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Inspection on 04/09/07 for Chiswick Care Ltd

Also see our care home review for Chiswick Care Ltd for more information

This inspection was carried out on 4th September 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The people living in the home appeared very happy and have a good relationship with the staff. One resident said "the staff are absolutely super". The home provides a high standard of care and support to a group of people with a range of complex needs. The home by working consistently and professionally with the residents in partnership with other care professionals is able to support the residents to make significant progress with their personal development. The manager and staff demonstrated a good knowledge of the people living in the service and were able to recognise their individual needs and how to respond appropriately to them. The residents are supported to develop their independent living skills in the home based on their individual needs. The residents are supported to access a range of educational and leisure activities based on their individual interests and this enables them to have participation in the local community. The manager and staff show a high level of enthusiasm and commitment to their work in the home. The home is very clean, comfortable and homely and the residents each have an attractive single bedroom. Some of the people living in the home have close contact with families and friends and this is promoted by the home. The residents dietary needs are met with a balanced and varied selection of fresh food that meets their health needs, tastes and cultural needs.

What has improved since the last inspection?

The last inspection took place on the 14 December 2006 and there were nine requirements and six of these have been met. Each resident now has a record of how they are being supported to manage their personal finances, staff have received training on supporting people with complex behaviours, each member of staff has a copy of their ID in their file, new staff are completing their induction training, staff are receiving regular supervision and staff who have completed or are undertaking their NVQ training are providing the home with copies of their certificates. Overall the staff working in the home are better trained and managed and this improves the support they then are able to provide to the residents in the home.

What the care home could do better:

The report has identified a number of areas for improvement at this inspection. In terms of the support given to the residents there needs to be further work on the development of person centred care plans, review meetings need to take place at least once a year and in the information in the care plans needs to be accurate including information on personal finances. One resident should be supported to explore supported employment. The residents also need to be assisted to ensure they have regular dental and optical checks and the outcomes of healthcare appointments need to be recorded. One person needs guidelines for when his PRN medication should be administered. All residents who receive DSS benefits must have these paid into their bank accounts and not the company account. The staff need their training on epilepsy refreshed and would benefit from makaton training. Some health and safety training such as moving and handling and infection control needs to take place. All the staff where needed must have a copy of their current document giving them permission to work in the country and they must all have a contract of employment. There must be an analysis of the training needs of the whole staff team so a training programme can be planned. An electrical installation safety check needs to take place and work identified from a fire safety risk assessment needs to be completed.

CARE HOME ADULTS 18-65 Chiswick Care Ltd 11-13 Chiswick Road London N9 7AN Lead Inspector Jane Ray Key Unannounced Inspection 4th September 2007 09:00 Chiswick Care Ltd DS0000010618.V345622.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 Chiswick Care Ltd DS0000010618.V345622.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. Chiswick Care Ltd DS0000010618.V345622.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chiswick Care Ltd Address 11-13 Chiswick Road London N9 7AN 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) 020 8803 8002 020 8887 6664 Mr Bhooneswur Krite Luchmun Mrs Reeta Luchman Reeta Luchmun Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Chiswick Care Ltd DS0000010618.V345622.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. One specified service user who is over 65 years of age may remain accommodated in the home. This condition will remain until such time as the home can no longer meet his needs. 30th May 2006 Date of last inspection Brief Description of the Service: 11-13 Chiswick Road, London, N9 7AN is a care home owned and run by Chiswick Care Limited. The home is located in a residential area of North London with community resources and facilities within close proximity. Mrs Reeta Luchman is the registered manager of the home. The home has two bathrooms, a kitchen, a lounge and a large paved garden at the back of the building. Chiswick Care provides support and supervision for six adults with a learning disability and associated mental health problems. Each resident has a single bedroom. At the time of the inspection the service was fully occupied with one resident being over the age of 65 although the home was continuing to be able to meet his needs. The people living in the home are supported to access communitybased facilities such as libraries, sports facilities, cinemas and shops. There are a range of leisure activities provided at the home. The people living in the home make good use of public transport and services such as dial a ride. In addition to support during the day, the home has one member of staff who is awake at night to respond to the needs of the service users at night. At the time of the inspection there were six men living in the service. The current range of fees in the home is from £732 - £1490 a week. The provider must make information available about the service, including inspection reports, to the people living in the home and other stakeholders. Chiswick Care Ltd DS0000010618.V345622.