The back garden is small, although in keeping with the local area. It is dominated by a concrete ramp, which leads from the patio area to the parking at the rear of the building. Angel Home G53-G53 S7204 Angel Home V211372 250505 Stage 0.doc Version 1.30 Page 17 The garden in general must be tidied up; there is a fence missing; the washing line hangs very low and is potentially dangerous; there is disused equipment lying around. A requirement has been made that the state of the garden must be improved. The home is equipped with a downstairs toilet, and an upstairs bathroom and toilet. The bath itself does allow for staff to assist with bathing in that it is accessible from all sides, however, there are no grab rails fitted at all. This does not allow for independence. The home must therefore seek advise from an Occupational Therapist with regard to the provision of aids and equipment. Any recommendations made by the Occupational Therapist must be put in place. Angel Home G53-G53 S7204 Angel Home V211372 250505 Stage 0.doc Version 1.30 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,34,35 and 36 Service users stated that they liked the staff at the home. In general, it seems that the staff group offered a range of skill mix and experience. In terms of gender mix however, it was noted that there are four male service users and none amongst the staff group. All new before appointment and existing staff in post must have Criminal Record bureau checks to ensure the safety and protection of the service users. EVIDENCE: Angel Home has a small staff team of five individuals, who have provided a degree of consistency for the service users. Bank staff are used on occasions, but this is limited. There has been a change in staffing recently, in that one member of staff left and someone else has been recruited. This is only on a very part-time basis of ten hours per week. The personnel records showed that in general all the required checks had been completed. However, the Criminal Records Bureaux was not in place, although there was evidence that it had been applied for. Until such time as the CRB check is received, this individual must not work on their own with service users, and must not provide any personal care at all. In the main, two people staff the home in the mornings and in the evenings during weekdays and at weekends. There is one waking night staff. Angel Home G53-G53 S7204 Angel Home V211372 250505 Stage 0.doc Version 1.30 Page 19 Training opportunities were available to all staff at the required level. The member of staff interviewed was able to give a clear description of the induction process that she had undergone; as well as other training that was available to her. The manager stated that supervision was completed to the required level; two members of staff confirmed this. Although the records could not used to verify this, as the manager stated that there were issues of confidentiality. Angel Home G53-G53 S7204 Angel Home V211372 250505 Stage 0.doc Version 1.30 Page 20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,39,40 and 42 The manager has many mechanisms in place to ensure that service users are consulted about living in the home. There is a degree of openness within the home, which is created by the manager so that staff do feel valued which ensures service users care is paramount. EVIDENCE: The manager of the home has considerable experience in the care field, including working with people with learning difficulties for nine years, and a further seven years with the elderly. The manager is also the registered owner of the home, which was set up in 1996. A previous requirement that the manager must complete her NVQ Level 4 by 2005 remains outstanding. The manager has enrolled on the course but it is yet to start. This is of concern to the Commission and must be addressed with some urgency. Angel Home G53-G53 S7204 Angel Home V211372 250505 Stage 0.doc Version 1.30 Page 21 The deputy of the home is an immediate family member of the manager. This relationship has been discussed at length both with the manager and deputy, and with the staff within the home. It does not appear that this relationship has any adverse effect on the running of the home, or upon the care given to the service users. The manager of the home undertakes internal audits of the views of service users on a regular basis. The completion of these audits, along with the completion of the Commissions questionnaires is completed by service users and their advocates. The results of these surveys are available to the Commission. The home takes seriously its responsibilities for the health and welfare of service users and staff. To this end, all the required checks regarding fire appliances, gas and portable appliance testing is completed on a regularly basis. Fire alarm testes are carried out weekly, actual drills are undertaken monthly. Staff all appear to have undertaken appropriate training within health and safety, such as fire safety, first aid and food and hygiene. Angel Home G53-G53 S7204 Angel Home V211372 250505 Stage 0.doc Version 1.30 Page 22 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 3 x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 2 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 x 3 3 Standard No 31 32 33 34 35 36 Score x x 3 2 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Angel Home Score 2 3 2 x Standard No 37 38 39 40 41 42 43 Score 2 x 3 3 x 3 x G53-G53 S7204 Angel Home V211372 250505 Stage 0.doc Version 1.30 Page 23 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 6 Regulation 15(1) & (2) Requirement Timescale for action 25.7.05 2. 24 23(2) Individual plans must include the current and changing needs, and aspirations of the service user; and how these goals are to be achieved The condition of the garden must 25.8.05 be improved. a. The broken fence to be repaired b. The disused items to be removed c. The washing line to be repositioned Paracetmol received under prescribition should be labelled as such, and must be stored away in the medicine cabinet Staff administrating medication must have completed an accredited training course The home must complete CRB checks on all staff; and for new staff where the CRB has been applied for and yet to be , the individual must not work alone with service users The manager of the home must completed NVQ Level 4 3. 20 13(2) 25.5.05 Immediate 25.7.05 25.5.05 Immediate 4. 5. 20 34 12(1)(A) 19(1)(a) 6. 37 9(2)(b)(i) 25.5.05 Immediate Page 24 Angel Home G53-G53 S7204 Angel Home V211372 250505 Stage 0.doc Version 1.30 7. 8. 18 29 12(4)(a) 23(2)(n) Staff must ensure the privacy and dignity of service users at all times The home must provide aids and adaptions and equipment following an assessment by an occuptional therapist, that is suitable for the assessed needs of service users in order to maximise their independence 25.5.05 Immediate 25.9.05 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 Good Practice Recommendations Angel Home G53-G53 S7204 Angel Home V211372 250505 Stage 0.doc Version 1.30 Page 25 Commission for Social Care Inspection CSCI 8th Floor Grosvenor House 125 High Street, Croydon CR0 9XP National Enquiry Line: 0845 015 0120 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 Angel Home G53-G53 S7204 Angel Home V211372 250505 Stage 0.doc Version 1.30 Page 26 - 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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