Inspection on 26/02/07 for Apna Ghar

This inspection was carried out on 26th February 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Apna Ghar 15/03/06

Apna Ghar 20/09/05

Apna Ghar 29/03/05

Apna Ghar 03/06/04

Similar services:

1 Marten Road

Daubeney House

Three Gables

Aldwick House

49 Glendale

The Springs Community

Crossways Community

Belle Vue Country House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Apna Ghar 1 Kingswood Road Gillingham Kent ME7 1EA Lead Inspector Marion Weller Key Unannounced Inspection 26th February 2007 09:45 Apna Ghar DS0000028849.V320980.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 Apna Ghar DS0000028849.V320980.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. Apna Ghar DS0000028849.V320980.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Apna Ghar Address 1 Kingswood Road Gillingham Kent ME7 1EA 01634 850445 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) niloferlueyonder.co.uk Mrs Nilofer Englefield Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (2), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (1) Apna Ghar DS0000028849.V320980.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One (1) Person over 65 with Mental health Difficulties. Two (2) People with Mental Health Difficulties. 15.03.06 Date of last inspection Brief Description of the Service: Apna Ghar is a small privately run home situated a few minutes walk from the centre of Gillingham and the train station. It has easy access for all local amenities. The home comprises of a semi-detached property on a corner plot with homely accommodation situated over two floors. It offers 24 hour care for people with mental health difficulties of ethnic minority and this is reflected in the care and support provided by the management and small stable staff team. Current fees range from £391-£420 per week according to assessed personal need. Apna Ghar DS0000028849.V320980.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Marion Weller and Sue Mc Grath, Regulatory Inspectors conducted this key unannounced inspection of the home between 9:45 am and 12:00 pm. During that time the inspectors spoke mainly with the owner/manager. Some judgements about the quality of life in the home were taken from observations and conversation. Some records and documents were looked at. In addition a tour of the building was undertaken. Three survey responses were received prior to the inspection. Responses from residents indicated that they were very satisfied with the standard of care the home provided. Statements on surveys included: “What is good about living in the home is that I am safe” And “I am safe and comfortable.” The owner gave her full cooperation throughout the visit. What the service does well: What has improved since the last inspection? Since the last inspection the home has arranged and supported some residents to take part in an eight-day trip to India. This is the first extended holiday of this type the home has arranged for residents and it was said to be very successful. Recommendations made at the last inspection to make good loose tiles near the kitchen sink have been complied with and the bath panel has been tiled to improve its visual appearance. Apna Ghar DS0000028849.V320980.R01.S.doc Version 5.2 Page 6 One resident’s bedroom has had a large wardrobe fitted to provide them with additional storage space. The home now has a monitored dosage system to assist with medication administration. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Apna Ghar DS0000028849.V320980.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Apna Ghar DS0000028849.V320980.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12345 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People accessing and using this service largely have all the information they need to make an informed decision about whether the service is right for them. The personalised pre admission assessment means that residents’ needs are clearly identified and planned before they move into the home, particularly in relation to their cultural and religious needs. Residents are given a contract that clearly tells them about the service they will receive. EVIDENCE: The home has a Statement of Purpose and a Service User Guide, which provide residents or their representatives with the information they need to make a firm decision about moving to the home. The home caters for the preferences and needs of specific ethnic communities and staff can communicate effectively with residents using the individual’s preferred mode of communication. Information documents are written in English, but the home’s owner/ manager translates into the ethnic language the prospective or current resident prefers. Apna Ghar DS0000028849.V320980.R01.S.doc Version 5.2 Page 9 The manager stated that the home’s information documents are reviewed annually or more frequently if there is a need. The documents were clear, easy to read and informative. They would however benefit from further review. The Dept of Health has changed regulatory requirements recently to clarify in more detail the type of general information about fees and related services that care home providers must include in information documents. Some of the home’s information documents also mention NCSC instead of the CSCI. The regulators title needs to be correctly recorded to avoid confusion for prospective residents and to evidence the documents are current. The manager stated her intention to review the home’s documents in line with updated guidance and advice. Residents have a full pre admission assessment undertaken by the manager prior to moving in to ensure their needs can be met by the home. Individuals are also reassessed if they are admitted to hospital for in patient treatment and wish to return to the home on discharge. Residents and their representatives are able to visit the home before deciding to move in. Residents’ files contained individual written contracts of terms and conditions applicable to the placement. Fees charged to individuals for their care were detailed on each document and the resident had signed them. Apna Ghar DS0000028849.V320980.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 8 9 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to participate in the day-to-day running of the home and they are supported in taking risks as part of an independent lifestyle. Their right to confidentiality is upheld. EVIDENCE: Residents have access to understandable and up to date information about activities and services and appropriate communication support. Care plans viewed, evidenced risk assessments had been carried out on most aspects of a resident’s daily life for their protection and support in leading an independent lifestyle. Confidential records were observed to be securely stored when not in use. Apna Ghar DS0000028849.V320980.