Inspection on 20/03/07 for Casarita

This inspection was carried out on 20th March 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Casarita 02/03/09

Casarita 22/12/05

Casarita 12/05/05

Casarita 25/01/05

Casarita 19/07/04

Casarita 18/02/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Casarita 270 Fakenham Road Taverham Norwich Norfolk NR8 6AD Lead Inspector Mr Jerry Crehan Unannounced Inspection 20th March 2007 16:15 Casarita DS0000027656.V334132.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 Casarita DS0000027656.V334132.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. Casarita DS0000027656.V334132.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Casarita Address 270 Fakenham Road Taverham Norwich Norfolk NR8 6AD 01603 279222 01603 279529 cas.jeesal@virgin.net www.jeesal.org Jeesal Residential Care Services Limited 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) Position Vacant Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Casarita DS0000027656.V334132.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 22nd December 2005 Brief Description of the Service: Casarita is a modern, two storey detached house with a single storey annexe. The home stands in its own grounds on the main road into Norwich in the suburb of Taverham. It is situated within a few minutes walk of shops, post office and a public house. The home has two vehicles. Accommodation is provided for up to seven adults with a learning disability, some of who demonstrate challenging behaviours. All of the tenants have their own bedroom and the majority of these have ensuite shower and toilet. One of the service users lies separately in the annexe and has a dedicated staff team. The Home is owned and managed by Jeesal Residential Care Services Limited. Casarita DS0000027656.V334132.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection compromised an unannounced visit to the home that took place over 4 hours on 20th March 2007. Opportunity was taken to tour the premises, talk to tenants, the deputy manager and staff, look at care records and policies. The inspection report reflects evidence from inspection of Key Standards and other National Minimum Standards. Four comment cards were received from relatives before the inspection visit. These reflected positive views about the service and care for service users, which have also been reflected in the report. A comment card from a visiting GP also reflected positively about the home. Five comment cards were received from service users. These also reflected positive views about the home and about care staff. The range of weekly fees for the home is £883 to £2,175. What the service does well: • • The home thoroughly assesses the needs and aspirations of people thinking about moving into the home. There is good communication between staff and tenants, which is supported by a comprehensive training programme for staff that includes specialist training in communication. Tenants are supported to make decisions about aspects of their lives with support and within their capabilities. Links with the community are well maintained and focused around the individual needs of the tenants. The home has been successful in meeting complex and wide ranging health needs of tenants. The home has robust procedures and training for staff with regard to the protection of tenants from abuse. There is a homely environment that is safe, comfortable and suitable to the needs of tenants. There is a good staff team who are well trained, supported and supervised by the manager. • • • • • • Casarita DS0000027656.V334132.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Casarita DS0000027656.V334132.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 Casarita DS0000027656.V334132.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): Standard 2 Quality in this outcome area is good. The needs and aspirations of people thinking about moving into the home are assessed, and they are given the opportunity to visit and stay at the service before moving in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an assessment pro-forma and ‘application form’ used by the manager or other senior staff when collecting information. These documents are well designed to ascertain the level of support required by, and aspirations of, any prospective tenant. There was evidence of good assessment of prospective tenants. A wide range of information had been collected prior to admission of the newest tenant. It was also clear that they had had the opportunity to visit the service on several occasions before moving in, and they appeared to be appropriately placed within the overall service user group. Casarita DS0000027656.V334132.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is good. Tenants care needs are reflected in their individual plans that care staff follow. There is good communication between staff and tenants. Tenants are supported to make decisions about their lives within their capacities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two care plans were looked at in detail, others were looked at in less detail. The care plans all contain detailed assessments, care plans and risk assessments. Care plans and risk assessments provide care staff with very clear information about what care is required by the tenant and how this should be provided. Tenants spoken with were aware of their care plans and stated that they review their care plans with staff. There was good communication between staff and tenants over their care and ongoing decision making about their preferences. Specialist communication training for staff in ‘Signalong’, (a Casarita DS0000027656.V334132.R01.S.doc Version 5.2 Page 10 means of communication used by two tenants) supports good communication between staff and tenants. Risks are recognised and assessed appropriately with clear guidance provided to staff about how to manage the risks. There was evidence of regular review of risk and updates to risk assessments where there have been changes in need. Risk assessment examples seen include: epilepsy, kitchen access, community access, risk of absconding – each giving clear and specific guidance for staff. A risk assessment for tenants finances is undertaken and examples of these seen. These assessments indicate whether and what responsibility the tenant has for their own finances. How this is to be supported and by who. It indicates procedural safeguards in place to protect the tenant. The documents are available for tenants in word and illustrative picture format to assist their understanding if required, and are examples of good practice. Casarita DS0000027656.V334132.