Inspection on 16/08/07 for Cleveland House

This inspection was carried out on 16th August 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cleveland House 04/08/06

Cleveland House 12/01/06

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Cleveland House 1 Cleveland Road South Woodford London E18 2AN Lead Inspector Jackie Date Unannounced Inspection 16 to 20 August 2007 9:40 th th Cleveland House DS0000066298.V340116.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 Cleveland House DS0000066298.V340116.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. Cleveland House DS0000066298.V340116.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cleveland House Address 1 Cleveland Road South Woodford London E18 2AN 020 8530 2180 020 8252 2283 info@cmg-corporate.com www.caremanagementgroup.com Care Management Group Ltd 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) ****Post Vacant**** Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Cleveland House DS0000066298.V340116.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th November 2006 Brief Description of the Service: Cleveland House is a ten-bedded home for adults with learning disabilities and challenging behaviour. The building does not have any adaptations for people with physical disabilities and would not be accessible to wheelchair users. It is in a residential area of South Woodford close to local shops and amenities and to transport networks. At the time of the inspection there were 9 residents, seven males and two females, living at the home. Most of the residents have limited communication. Some residents access day services, others are supported in community based activities by the staff team. The scale of charges per week for each resident range from £1,100 to £2,215 per week. The manager provided this information at the time of the visit. Information about the service provided is contained in the service users guide. Cleveland House DS0000066298.V340116.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and started at 9:40 am. It took place over 8 hours. A second shorter unannounced visit was made on 20th August. The purpose of this was to check some concerns regarding the environment that had been raised by one of the relatives when they were contacted for feedback about the service. This was a key inspection and all of the key inspection standards were tested. Staff were asked about the care that residents receive, and were also observed carrying out their duties. Where possible residents were asked to give their views on the service and their experience of living in the home. All of the shared areas and 6 bedrooms were seen. Staff, care and other records were checked. Relatives, social workers and healthcare professionals were contacted and asked for their opinions of the service. At the time of writing this report feedback had been received from 7 relatives and one social worker. Any feedback subsequently received will be taken into account for future inspections. Keyworkers supported the residents to complete feedback forms or completed them on the residents’ behalf. The last key inspection was in August 2006. Since that time three shorter random unannounced inspections have been carried out. The first was in November 2006 to assess the progress made by the home and to monitor the actions taken to address the requirements made. The second was made in March 2007 with a specialist pharmacist inspector. This was as a result of a very serious medication incident. The third was made in May 2007 in response to concerns raised with the Commission about staffing. Where appropriate references are made about these inspections in relevant sections of this report. Services are now required to complete an AQAA (Annual Quality Assurance Assessment) and the completed form was received on 9th July 2007. Information provided in this document also formed part of the overall inspection. The inspector would like to thank the residents and staff for their input during the inspection. What the service does well: Staff continue to work hard to try to give residents the care and support that they need during a time when there have been a lot of changes. Cleveland House DS0000066298.V340116.R01.S.doc Version 5.2 Page 6 Staff on duty knew the residents well and were able to demonstrate a good awareness of residents’ needs, likes and differing ways of communicating. A relative said, “they look after my son very well and see to all his needs. I am happy with the way the staff look after all the service users”. Another relative said “ the staff are very nice but there have been a lot of changes.” A resident said, “the food is very good. We have lots of choice and the fridge and freezer are always full. We choose what we want to eat.” What has improved since the last inspection? What they could do better: A system needs to be in place so that any repairs or breakages are noted and reported and that repairs are completed in a timely fashion. This will ensure that the environment is safe for all that use the home and that equipment is in good working order. All complaints/dissatisfaction need to be recorded along with any action taken. This will give a more accurate picture of the quality of the service provided and help to identify any patterns at an early stage so that prompt action can be taken. Cleveland House DS0000066298.V340116.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. Cleveland House DS0000066298.V340116.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 Cleveland House DS0000066298.V340116.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): 2, 4 & 5. People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Appropriate information is gathered on a prospective resident prior to their moving into the home and this gives staff a picture of the individual’s needs and how to meet these. Prospective residents and their relatives can spend time in the home to find out what it would be like to live there and to enable the resident to make a choice about living in the home, within their capacity to do so. Residents have contracts/statement of terms and conditions and therefore have detailed information about the service that they are entitled to. EVIDENCE: The organisations admission procedure and policy is that an assessment officer from the assessment and referral team assesses any prospective residents. Assessments cover all of the required areas and include, health, communication, behaviour, relationships and sexual needs and cultural and spiritual needs. The newest resident moved in earlier this year and appropriate assessments were available on file. After initial information Cleveland House DS0000066298.V340116.R01.S.doc Version 5.2 Page 10 gathering the manager had met the prospective resident and had then been involved in the ongoing assessment and transition process. The individual had complex needs and a comprehensive transition was organised. The person visited the home and additionally staff visited his previous placement to get to know him and to meet staff that were already working with him. When the resident first moved into Cleveland House a member of staff from his previous placement provided additional support and guidance. This assisted the transition process and also helped staff to further get to know the person and how to communicate and work with him. Therefore sufficient information was gathered on a prospective service user to enable their needs to be identified and for a decision to be made about the home’s capacity to meet their assessed needs. Also prospective residents are given the opportunity to visit the service and to meet staff and residents before they decide if they want to live there. The residents have individually costed contracts between themselves and the provider. The contracts were available at the home and copies were seen in residents’ files. Therefore residents have details about the service that they are entitled to. Cleveland House DS0000066298.V340116.