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 16 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents engage in activities that meet their leisure and cultural needs within the home and the local community. They benefit from a healthy diet that is of their choosing. EVIDENCE: Residents play board games, read and watch television/DVDs mainly of Asian programmes. In the community they attend the local Temple, the Brook Theatre for cultural events, library and a day centre. The home also arranges trips to a London cinema to watch Asian films, as none are available locally. Since the last inspection the home has arranged and supported two residents to take part in an eight-day trip to India. The remaining resident was consulted about the trip but chose not to be included and was supported by staff at home while the others were away. Apna Ghar DS0000028849.V320980.R01.S.doc Version 5.2 Page 12 During the inspection the three residents went shopping for food and other essentials to support their chosen lifestyle. Residents have appropriate personal and family relationships. The owner/ manager spoke of occasions when residents go to visit family members, particularly during festivals. The resident group of three individuals are mainly vegetarian and this is taken into account with menu planning. The manager states that one resident will usually consult others on their choice of meals and menu planning and they are encouraged to take part in the preparation and cooking of their choices. Residents’ rights are clearly respected and each individual has clear responsibilities in the home. There are regular ‘house meetings’ where views are aired, information and support is offered by the manager and responsibilities within the home are discussed. Apna Ghar DS0000028849.V320980.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18 19 20 21 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from having clear and in-depth care plans that identify their individual needs, identify risks and give clear guidance to staff. Residents can feel confidant that they have full access to healthcare professionals and that the home ensures their cultural and religious needs are met. Residents are largely protected by the home’s policies and procedures regarding medication. They can be confident that where shortfalls exist the home will review its arrangements and facilities in light of good practice advice to secure their safety and protection. Residents are treated with respect and their privacy and dignity is promoted within the home. EVIDENCE: Each resident has a care plan. These were found to be comprehensive and detailed. Care plans had been regularly reviewed and the main plan had been Apna Ghar DS0000028849.V320980.R01.S.doc Version 5.2 Page 14 revised where necessary. Daily records were being maintained in separate bound books. The content of records clearly reflected elements of the care plans seen. All documents were up to date. Residents or their representatives/ relatives were appropriately involved with reviews of care provided. Residents were seen to have regular access to health professionals. Care plans had been signed by residents as evidence of their involvement in the formulation of the plan and their agreement to it. The ageing, death or illness of the individuals involved were mentioned in care plans and planned for. This aspect of care is discussed with residents on admission. Risk assessments were in evidence, which covered, environmental, care and behavioural aspects of the individuals care. Care staff all speaks the preferred languages of su’s in residence, good communication is maintained in the home. The manager understands how to approach residents in a culturally aware and very respectful manner. Medication is basically managed well in the home but there are some minor areas that could be improved upon. Medication administration sheets were being completed with no obvious gaps. However, some entries had been made in pencil. Good practice demands that they are completed in pen. The home has a Monitored Dosage System to support the safe administration of medicines to residents. This is a recent development in the home. Medicines are currently stored in a locked metal cupboard near to the home’s kitchen. Storage of medicines in a kitchen or bathroom environment is not best practice. Medicines should be stored away from sources of heat and moisture. The manager or designated staff hold the keys to the cupboard while they are on duty. Residents are given the choice of self-medication within a risk assessment framework upon admission. Currently all medication is administered to residents by staff. One resident was seen to have an empty medicine bottle on a bedroom shelf. The writing on the label was indistinct and gave no clear indication of the medicine/ dosage instructions or the resident’s name. The manager explained the container is used to transport medicine the person needs to take at a day centre. This is technically secondary dispensing and is not best practice. The manager was advised to take advice and revisit the home’s medication policy and procedures documents and the individuals risk assessments. Medicine should not be taken out of an MDS system for administration later. In most cases where this happens, there will be an alternative. The owner/manager and staff have previously attended medication training on the safe administration of medication. More medication administration training is planned. Most of the home’s staff are qualified to NVQ Level 2 and this area of knowledge is also covered on the course. The manager stated her intention to resolve the shortfalls identified. Apna Ghar DS0000028849.V320980.R01.S.doc Version 5.2 Page 15 Medication is regularly reviewed by health professionals for all residents in the home. One resident is a tablet controlled diabetic. The home’s staff do not do undertake blood sugar monitoring tests. The manager stated that the hospital regularly monitors the care and treatment of the condition. Residents’ diets and personal preferences regarding food are recorded by the home. Apna Ghar DS0000028849.V320980.R01.S.doc Version 5.2 Page 16 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 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected from abuse, neglect and self-harm. Residents views are listened to and acted upon. EVIDENCE: All staff members have completed Adult Protection training and mandatory up date training is currently being arranged by the owner/manager for 2007. The home has policies and procedures for reporting concerns. The home has adopted the Kent & Medway Adult Protection Protocols in order to ensure that both residents and staff are fully protected. Survey responses from residents stated that they felt safe and secure in the home. They knew who to take issues of concern to. The owner/manager explained that individuals are encouraged to share their problems and concerns with her and the home’s staff. They will report on to the Community