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 4 September 2007 and was unannounced. The inspection lasted for six hours and was the key annual inspection. The inspection looked at how the home was performing in terms of the key National Minimum Standards for Younger Adults and the associated regulations. The inspector was able to speak to and observe the support given to five of the six current service users. The inspector was also able to spend time talking to the manager as well as the two members of care staff who were working in the home. The inspector did a tour of the premises and also looked at a range of records including service users records, staff files and health and safety documentation. The home had provided the inspector with a completed preinspection questionnaire and self-assessment questionnaire (AQAA) prior to the inspection. What the service does well: The people living in the home appeared very happy and have a good relationship with the staff. One resident said “the staff are absolutely super”. The home provides a high standard of care and support to a group of people with a range of complex needs. The home by working consistently and professionally with the residents in partnership with other care professionals is able to support the residents to make significant progress with their personal development. The manager and staff demonstrated a good knowledge of the people living in the service and were able to recognise their individual needs and how to respond appropriately to them. The residents are supported to develop their independent living skills in the home based on their individual needs. The residents are supported to access a range of educational and leisure activities based on their individual interests and this enables them to have participation in the local community. The manager and staff show a high level of enthusiasm and commitment to their work in the home. Chiswick Care Ltd DS0000010618.V345622.R01.S.doc Version 5.2 Page 6 The home is very clean, comfortable and homely and the residents each have an attractive single bedroom. Some of the people living in the home have close contact with families and friends and this is promoted by the home. The residents dietary needs are met with a balanced and varied selection of fresh food that meets their health needs, tastes and cultural needs. What has improved since the last inspection? What they could do better: The report has identified a number of areas for improvement at this inspection. In terms of the support given to the residents there needs to be further work on the development of person centred care plans, review meetings need to take place at least once a year and in the information in the care plans needs to be accurate including information on personal finances. One resident should be supported to explore supported employment. The residents also need to be assisted to ensure they have regular dental and optical checks and the outcomes of healthcare appointments need to be recorded. One person needs guidelines for when his PRN medication should be administered. All residents who receive DSS benefits must have these paid into their bank accounts and not the company account. The staff need their training on epilepsy refreshed and would benefit from makaton training. Some health and safety training such as moving and handling and infection control needs to take place. All the staff where needed must have a copy of their current document giving them permission to work in the country and they must all have a contract of employment. There must be an analysis of the training needs of the whole staff team so a training programme can be planned. An electrical installation safety check needs to take place and work identified from a fire safety risk assessment needs to be completed. Chiswick Care Ltd DS0000010618.V345622.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. Chiswick Care Ltd DS0000010618.V345622.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 Chiswick Care Ltd DS0000010618.V345622.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): Standards 1,2,3,4 and 5 were inspected. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home can be assured that they will be assessed and that the service can meet their needs. Some staff need their epilepsy training updated and would benefit from makaton training. EVIDENCE: I looked at the statement of purpose and service user guide. The statement of purpose contains all the appropriate information. The service user guide is in a clear format and clearly explains what the home will provide. Four service user case notes were inspected and these all included a contract between the home and the resident and these had been signed as needed by the resident or an appropriate representative. Since the last inspection one new resident has moved into the home. He had a full assessment prepared by social services and this had been made available to the home prior to his admission. In addition the home had carried out their own assessment and a copy of this was available in his case notes. Chiswick Care Ltd DS0000010618.V345622.R01.S.doc Version 5.2 Page 10 The manager explained that the new resident had made a number of visits to the home and had respite care on two occasions. The admissions process is reflected in the statement of purpose. The staff spoken to said they had received training on meeting the needs of the people living in the home. This was reflected in their training records. It was however noted that some staff needed to have their epilepsy training updated and it is recommended that this is arranged with the learning disability team. It was also noted that the person who has most recently moved to the home uses some makaton sign language and the staff would benefit from some makaton training in order to communicate most effectively with him. Chiswick Care Ltd DS0000010618.V345622.