Inspection on 23/04/07 for Cherry Tree House

This inspection was carried out on 23rd April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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

Cherry Tree House 05/01/06

Cherry Tree House 09/09/05

Cherry Tree House 16/12/04

Cherry Tree House 16/04/04

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Ashwood House (Leyton)

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

CARE HOME ADULTS 18-65 Cherry Tree House 49 Hainault Road Romford Essex RM5 3AA Lead Inspector Roger Farrell Unannounced Inspection 23rd April 2007 10:30 DS0000027854.V337542.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 DS0000027854.V337542.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. DS0000027854.V337542.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cherry Tree House Address 49 Hainault Road Romford Essex RM5 3AA 01708 735387 01708 735387 rita@outlookcare.org.uk 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) Outlook Care Mrs Rita Evelyn Hall Care Home 5 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (5) of places DS0000027854.V337542.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th January 2006 Brief Description of the Service: Cherry Tree House is a care home that provides accommodation and support for up to five people who have in the past experienced mental health problems. Three of the four current residents are older persons. Opened in 1991, it is run by Outlook Care Limited, a not for profit organisation that operate a range of accommodation and support services for vulnerable adults in North East London and Essex. There are two staff on duty through the day, with someone on-call in the house overnight. However, all residents have good independence skills. Most staff, including the manager have worked at this home for a number of years. The original funding was a block contract with Barking, Havering and Brentwood Health Care Trust as part of the closure of old style long-stay wards. Outlook Care took over the running of the home from the Trust eight years ago. The house is a detached property on the corner plot of a slip road just off the busy A12 duel carriageway. The building is owned and maintained by North East Thames Housing Trust. DS0000027854.V337542.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 10:30am to 5:45pm on 23 April 2007. Rita Hall has been the manager for four years and was available through the day to help with the inspector’s checks. Sadly, one of the original residents who had moved in fifteen years ago had recently passed away in hospital at the age of seventy-two. The home’s last inspection was in January 2006, with a more detailed assessment four month’s earlier. The positive conclusion was – “The continuing success and stability of this service means that, as with last year’s reports, it has not been necessary to set any requirements. Despite the four established residents growing older, they remain relatively independent and able to follow lifestyles of their choice. To help them with this they can rely on a competent manager, a solid staff team, and a well maintained home.” The inspector’s judgements were backed up by quotes such as - “The overall quality of care provided to residents is excellent. It allows them to maintain an independent lifestyle but with lots of care and encouragement on hand when needed.”; and - “I am very happy with the home. [My relative] has been well looked after. Lovely staff, very caring. I am happy with the home.” At this recent visit the manager gave an overview of each resident’s support needs, including any physical and mental health issues; reactions to the recent loss of a housemate; and how people spend their time. In the course of the day the inspector asked for a range of paperwork to be copied and sent to him, and these were provided within the deadline. This included the up-to-date contact details for relatives. The inspector would like to thank the four relatives who returned forms. He has also taken into account the written comments of others who visit the home, such as a befriender, an advocate, and various health care workers. He also looked at the forms completed by residents as part of the home’s quality survey. These views and comments have influenced the positive conclusions reached in this report. The inspector took time to explain to the manager the changes in the way care services are monitored. Using a flow chart, he described each change, including – the frequency and types of inspection; the increased importance of self-assessments; ‘star-ratings’, and how these will be made public; and ways of hearing the views of people who use services and their representatives. He also outlined how the Commission is moving towards having regional contact offices, and how to make sure information reaches the right inspector. At his visit the inspector was able to speak with the three residents who were at home. He would like to thank the residents for the warm welcome he receives; and the efficient way the manager deals with his enquiries. DS0000027854.V337542.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Asked about improvements in questionnaires, typical answers were – “I can’t think of anything to improve.”; and “Improvements? Nothing in particular.” A view echoed in the following quote from a relative - “I do know that my (relative) seems well looked after and gets any help she may need.” Most standards were covered at this inspection, and all are rated as at least the ‘good’ - with fifteen achieving the top ‘commendable’ score. DS0000027854.V337542.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000027854.V337542.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 DS0000027854.V337542.