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, 15, 16, 17 Quality in this outcome area is good. The home caters effectively for the lifestyle abilities and preferences of tenants. Links with the community are well maintained and focused around the individual needs of the tenants. Tenants dietary needs are met and they are supported to make dietary choices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of the inspection tenants were undertaking a variety of activity at the home and in community day service settings. There were sufficient staff on duty to support tenants in their preferred activity during the day. At the busiest times of the morning and afternoon some tenants are supported on a 1:1 basis in order to access their chosen activity. A tenant said that earlier during the day of the inspection visit, they had gone out to the local pub for a glass of lemonade with staff and other tenants. Casarita DS0000027656.V334132.R01.S.doc Version 5.2 Page 12 Another tenant talked about their four day a week attendance at their day service where they are supported to undertake a range of activities in the community. Other activities described by either staff or tenants included arts and crafts, cooking, music, and trips to local attractions. A tenant said that they had enjoyed gardening in the past week when the weather was better. Some tenants described their contact with their families. There are telephone facilities for tenants to make or receive telephone calls in private. As the home has its own transport (a car and a ‘people carrier’) to support activities and other appointments, it has on occasions been able to support contact between tenants and their families. There were no visits to the home by relatives of tenants during the inspection visit. Each of the five comment cards from tenants received prior to the inspection indicate that they can have visitors. Tenants (who can assist in aspects of meal preparation) choose meals at the home. Menus seen were very varied, and the meal on the evening of the inspection visit looked appealing. One tenant had preferred to cook a different option to the main option available and was being assisted by staff to do this. This tenant communicated how they had lost excess weight through a healthy eating programme. Tenants safe access to the two kitchen areas are individually risk assessed. Casarita DS0000027656.V334132.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 Quality in this outcome area is good. The health and personal care needs of the tenants are well attended to. Medication is managed safely. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans indicate tenants individual support needs, and care staff are clear about the most appropriate ways to provide support, including personal and health care advice from a range of professionals. Staff spoken with during the inspection visit were knowledgeable and well informed about the health care needs of service users. The home had supported a tenant through terminal illness over recent months. They provided appropriate support with the assistance of community health professionals including the GP, Macmillan nurses, and the Palliative care nurse. There is no specialist equipment at the home required. The home uses a monitored dosage system for the medication. Medication is stored securely and appropriate records are kept for the receipt of medication into the home, its administration and any medication returned to the pharmacy. On review of medication no discrepancies were identified, and records were good. Staff receive training with regard to medication. The Casarita DS0000027656.V334132.R01.S.doc Version 5.2 Page 14 homes policy is for two staff to be involved in the administration of medication, however, there is no evident loss of accountability within the process undertaken. A risk assessment should be completed to support a long-standing arrangement whereby a tenant takes responsibility for providing their medication to their day care provider (see requirement 1). The current arrangement evidently works satisfactorily, however, a risk assessment should be completed with review date to monitor the arrangement. Casarita DS0000027656.V334132.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good There are good systems for protecting and responding to the concerns and complaints of tenants. Staff receive training about the rights of, and vulnerability of tenants and the procedure to follow if concerned about possible abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure, which is also available in symbol format in each tenant’s bedroom. Tenants indicated in comment cards received prior to the inspection visit, and at the visit that they would tell the staff if there were something they were not happy about. There are weekly tenants meetings were concerns can be aired and discussed. The work that staff are currently undertaking with regard to communication (Signalong) will enable tenants to be able to raise concerns more easily. The Commission has not received any complaints about the home since the last inspection visit. The Manager indicated that the home had not received any complaints either. The Proprietor had made an appropriate referral under the Norfolk Adult Protection Procedures. This concerns allegations of financial abuse of tenants. The matter is the subject of ongoing investigation by Norfolk Police. The allegations have been discussed openly at the home and with relatives of tenants by the proprietors and by staff at the home. Norfolk APU have commented on the high level of openness and cooperation by the proprietors within the investigation. This is supported by the Commission having received Casarita DS0000027656.V334132.R01.S.doc Version 5.2 Page 16 no expressions of concern or complaint by tenants, relatives or others in connection with the matter. Staff all receive training with regard to Safeguarding Adults within their induction and ongoing training. Each of the staff who spoke to the inspector were clear about the action they would take if concerned about the possibility of abuse taking place and were confident that the Manager and Proprietor would deal with this appropriately. They were equally aware of the home’s ‘Whistle-blowing’ procedure and its function. Casarita DS0000027656.V334132.R01.S.doc Version 5.2 Page 17 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, 28 & 30 Quality in this outcome area is good. A homely environment is provided for tenants with improvements planned. The environment is safe and comfortable. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The premises are suitable for the homes stated purpose, and in keeping with the local community. The interior accommodation is in a satisfactory state of repair, with adequate furnishings and fittings. The manager indicated that some service user bedrooms are due to be redecorated. Each tenant has their own bedroom. These are clearly personalised and decorated in a way which reflects the tenants choice and interests. At the time of the visit a tenant was rearranging their bedroom with the assistance of staff. The manager has relocated her office which was in the grounds of the home but not attached. The new office area is on the first floor of the home keeping the manager ‘in touch’ with events. The majority of service users hold their own bedroom door key, so can secure their bedrooms when not in use. Casarita DS0000027656.V334132.R01.S.doc Version 5.2 Page 18 The gardens are well kept and accessible to tenants. There is sufficient communal space at the home for the service user group; this includes kitchen, dining and lounge areas. The home benefits from large grounds and garden. Although staff lockers have been provided there appear to be insufficient to accommodate the belongings of staff on duty, as these were left in the corner of the kitchen. It is recommended that additional storage be provided in order that all staff have somewhere secure to store their belongings (see recommendations). Premises were clean and hygienic. Casarita DS0000027656.V334132.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. Staff receive good support and training, which enables them to carry out their roles effectively. Staff recruitment practices protect service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were six tenants accommodated at the home at the time of the inspection, they were cared for by three staff. This is the usual staff compliment throughout the day, with a waking night carer at night. As indicated earlier in this report other care staff are available to support day care activities. There is a care staff compliment of twelve. From information provided by the manager there are currently five carers with a qualification at (at least) NVQ level 2. A further two carers are due to sign up for NVQ training the week following the inspection (see Requirement 2). From discussion with support workers and a review of personnel files, it was evident that tenants are protected by good recruitment practices. Records seen provide evidence that staff receive good induction and training from the proprietor’s own training department. Care staff confirmed that the training is relevant and appropriate to their roles. Training schedules for the Casarita DS0000027656.V334132.R01.S.doc Version 5.2 Page 20 home shows that staff are booked to attend a range of courses over the coming months. This includes mandatory training such as medication administration, first aid, fire safety and moving and handling, and some specialist training such as autistic spectrum disorder, Signalong and epilepsy training. There is a stable staff group with experience, including the manager and deputy. There is a programme of formal supervision for staff. Staff indicate that they are well supervised, and this is supported by records. The manager and deputy manager undertake all staff supervision. Casarita DS0000027656.V334132.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, 39, 42 Quality in this outcome area is good. The new manager has relevant experience and is in the process of applying for registration. The home is well managed in a clear and robust way, which puts the needs of tenants first. There are good systems to ensure tenants and others associated ‘stakeholders’, can influence decision making about the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The previous registered manager has been dismissed from her post since the last inspection of the home. The subject of her dismissal is subject to an ongoing police investigation following theft related allegations affecting tenants at the home. Casarita DS0000027656.V334132.R01.S.doc Version 5.2 Page 22 The new manager has been ‘acting’ manager since October 2006 and was appointed to the manager’s post in November 2006. She is currently in the process of applying for Registration with the Commission. The new manager has an extensive nursing background and five years experience of working with people with a learning disability, including three years with management responsibilities. She has qualifications at NVQ level 3 and is currently undertaking the Registered Managers Award. There was evidence in the inspection visit that care staff find the manager approachable and clear about her expectations of them and their work. From records of regular staff meetings it was evident that she has a robust and open management style, is open about difficult issues and seeks to deal with them. The staff team have obviously worked together well to support a tenant with a terminal illness, and have worked together to restore tenants (and their relatives) confidence since the suspension and subsequent dismissal of the previous registered manager. There is an on call system for staff that provides access to a senior staff member at any time. The home produces an annual development plan. There are several ways in which the quality of the service is monitored. These include monthly reviews of tenants care plans, tenants meetings, staff meetings, annual questionnaires to professionals and relatives, health and safety monitoring, and the ‘Tenants Forum’ meeting that takes place with tenants from other of the Proprietors homes. The home demonstrates good practices ensuring tenants health, safety and welfare. Relevant health and safety training for staff, including moving and handling, first aid, fire drills and fire safety training, and food hygiene training, support practices. Casarita DS0000027656.V334132.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 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 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 2 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 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Casarita DS0000027656.V334132.R01.S.doc Version 5.2 Page 24 No 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 OP20 Regulation 13.2 Requirement Timescale for action 30/04/07 2 OP32 18(1)(a) The registered person must ensure safe procedures are followed and reviewed for the administration of medicines at all times. The registered person must 31/07/07 ensure continued progress toward meeting a minimum ratio of 50 NVQ 2 (or above) trained staff. 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 OP28 Good Practice Recommendations It is recommended that additional storage be provided in order that all staff have somewhere secure to store their belongings. 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