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. People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Residents’ care plans and risk assessments contain sufficient information to enable staff to safely meet their needs. Residents are consulted about what happens in the home as far as they are able. Residents’ personal information is safely stored to maintain confidentiality. EVIDENCE: All of the residents have plans which give details of how they need/like to be supported. Areas covered included health, self-care, communication, psychological needs, relationships and sexual needs, community presence and cultural needs. A selection of care plans were examined during the visit and the information contained in them was detailed and relevant. They also indicate strengths and priorities and what individuals like and dislike. For example one resident’s care plan states that he likes to look nice and likes beer and milkshake. It also says that he is very wary of balloons. Care plans seen Cleveland House DS0000066298.V340116.R01.S.doc Version 5.2 Page 12 were up to date and gave clear information about individual residents and demonstrated that staff have knowledge about individuals. Care plans are reviewed monthly by staff and 6 monthly reviews are held to which the resident, their relatives and representatives are invited. In addition “working with” documents have been developed for individual residents. These give a picture of each person and include ‘about me, things I like, things I don’t like, my perfect day, my nightmare day, what is important to me, what I do when I get upset, what to do if I am upset and how to communicate with me”. Residents’ plans contain detailed and current information so that staff can meet their needs. From discussions with the manager it was evident that the intention is to introduce “person centred planning” for all residents. Daily recordings are made about what each person has done and support that they have been given. This is an area for ongoing development and the manager and staff team are aware of this and continue to address this. In addition night staff make recordings. Therefore there is information about each individual, which can be used as part of the review process and to identify ongoing and changing needs. There are risk assessments in place. These identify risks for the residents and staff and indicate ways in which the risks can be reduced to enable the residents’ needs to be met as safely as possible. Risk assessments are relevant to individual needs. Risk assessments have been reviewed and are up to date. These include updated guidelines for managing behaviour and motivating one of the residents. Therefore staff have up-to-date information about risks to residents and how to minimise them. This will help to keep residents safe. Residents meetings are now held each month and a record is kept of these. Some of the residents can and do express their views about what they want to do and what they like. For example one resident said that she wanted to bake a cake and during the course of the afternoon a member of staff supported her to do this. Another resident was involved in the interviews for new staff and asked questions of her choice. Staff spoken to said that although not all of the residents can say what they want they can and do let you know what they do not like or do not want to do. For example for one resident staff have to select his clothing but if it is not what he wants he refuses to wear it. During the course of the visit it was noted that staff asked residents what they wanted to do and then supported them to do this. Therefore the residents are involved in the running of the home as far as they are able. They are encouraged to make decisions about what happens as far as they are able. Residents’ records and other information are stored in a lockable cabinet in the office and staff are aware of issues of confidentiality. Cleveland House DS0000066298.V340116.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): 11, 12, 13, 14, 15, 16 & 17. People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. The residents are encouraged to take part in activities and to be part of the local community and this is being developed further to ensure that they have as fulfilling a lifestyle as possible and that they are as independent as possible. Residents are supported to keep in contact with their relatives and most relatives visit regularly. The residents are supported and encouraged to have a diet that is healthy and meets their need. This includes their cultural preferences. EVIDENCE: One of the residents attends a local authority day service for five days and another for two days each week. Residents have the opportunity of using the day service attached to another care home operated by CMG (Lilliputs). Cleveland House DS0000066298.V340116.R01.S.doc Version 5.2 Page 14 Residents are supported to take part in a variety of activities both in the home and in the community. For example going to the cinema, pubs, shopping, the park, out for lunch and bowling. On the day of the visit all of the residents went out for part or all of the day to do different things. The home has a seven-seater lease vehicle and this is used to take residents out. Residents also use public transport when they go out. The organisation owns a holiday home in Clacton and residents can have short breaks there. In addition three residents went on holiday earlier this year and the other residents were going on holiday on the day of the second visit. The residents were obviously looking forward to this and a resident that had already been on holiday said that he liked it and wanted to go again. Feedback from residents’ relatives and staff was that residents are doing a lot more activities. One relative said “my son is happy and in addition to day services goes out regularly.” Another resident had, for some time, been refusing to participate in activities and was spending a lot of time in bed. This person was also screaming a lot. At the time of this visit the resident was up , sitting and talking to staff and other residents. She has been going out regularly and this includes swimming. On the day of the visit she baked a cake. The staff team are to be congratulated for their work with this resident as her quality of life has improved tremendously and she was obviously so much better and happier. Residents are encouraged and supported to do as much as they can for themselves. For example making drinks and preparing breakfast. Care plans contained information about how residents should be encouraged to do things for themselves even if this is a small thing. For example one persons personal care guidelines says to encourage him to hold the toothbrush. Staff spoken to said that residents are doing a lot more now, both for themselves and in terms of activities. The recent