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, and 5. Quality in this outcome area is ‘excellent’. This judgement has been made using available evidence including the visit to this service. The main area considered under this section is how assessments are carried out. Outlook Care has a good set of guidelines and assessment forms covering move-ins. These were used during the introduction of the last resident to join the household in 2005. The way the new person was helped make the transition; the detailed assessment documentation; and how they linked up with the social worker and others showed a thorough approach to assessment and planning. This included how the needs and views of existing residents were taken into consideration. One health worker wrote - “Cherry Tree House is an extremely well organised home. It is always very welcoming to new residents and can also adapt to dealing with clients with a wide range of needs. It is homely, supportive and seems to tailor care to clients individual needs.” Existing and future residents can feel confident that their best interests are fully taken into account. There is also a helpful approach to providing information in an understandable way. EVIDENCE: At an earlier visit the manager gave a detailed description of the planning, introduction and move in of the last resident to join this household group. This included consideration of the age difference of this person compared to the established residents. The inspector looked at the paperwork covering the move in. This showed that the organisation’s policy, ‘Referral Procedure – Residential Care’, was followed. The service user’s file contained the required range of information. This included – a good referral report from the social worker; the organisation’s referral form; the manager’s detailed assessment DS0000027854.V337542.R01.S.doc Version 5.2 Page 10 and checklist; planning and progress reports covering the introductory visits and stays, and the early period following moving in. The standard format ‘health file’ and ‘pcp file’ had been set up, and this had a copy of the recent CPA review. Good links had been established with staff at the resource centres the resident attends during the week. Good attention to detail evident in this documentation, including picking up on an error in the main social work report, shows a very high standard of practice and manager coordination. That resident confirmed his satisfaction with the move-in and how he had adapted to this setting. There had been some initial contact regarding a referral to the vacant place. The manager had been to meet this person a number of times in hospital, and a home visit had taken place. Due to legal and family considerations the pace was likely to be slow, but assurances were given that all the correct steps would be followed, as had been the case with the last move in. There is a detailed and attractively presented ‘statement of purpose’. This is in a format that is understandable to service users, including the using pictures. Of an equally high standard is the ‘service users’ guide’, that also makes good use of pictures. They cover all areas asked for under these standards, including a section on service users’ views. Copies of these and other main documents are available in the hall, along with a pictorial version of the complaints’ procedure. Both the service users and staff notice boards have an appropriate range of up-to-date information. Residents’ files have signed copies of the contracts issued by Havering Housing Consortium to the original tenants; the more recent version of the Licensee Agreement provided by East Thames Housing Association; and letters from Outlook Care on rent adjustments. There is also a pictorial licencee agreement. DS0000027854.V337542.R01.S.doc Version 5.2 Page 11 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 ‘excellent.’ This judgement has been made using available evidence including a visit to this service. Outlook Cares’ service user file format was mainly developed to cover services for people with a learning difficulty. Previous reports have praised the way that this home has developed a care plan and monitoring system appropriate to the needs of people who have had mental health needs. This system continues to be used effectively, including showing how residents are involved in decisions about their lifestyles. Residents can be confident that their support needs, including health monitoring, are well documented and followed through. One comment was - “My (relative) was in a privately run home before going to ‘Cherry Tree House’. The care at ‘Cherry Tree House’ is by far better and more caring than the other house. The home takes an active interest in (service users) whereas the other home tended to leave them to their own devises.” EVIDENCE: The manager and team continue to operate a very high standard of care planning and monitoring files. In addition to Outlook Care’s main ‘pcp’ format, there are well-arranged ‘health care files’. The ‘pcp files’ continue to be used as the main method of including residents in making choices. Additionally, the ‘health care files’ have a more detailed practice planning system with relevant observations and monitoring suited to this service user group, including needs DS0000027854.V337542.R01.S.doc Version 5.2 Page 12 associated with getting older. They are efficiently arranged into modules, are kept up-to-date, and entries are well expressed. The manager outlined a recent initiative to track through individual goals using a ‘star outcome monitoring tool’ . This justifies maintaining the rating for Standard 6 at the ‘commendable’ level. An example of seeing matters through was that the oldest resident had just moved to the downstairs bedroom. He told the inspector how pleased he was with the change that had taken place a couple of days earlier, including the way the room had been redecorated and new carpet fitted. This residents comments included - “The staff treat me well because they show me respect…..I like the standard of accommodation because the house gets refurbished.” In addition to the ‘pcp files’, other ways of making sure residents have a voice are the fortnightly residents’ meetings, with all staff signing to say they have read the minutes. Residents are kept informed about the various local forums for people who use services, but in general the residents do not wish to participate – though one person did attend the main annual conference. An advocate who visits wrote - “Staff always contact us regarding any events affecting service users/residents to ensure (advocacy service) involvement as appropriate.” Individual files have a range of specific risk assessments that are reviewed and brought up to date if necessary. There are also individual ‘finance files’, including itemised sheets for all transactions involving staff. DS0000027854.V337542.