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): Standards 6,7,8 and 9 were inspected. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home are supported to have a care plan but these need to be person centred and accurate and to be reviewed at least once a year at a review meeting that includes the resident with his family and care professionals. The people living in the home are supported to make decisions and choices in their daily lives. EVIDENCE: Four resident case notes were inspected. Each person has an individual care plan. This document is a summary of each persons health, social and emotional needs and how they need to be supported in each area of their lives and what they are hoping to achieve. I read the care plans and found that although they had been reviewed one still contained inaccurate information. For example the persons care plan said he received input from the Chiswick Care Ltd DS0000010618.V345622.R01.S.doc Version 5.2 Page 12 occupational therapist but this is no longer taking place. The manager also explained that each resident is supported with a key worker session to look at how this person is progressing. I looked at the records of these meetings, which are taking place every month or two and it was positive to note that the key-workers were monitoring the progress of the residents. I was concerned to note that there was not much evidence of the residents being involved in the development of their care plans and they had not signed the documents. Some of the people in the home could be very engaged in this process and would benefit from the care plan formats being more accessible such as through the use of photos. Two of the four residents had participated in a review meeting in the last year but for one of them there were no minutes of this meeting and so it was not possible to see what action had been agreed. One person was having his review next week and one person needed a review meeting to be arranged. The four service users all had a named key worker and one service user when asked knew the name of his key worker. The staff were observed discussing their key worker responsibilities and understood this role. The four service users all have complex behaviours. Each service user has a document describing these behaviours and enables the staff to identify when the service user is distressed and what action they should take in response to this situation. The incidents of challenging behaviours are recorded separately so any issues can be identified. Some of the service users have restrictions in place, for example one service user keeps his cigarettes in the office at night and some service users need to place their money in the office for safe keeping. The reasons for these restrictions are recorded in their care plans. At the last inspection there was a requirement that each person living in the home has a record of the individual arrangements in place to support them to manage their personal finances. Four case notes were inspected at this inspection and they all had a record of how this support is provided but one was inaccurate as it said the company rather than the relatives acted as the appointee. It is essential all the financial arrangements are correctly recorded. Two residents had also opened bank accounts since the last inspection and these details also need to be available. The four service user case notes inspected all included a comprehensive individual risk assessment covering all areas of potential risk and this identified what action the home would take in response to the identified risks. Throughout the inspection the service uses were observed being consulted about decisions concerning their daily lives. This included being asked what Chiswick Care Ltd DS0000010618.V345622.R01.S.doc Version 5.2 Page 13 they wanted for breakfast and what activities they wanted to do. The residents were able to have a good discussion with the staff about their daily lives. For example one resident asked the staff if they would like him to buy some milk for the home on his way back from his art class. I looked at the record of the residents meetings that appear to take place every two or three months. These discuss issues relating to the home such as food, leisure activities and holidays. The records show that the residents come up with lots of suggestions but it is not clear if these are being followed through. It is recommended that at the start of each residents meeting they look at the progress made in completing the actions agreed at the previous meeting. Chiswick Care Ltd DS0000010618.V345622.R01.S.doc Version 5.2 Page 14 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): Standards 11,12,13,14,15,16 and 17 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home are supported to have full and active lifestyles that reflect their interests and offer opportunities for the development of new skills. They also enjoy contact with their relatives and friends. EVIDENCE: The residents and manager explained that they access a range of activities based on individual needs and interests. Two people who live in the home attend a day service five days a week. Three service users enjoy going to college for gardening, computer art and numeracy and literacy. The manager explained that one resident has got a certificate for his college work and wants to think about employment and so it was recommended that supported Chiswick Care Ltd DS0000010618.V345622.R01.S.doc Version 5.2 Page 15 employment schemes are contacted for advice. Three go weekly to a drop in leisure centre and on the day of the inspection two of the men were going to an art class. Some enjoy going to two evening clubs for people with a learning disability. In addition the daily records show that they enjoy lots of leisure activities including meals out, shopping, cinema, bowling and sporting activities such as football and badminton. One