Psychiatric Nurse or the individuals Care Manager if necessary. The home arranges regular ‘house meetings’ which all residents attend. This is an opportunity for views to be aired. Residents’ rights and responsibilities are regularly discussed. Apna Ghar DS0000028849.V320980.R01.S.doc Version 5.2 Page 17 The home has received no formal complaints or concerns since the last inspection. The manager said formal records would be kept if this happened. Apna Ghar DS0000028849.V320980.R01.S.doc Version 5.2 Page 18 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 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a homely and comfortable environment with adequate personal and communal space. EVIDENCE: The home has comfortable furnishings of a good standard with a lounge and dining area of adequate size for three residents. Bedrooms are of a good size and personal possessions reflect the interests and lifestyles of residents. The owner/manager has recently installed a fitted wardrobe in one bedroom to increase storage space for the occupant. Recommendations made at the last inspection to make good loose tiles near the kitchen sink have been complied with and in the residents bathroom the bath panel has been tiled to improve the visual appearance. The kitchen was clean and tidy and there is a separate utility room which houses adequate laundry facilities for residents use. Apna Ghar DS0000028849.V320980.R01.S.doc Version 5.2 Page 19 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 34 35 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from being cared for by a dedicated staff team who are well supported and supervised. The home continues to effectively train its staff to ensure residents’ needs are met at all times. Some minor improvements to the home’s recruitment documentation will benefit residents’ safety and security. EVIDENCE: The home has a small and basically stable staff team, which number five individuals. That number includes the owner/manager. All staff have undergone the home’s comprehensive induction programme and have clearly defined job descriptions that clarify roles and responsibilities in the home. Apna Ghar DS0000028849.V320980.R01.S.doc Version 5.2 Page 20 All of the staff team have either completed NVQ level 2 in care or are close to completion of the award. All staff holds a current first aid certificate. The manager is in the process of arranging mandatory update training this year. Survey respondents said they got on with staff and felt safe and secure with them. The manager and staff are obviously skilled in the provision of this small, specialist service and evidenced a good understanding of individual needs with particular attention paid to their cultural backgrounds and personal interests. Staff files were viewed; these largely meet the demands of regulation. Two minor shortfalls were discussed with the manager. Applicants for employment must provide a full employment history, together with satisfactory explanations of any gaps in their previous employment. Gaps not explained on applications should be discussed, and responses recorded at interview. The applicant must make a clear statement as to their mental and physical health, and by doing so; confirm their suitability for the position for which they are applying. CRB and POVA checks are in place for all staff. Staff are regularly supervised. records seen evidenced identification of training needs and appraisal of work with residents. Apna Ghar DS0000028849.V320980.R01.S.doc Version 5.2 Page 21 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 38 39 40 42 43 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health, safety and welfare of residents are promoted and protected and they benefit from competent and accountable management of the service. EVIDENCE: The home provides a specialist service, which offers 24-hour care for people with mental health difficulties from ethnic minority groups. The owner/manager said the service is always in demand as there is very little other provision of this type locally. When asked to explain what she felt the home did well she said, “We offer a very person centred and specialist service that is in demand both locally and nationally. We provide a very secure and supportive environment where individuals with mental health needs can be Apna Ghar DS0000028849.V320980.R01.S.doc Version 5.2 Page 22 sure that their independence and well being will be promoted”. The manager speaks regularly with residents and their representative as to the service offered to them and is keen to look at ways in which she can further develop the provision. The owner/manager is experienced and runs the home competently and in the best interests of residents, she is qualified to do so and is well respected. Other professionals refer to her as a source of information and help when dealing with the needs of ethnic minority groups with mental health problems in the Medway Towns. She has completed NVQ 4 in Care and has also achieved the Registered Managers award. The owner/ manager regularly updates her skills and remains current by attending any relevant training. Staff receive induction training that includes safe working practices, and the home has policies and procedures in place for the promotion and protection of service user health, safety and welfare. There are clear lines of accountability in the home and documentation is largely maintained to a good standard. Residents can be confident that where shortfalls exist, as mentioned in the report, the home will review its arrangements and facilities in light of good practice advice to secure their safety and protection. Apna Ghar DS0000028849.V320980.R01.S.doc Version 5.2 Page 23 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 2 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 3 4 3 3 X 3 3 Apna Ghar DS0000028849.V320980.R01.S.doc Version 5.2 Page 24 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 Home’s Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 YA1 Good Practice Recommendations It is recommended that the home’s information documents be revised to ensure they reflect updated regulatory requirements about fees and related services. It is recommended that the home’s information documents record the correct title of the regulator to avoid confusion for residents and to evidence they are current. It is strongly recommended that the manager fulfil the stated intention of reviewing the medication administration practices and storage facilities in the home in line with good practice advice to secure residents safety and protection. It is recommended that the manager fulfil the stated intention of reviewing recruitment documentation and records to ensure full compliance with regulation. 2 YA1 3 YA20 4 YA34 Apna Ghar DS0000028849.V320980.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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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