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. Quality in this outcome area is ‘good’. This judgement has been made using available evidence including a visit to this service that involved residents confirming they are satisfied with the range of opportunities offered. All residents are active, including having hobbies such as knitting, word puzzles and maintaining the garden. A relative wrote – “They look at each different need….this includes medically as well as things like holiday breaks, excursions and buying clothes.” Residents again confirmed they are happy with meal arrangements, and do use the kitchen to make drinks, snakes and are involved in making some main meals. One resident wrote - “I like the food because we get a good selection.” Another confirmed that meals for the week are discussed every Saturday, and that she helps with the shopping on Mondays. EVIDENCE: The manager was able to present strong evidence in support of this group of standards. This included the ‘weekly activities chart’ and copies of each person’s ‘weekly schedule’. Individual files have monthly resumes of main events, including social events. In addition, the manager prepared a digest of activities over the past year, including a number of return stays at favourite holiday camps in Hayling Islands; a ‘Turkey and Tinsel’ winter break; and other DS0000027854.V337542.R01.S.doc Version 5.2 Page 14 holidays taken with clubs. Local trips have included museums, musicals, and a recent bowling tournament. Also listed were other opportunities offered, but not taken up. Talking about holidays and social events is a standard item at the fortnightly house meetings. When speaking to the inspector, satisfaction with holidays is often mentioned, including showing him photographs. Some residents have been involved in supported employment in the past, but a number now consider themselves retired, including a resident who did a part-time gardening job until last year. The weekly programmes show a good range of regular clubs and day centres, with attendance in line with each resident’s wishes. As appropriate, options to be involved in groups for older persons have been offered and arranged. The youngest resident has maintained the links with the two day centres he has attended regularly since before moving in. The activities plans show that opportunities are reviewed regularly with each person. Three residents talked about their activities, one person describing her most recent amateur dramatics role. The manager gave an overview of each person’s family and social links. One resident who does not have family contact has a befriender arranged through Age Concern who he sees every month. This person wrote – “I have been visiting as (a befriender) for years. The staff are always very helpful and friendly. I can see they enjoy their jobs and this helps create a lovely atmosphere.” There is a good tradition of residents helping with household tasks. Generally residents do their own laundry with some minimal assistance. They help with meal preparation and make their own snacks. All use keys to the front door and their bedrooms. There is a section in each person’s file where details are recorded if any restriction is ever used, such as to ensure safety when going out. The three residents at the house during this visit said again that they are happy with meals, confirming that their choices are fully considered. DS0000027854.V337542.R01.S.doc Version 5.2 Page 15 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 and 21. Quality in this outcome area is ‘good’. This judgement has been made using available evidence including a visit to this service. This included the manager giving a description of each resident’s contact with medical services over the last year. Good systems are in place to detect and monitor physical and mental health, as well as safe arrangements for helping with medication. Comments from health and social practitioners included – “Staff are always very prompt with information and know the service users well…..the staff are very open and honest with the service users and have clear ways of working.” Another person commented – “Staff have always been able to provide me with any relevant information whenever I have asked…..Two way communication is very good…I am happy as to how staff assist and prepare the service users for any ensuing intervention.” EVIDENCE: At this visit the manager gave an overview of each person’s health care needs and medical support. As appropriate, psychiatric consultations and medication reviews are suitably documented. The ‘health care files’ are still being maintained to a high standard, showing good monitoring and a sensitive approach to supporting residents with their personal care needs. This includes being alert to problems that may develop as a result of aging. One recorded comment was - “(The doctor) said what a good report staff completed and presented at the medication/CPA review. All at the review agreed how well (the service user) had progressed since moving to Cherry Tree House.” A visiting DS0000027854.V337542.R01.S.doc Version 5.2 Page 16 health care worker wrote - “I have always met with the service user in her room whenever I visit.” The manager gave an update on concerns raised by the organisation and the family of the resident who died regarding her hospital care. Good steps had been taken to help this resident whilst she was at the home to maintain her mobility. The manager had contacted a bereavement service following the recent death, but none of the service users took up the offer. Staff show persistence, such as with one resident who is resistant to having dental care. Earlier a relative had wrote to the inspector saying – “My [relative’s] mental and physical well being has improved no end. The house and carers are what all homes should be like. The staff are very good at their jobs.