resident explained how he plays in a football team and this involves regular training as well as matches. The person living in the home who is over the age of 65 explained that he is now going to the Age Concern day centre twice a week. The people in the home choose to practice their religion according to their individual wishes. One of the men said he likes to go to church every week and is a practicing Catholic. One of the men celebrates Muslim festivals with his relatives and another resident occasionally goes to church with his parents. The manager explained that they will all be going on holiday to Cornwall in the next few weeks and one of the men said how much he was looking forward to this experience. The residents were observed helping with domestic activities such as tidying their bedroom and clearing up after breakfast. There is a rota for the people so they know what assistance they need to give. One resident confirmed the rota is followed and that he enjoys doing the washing up. He also offered to help with some shopping from the local shop. The manager explained that most of the residents have contact with their families and friends. They are made welcome in the home or residents are supported to go to their family homes. One person living in the home told the inspector about his friends and how they visit him in the home or he goes out to meet them. During the inspection I could observe that routines in the home are very flexible. One resident explained how he likes to stay up later at night and watch films on his TV. Another resident was observed getting up later and having a more leisurely breakfast. One person living in the home was observed using his bedroom and front door key. It was observed that there was a friendly atmosphere in the home with the staff chatting to the residents and the men also supporting each other. One of the men said how much he was getting on with the new resident who has moved to the home and he said “these people are like my family”. The menu for the week was inspected and this offered a healthy and varied diet. The manager explained that two of the residents are not offered food, containing pork for religious reasons but sometimes choose for themselves to eat this food. Several of the men commented on how much they enjoyed the Chiswick Care Ltd DS0000010618.V345622.R01.S.doc Version 5.2 Page 16 food. One resident needs a soft diet and help with eating. This was observed to happen in an appropriate manner. Chiswick Care Ltd DS0000010618.V345622.R01.S.doc Version 5.2 Page 17 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): Standards 18,19 and 20 were inspected. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home can be assured that they will be assisted to access healthcare appointments to get the support they need, although a few have outstanding primary healthcare appointments. Medication systems within the homes are well organised, although PRN protocols are needed for one person. EVIDENCE: I observed during the inspection that the people living in the home were given support with their personal care based on their individual needs. The residents were all immaculately dressed and groomed. The men said that they helped to choose their clothes and I observed that their clothes reflected their age and lifestyles. The people living in the home were observed participating in domestic activities in the home including cleaning their bedrooms, helping with the Chiswick Care Ltd DS0000010618.V345622.R01.S.doc Version 5.2 Page 18 washing up and unpacking the shopping. Their individual care plans also included how they were being supported to develop their independent living skills. The healthcare records were inspected for the four people living in the home. They had all been supported to access the GP but two had no record of seeing the dentist or the optician for their primary healthcare checks in the last 12 months. One of the residents said that he knew he needed to see the optician. In addition the residents receive input for their specialist healthcare needs and it is also positive to note that a number of other services including psychiatry and an audiology clinic had been accessed as required for specialist advice. All the people living in the home are supported to check their weight on a monthly basis. The home keeps a log of the healthcare appointments but these did not appear to be completely accurate and did not record the outcome of the appointments. It was however observed during the inspection that the home supports the residents to get the healthcare input they need. One resident had not been well the night prior to the inspection and had been taken to see the GP and also to the hospital. The home uses Boots blister pack medication system. The medication administration records were inspected and are completed correctly. The medication entering the home is recorded appropriately on the medication administration record. There is a separate record for medication returned to the pharmacist. The medication available was correct. Some of the residents have PRN medication, but for one person there were no guidelines in place for when his PRN lorazepam should be administered. Training records were inspected for four of the staff and three had completed medication training and the other member of staff who works at night does not administer medication. Chiswick Care Ltd DS0000010618.V345622.R01.S.doc Version 5.2 Page 19 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): Standards 22 and 23 were inspected. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home can be assured that the correct training and procedures are in place to ensure staff have the knowledge to protect them from the risk of being abused. Residents DSS benefits that are paid into a company account need to go directly into their individual bank accounts. EVIDENCE: The manager explained that the home has not received any complaints since the previous inspection. The complaints policy is displayed for the service users to access as required. The manager and staff member on duty explained that the staff had all had adult protection training. I looked at the staff training records for four members of staff and one now needed some refresher training. The home has an adult protection procedure that has been checked on a previous inspection and is satisfactory. Since the last inspection the staff have received training on how to support people who have complex behaviours and this training was felt to be very helpful. Chiswick Care Ltd DS0000010618.V345622.R01.S.doc Version 5.2 Page 20 The inspector looked at the personal finances for two people living in the home. They each have a bank account and their DLA is paid directly into this account. Their income support is however still paid into the company account. Their appointee pays their personal allowance into their cash balance held in the home. The records are clear and where expenditure has occurred this is recorded and where possible receipts are obtained. The DSS benefits including the income support must all go to the resident and not be paid into the company accounts. Any contribution that is owed to the company can be paid back by the resident. Chiswick Care Ltd DS0000010618.V345622.R01.S.doc Version 5.2 Page 21 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): Standards 24,25,27,28 and 30 were inspected. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home are benefiting from an environment that is clean, tidy and homely. EVIDENCE: The inspector did a tour of the home and looked at all the bedrooms with the exception of one room where the service user was out and the room was locked. The home was clean and tidy throughout. Each service users bedroom was well furnished and was homely and personalized. The communal space consists of a large lounge and dining area and a separate kitchen. These were also well furnished and comfortable. There are adequate bathing facilities with a Chiswick Care Ltd DS0000010618.V345622.R01.S.doc Version 5.2 Page 22 bathroom on each floor. The home has a laundry on the first floor. All the equipment in the home was observed to be in good working order. The door to the downstairs bathroom was not closely properly and the manager said this was in the process of being rectified. Chiswick Care Ltd DS0000010618.V345622.R01.S.doc Version 5.2 Page 23 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): Standards 32,33,34,35 and 36 were inspected. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home are supported by a stable team of staff who have completed the correct recruitment checks and are receiving the appropriate supervision. A training analysis for the whole staff team needs to be completed to ensure future training needs are met. EVIDENCE: At the time of the inspection there were thirteen care staff employed in the home including the manager. The staffing structure consists of the manager, deputy manager, senior carer and team of carers. During the day there are between two and three staff working depending on the activities taking place. This time is divided into an early and late shift from 8am to 10pm. At night there is one waking and one sleeping in member of staff on duty. The rota was inspected and clearly shows who is working. Chiswick Care Ltd DS0000010618.V345622.R01.S.doc Version 5.2 Page 24 Staff records were inspected for six members of staff. This included two staff who had started working in the previous year and four staff who had been in post for over a year. All the staff had application forms, ID, two written references and CRB disclosures. Two of the staff had visa’s giving permission to work in the country that appeared to have expired. The manager said that one had a new passport and one was applying for her visa to be extended. Evidence of this needs to be available in the staff records. One new member of staff who had been in post for nearly six months had not yet completed a contract of employment. Staff team meetings have been taking place every two months. The records of these meetings were inspected and show a range of issues relating to the operation of the home and the care of the services users are discussed. The manager explained that eight care staff have completed their NVQ in care and four staff are studying for their NVQ qualification. The certificates for this training were available in the staff training records. I was able to see in the training records of the two most recently recruited staff that they had completed the internal induction checklist and were working through the induction booklet that is in line with the TOPPS guidelines. The training records for four staff were inspected. The home does not have a training grid showing which staff have received each training and when. This means that there is not adequate evidence to confirm which training had been completed by each member of staff and when this training needs to be refreshed. The manager works in partnership with two other care providers to book training but needs a training analysis so she knows what training to book and when. The supervision records were inspected for the four staff. The manager is supervising all the staff. The staff had received good quality individual supervision on a regular basis. Chiswick Care Ltd DS0000010618.V345622.R01.S.doc Version 5.2 Page 25 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): Standards 37,38,39,42 and 43 were inspected. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users can be confident that the home is overseen by an experienced manager. Their health and safety is protected by the appropriate measures being in place although work identified in the fire safety risk assessment needs to be completed and the home also needs an electrical installation check. EVIDENCE: The home has a registered manager who in conjunction with her husband is also the owner of the home. The manager has the appropriate skills and experience and has also completed the NVQ level 4 in management of care. Chiswick Care Ltd DS0000010618.V345622.R01.S.doc Version 5.2 Page 26 Since the last inspection the home has completed another quality assurance exercise. This has included asking service users, relatives, care professionals and other stakeholders who know the home to complete questionnaires asking for feedback on the service. The results of these questionnaires have been collated and the manager explained that one point for action is being addressed. The home has appropriately reported any serious incidents concerning the service users to the CSCI. Accident and incident reports are also recorded appropriately in the home. Fire safety measures are in place. The fire safety records were inspected and weekly fire alarm checks and monthly fire drills are recorded. On the day of the inspection the fire doors in the home were closed. The fire alarm and extinguishers had received their service and records were available to confirm this had taken place. The home has an emergency plan and fire safety risk assessment. The fire safety risk assessment has identified some areas for improvement such as the need to clearly label escape routes and this work needs to be undertaken. The staff training records were inspected for four staff and they all had evidence of health and safety training covering fire safety, first aid and food hygiene. Three staff appeared to need moving and handling and infection control training either because they had not received the training or the training needs to be refreshed. The certificates were in place to confirm the gas system and the portable electrical appliances had been serviced and the water tanks checked for legionnaires. The electrical installations needed to be checked and this was outstanding. The current insurance certificate was displayed and was satisfactory. The home prepares annual financial accounts, but these were not available in the home to confirm the financial stability of the service. I am confident the business is financially sound as the home is fully occupied but recommend annual accounts are available for inspection. Chiswick Care Ltd DS0000010618.V345622.R01.S.doc Version 5.2 Page 27 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 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 1 ENVIRONMENT Standard No Score 24 3 25 3 26 x 27 3 28 3 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 3 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 3 3 3 x x 1 3 Chiswick Care Ltd DS0000010618.V345622.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES 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. 2. Standard YA6 YA6 Regulation 15(2) 15(1)(2) Requirement The registered person must ensure the care plans contain accurate information. The registered person must ensure that each resident is supported to have a person centred plan that identifies key goals and that progress with meeting these goals is regularly reviewed. The resident should be supported to contribute to his plan and sign the document where possible. This requirement is amended and restated from the previous two inspections. Timescale was 31/07/06 and 28/02/07. The registered person must support each resident to have a review meeting at least once a year and ensure the minutes of these meetings are available to ensure any action is followed through. The registered person must ensure that the record in each persons case notes of how they are supported to manage their finances is correct and includes DS0000010618.V345622.R01.S.doc Timescale for action 31/12/07 31/12/07 3. YA6 15(2) 31/12/07 4. YA7 13(6) 31/10/07 Chiswick Care Ltd Version 5.2 Page 29 all the necessary information. 5. YA19 13(1) The registered person must ensure that all the residents are supported to have regular dental and optical checks. The healthcare appointments must be accurately recorded and include information on the outcome of the appointment. The registered person must ensure that one service user who has PRN medication has guidelines in place stating when this medication can be administered. Where the manager acts as an appointee for the service users monies, the registered person must ensure the service user has a savings account and that their DSS benefits are paid directly into this account. This requirement is restated from the previous inspection. Timescale of 15/02/07 was unmet. The registered person must ensure that each member of staff has a completed contract of employment even if they are in a probationary period. This requirement is restated from the previous inspection. Timescale of 31/01/07 was unmet. The registered person must ensure that staff records include current information on permission to work in this country where needed. The registered person must prepare a training analysis for the whole staff team and then book training linked to the training needs of the team. The registered person must complete an electrical installation check. DS0000010618.V345622.R01.S.doc 31/10/07 6. YA20 13(2) 30/09/07 7. YA23 12(1) 31/10/07 8. YA34 7(2) 30/09/07 9. YA34 19(1)-(5) 30/09/07 10. YA35 18(1)(c) 31/10/07 11. YA42 13(4) 31/10/07 Chiswick Care Ltd Version 5.2 Page 30 12. YA42 23(4) 13. YA42 13(4)(5) The registered person must carry 31/10/07 out the outstanding work identified in the fire safety risk assessment. The registered person must 31/12/07 ensure the staff complete any outstanding health and safety training including moving and handling and infection control. 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. 2. 3. 4. Refer to Standard YA3 YA3 YA11 YA43 Good Practice Recommendations The registered person should ensure that the staff repeat their epilepsy training regularly. The registered person should support the staff to receive training on makaton. It is recommended that one of the people living in the home is supported to explore supported employment. The registered person should keep a copy of the annual audited accounts in the home. Chiswick Care Ltd DS0000010618.V345622.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Chiswick Care Ltd DS0000010618.V345622.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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