“ The home uses the Boots’ monitored dose system. Medication is kept in a locked bureau in the dining area, and separated in boxes for each person. Residents are encouraged to take their own medication under supervision, though there is a need for two staff to be involved in giving one person their liquid medication. Residents have their own signing sheets, as well as staff signing the mar charts. At this visit the inspector observed residents taking their mid-day medication, overseen by a staff member. All arrangements checked were satisfactory, including the files that contain guidance on the main types of drugs being used. There is a medication hand-over sheet. Where appropriate, the date had been written on when a package was opened. The manager does a weekly audit of medication and recording sheets. The supplying pharmacist had last done a check in November 2006, her report concluding – “No problems to report.” She went on to add – “I have had a very pleasant visit to the home today and all medication records were in excellent order…the home had a warm and welcoming feeling.” The organisation also carry out their own detailed medication audits, the last one at Cherry Tree House took place in January 2007. Again, satisfactory arrangements were reported. This included listing all staff as having had an annual competency assessment within the last three months. All staff have done the more detailed ‘Safe Handling of Medication’ course. DS0000027854.V337542.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. Quality in this outcome area is ‘excellent’. This judgement has been made using available evidence including a visit to this service. The manager is fully aware of the action to take if there is a complaint or a suspicion of abuse. Residents are aware of how they can raise concerns, including with an advocacy service. One resident wrote - “(If I was unhappy) I would speak to an advocate.” EVIDENCE: The home has a copy of Outlook Care’s complaint pack. This includes identifying a complaint’s contact person; a complaints flow chart; a large print version of ‘How to Make a Complaint’; and a complaint contact card. There was also a laminated picture complaints guide in the hall, along with a supply of the complaint forms. Information on how to contact the Commission is included. There have been no complaints logged since the last inspection. Also on display are contact details of a local advocacy service. An advocate wrote – “Staff always contact us regarding any events affecting service users/residents to ensure (our) involvement as appropriate.” A similar comment was - “The residents are happy with staff – no complaints have been raised with (us).” Copies of ‘No Secrets’, and the organisation’s relevant policies on safeguarding service users are available, including on whistle-blowing, and Havering Council’s local guidelines on adult protection. There was also a copy of the General Social Care Council’s Code of Practice, extracts of which the manager has on display in the office. Staff have confirmed that they had been briefed on the role of the GSCC, and all staff have signed to say they have been issued with a copy of the Code of Practice. DS0000027854.V337542.R01.S.doc Version 5.2 Page 18 In his last meeting with staff they gave satisfactory answers on protection issues. The manager made sure the right steps were taken following an incident last year away from the home, including involving the police. Also available was guidance on the new mental capacity regulations, including ‘best interest assessments.’ DS0000027854.V337542.R01.S.doc Version 5.2 Page 19 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, 25, 26, 27, 28, 29 and 30. Quality in this outcome area is ‘good’. This judgement has been made using available evidence including a visit to this service. This house is well suited to the needs of residents. Residents and staff take pride in maintaining the house in an excellent standard, and one residents efforts means that this also includes the garden. One resident wrote – “I like the standard of accommodation because the house gets refurbished.” A relative said – “The decoration of the house always looks homely.” EVIDENCE: The house is on a corner plot adjacent to a dual carriageway, but this does not seem to adversely affect the residents’ use of the garden, which is well screened and has been delightfully maintained by one resident over the years. Sound insulation has been improved by the recent fitting of double-glazing. The main shared area of the house is the combined ‘L-shaped’ lounge and diner. This has recently been redecorated and there is new seating. The kitchen, hall and utility room have also been repainted; new doors fitted to match the new windows; and some kitchen equipment has been replaced. All residents have their own bedrooms that reflect their individual tastes. Again, all bedrooms have been redecorated since the last inspection. The DS0000027854.V337542.R01.S.doc Version 5.2 Page 20 house is well served for bathrooms, with two upstairs, and a spacious showerroom on the ground floor with a walk-in shower. There is a separate toilet on the ground floor. All were found to be clean, with fresh towels and soap, and have suitable locks. There is an assistance call system that has been used in the past, but is not needed at present. One visitor wrote - “Since my feedback last year, the standards still seem very high to me, both in caring for the service users and maintenance to the home (eg. installing a handrail and extra wide steps in the garden).” An excellent standard of cleanliness was again found in all parts of the home. In addition to residents helping with some household tasks, there is also a part-time cleaner. One relative comment was - “They keep the house clean and well decorated, and help with the shopping.” The last independent infection control and hygiene assessment awarded a 100 score. In recognition of the consistently high standard found at successive visits, the household standard is again rated at the ‘commendable’ level. DS0000027854.V337542.R01.S.doc Version 5.2 Page 21 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): 31, 32, 33, 34, 35 and 36. Quality in this outcome area is ‘excellent’. This judgement has been made using available evidence including a visit to this service. This home has a remarkably stable, experienced and well-qualified staff team. Comments made by residents and relatives praise the support provided. Comments included - “The staff do keep us informed…… we are always made very welcome”; and “(Our relative) is very happy with the home and carers.” A nurse who visits wrote - “Staff are always friendly and helpful.” EVIDENCE: The normal pattern of cover is two people on both the early and late shifts, excluding the manager. Night cover is one person on sleep-in duty. Staff on duty at this visit corresponded with the planned rota. The manager says this level of cover is adequate to meet the needs of residents. The staff team is very stable, with most support workers having over five years experience in this setting. There have been no changes in the team for three years, the current deputy being the last person to join in May 2004. All the team have NVQ at Level 3, which exceeds considerably the level expected. Outlook Care cover gaps by using staff from their other homes doing monitored extra hours through agency bookings. This use of familiar staff will be used to cover an expected period of maternity leave later this year. DS0000027854.V337542.R01.S.doc Version 5.2 Page 22 The inspector has checked samples of staff files at previous visits. These have copies of all the required documents, including a separate file of CRB certificates. There is a regular programme of individual supervision, with a forward planning programme on display. There is also evidence that annual appraisals are carried out. DS0000027854.V337542.R01.S.doc Version 5.2 Page 23 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, 40, 41 and 42. Quality in this outcome area is ‘excellent’. This judgement has been made using available evidence including a visit to this service. The inspector continues to find this to be a very well managed service. Outlook Care have a systematic approach to operating their services by having up-to-date policies, procedures and accountability checks. This home’s manager works well within this structure, notably as most local services are for adults who have a learning disability rather than a former mental health needs. She again was found to be competent and methodical in responding to the updates asked for at this inspection. EVIDENCE: The manager has achieved the ‘registered managers award’, having already gained NVQ in Care at Level 4. She continues to ensure the home operates in line with the best practice principals of Outlook Care; meeting the rules set by legislation; and making sure service users have a safe and comfortable lifestyle. DS0000027854.V337542.R01.S.doc Version 5.2 Page 24 All documentation requested at this inspection was presented in an efficient manner. The organisation’s standardised policy and procedures files are available, listing when each was last revised. The inspector was shown the growing range of policies that have been done in an ‘Easy Read’ style this being a further step in achieving service user involvement. The company operate a quality assurance scheme – called the ’Continuous Improvement Programme’ (CIP). The manager is familiar with the guidance booklet that steers this initiative. All staff have been given a copy; have attended briefings; and “signed up” to the scheme. This has been tied in with the company’s intranet computer system, including ensuring staff are familiar with all current policies, guidelines, and practice forms. Other quality assurance schemes that can be evidenced include ‘ISO9002’; ‘Investors in People’; ‘Positive About Disabled People’; and reports to confirm regular monthly service audits in compliance with Regulation 26 of the “Care Standards Act 2000”. The evidence is sufficient to confirm the company’s commitment to quality assurance and control systems required under this heading, and leaves well placed to tackle the ‘AQAA’ assessments being introduced by the Commission this year. At this visit the inspector asked to see a range of documentation and certificates covering health and safety. This included fire safety arrangements; electrical, gas and water safety checks; periodic building safety checks; and insurance cover. The last inspection by and environmental health inspector was in January 2007, with satisfactory findings recorded. The last inspection by a fire safety in April 2005 also resulted in a favourable report. The most recent fire risk assessment by a consultant made one recommendation – the garage doors have improved seals with this upgrade being carried out to the doors as they are replaced. The ordered and efficient and thorough way in which the manager presented evidence under this heading again justifies the award of the highest ‘commendable’ rating. DS0000027854.V337542.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 4 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 4 23 4 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 4 STAFFING Standard No Score 31 3 32 4 33 3 34 4 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 4 4 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 3 3 4 4 X 4 4 4 X DS0000027854.V337542.R01.S.doc Version 5.2 Page 26 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. 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. Refer to Standard Good Practice Recommendations DS0000027854.V337542.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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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