review found that there has been improvement in these areas but that there is scope for further development. The manager had only just received the report from the review and will be working with the staff team to develop an action plan to meet the recommendations. All of the residents have contact with their families, some of their relatives visit the home regularly and some residents visit their families at home. Families are invited to celebrations at the home. Recently, after discussions with relatives, one resident had a Caribbean themed birthday party and in response to a request by the family the staff cooked curried goat for this. Residents also have contact with staff and residents at a nearby home run by the same organisation. Residents are supported to keep in contact with their family and relatives are welcomed at the home. Although relatives meetings are not being held regularly as part of an overall service review relatives had the opportunity to meet the operations director to discuss any issues and concerns and to provide feedback about the home. Some of the residents are able to say what they want to eat and are able to contribute to the menu planning. Staff use their knowledge of others likes and dislikes when planning the menu. When food was discussed at a recent Cleveland House DS0000066298.V340116.R01.S.doc Version 5.2 Page 15 residents meeting one person asked for kenge, which is a Ghanaian dish. One of the staff is from Ghana and she has agreed to purchase the ingredients and make it for him. In addition this resident’s mother likes to make traditional food for him and brings it to the home. Staff are from different parts of the world and at times cook food from their home country. For example Italy and Bulgaria. Therefore residents get a wide variety of food. None of the residents have any special dietary requirements but some residents are being encouraged to have healthier options to assist with weight control. Records are kept of what each person has to eat. One of the residents gave the inspector a note that she had written to the manager and asked that what she had said be put into the report. The note said “the food is very good and we have lots of choice. The fridge/freezer is always full. We choose what we want to eat. We have not got cheap food.” The fridge and freezer and store cupboards were all well stocked. This included fresh fruit and vegetables. Some residents like to purchase ice cream from the ice cream van. However one resident does not like ice cream so staff but him a cone and a flake when the others are having their ice cream. Residents receive a nutritious diet that meets their individual needs and preferences. Staff have received food hygiene training and the manager said that one of the residents was going to do this training as well. The home received a satisfactory food safety report following an inspection in March this year. During the visits it was noted that when residents asked for drinks they were then assisted to make them. Residents are also being encouraged to participate in chores in the kitchen and to assist with the shopping and there was a rota for this. Cleveland House DS0000066298.V340116.R01.S.doc Version 5.2 Page 16 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. People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Residents receive personal care that meets their individual needs and preferences and the staff team support them to get the healthcare that they need. The administration and recording of medication has improved to ensure that the residents are given prescribed medication as safely as possible. EVIDENCE: The residents require differing amounts of support with their personal care, but most are dependent on staff to meet their personal care needs. Details of the help that they need and how they prefer to be supported are in their individual plans. There is a risk assessment for bathing for one of the residents that has severe epilepsy. One relative said “ my son is always clean and nicely dressed”. However another relative has raised concerns about the personal care of one resident. The placing authority are following this up and have organised a review. Another relative said that a couple of months ago she had raised some concerns about her son’s oral hygiene and the manager had Cleveland House DS0000066298.V340116.R01.S.doc Version 5.2 Page 17 addressed this with staff. She also said that she thinks that the staff do their best to improve things. Staff and some of the residents are booked to attend an oral hygiene course. Recently a placing social worker visited and found that when she arrived at about 6pm all of the residents were in their nightwear. The manager acknowledged that the residents had all been in nightclothes early and said that this was because it had been a very hot day and residents had early showers. She also said that she had discussed this with the staff team and acknowledged that this was not good practice. She said that she had agreed with staff that if in future residents wish to shower early they should be supported to have a change of clothing rather than to put on nightwear. During the course of any of the unannounced visits by the inspector the residents have all been appropriately dressed. In general residents’ receive appropriate personal care and any issues or recommendations as a result of the concerns raised by one relative will be monitored as part of the ongoing inspection process. All of the residents go to the local doctor and specialist help is received from the community learning disabilities team. Staff take residents to all of their medical appointments. Residents’ files contain details of health care issues and show that residents have regular access to health care professionals. Records are kept of medical appointments and these show that residents have checks from the optician, dentist and, when needed, the chiropodist and community nurse. Feedback from a relative was that the residents are well cared for. One resident is prescribed rectal valium in the event of his having a severe seizure. Some staff have received training to administer and further training will be arranged for new staff. There is a protocol in place for the administration of this medication, which includes guidance that staff that have not received the necessary training should telephone for an ambulance. The need for this medication to be administered has only arisen once and a trained staff administered this. It was also noted that a trained member of staff took the medication out with him when he supported the resident to go out into the community. Therefore residents’ healthcare needs are being met. None of the residents are able to self medicate and medication is administered by two staff who both sign the record sheet. One of these is usually the senior member of staff on duty. Staff cannot administer medication until they have been deemed competent. In March this year there was a very serious incident involving medication. The necessary action was taken at the time and as a result of this a specialist pharmacist inspector carried out an unannounced inspection shortly after the incident. As a result of this inspection and the investigation into the incident a number of changes have been made and the procedure has been tightened up. Medication keys have been separated from other keys and the designated senior keeps these with them. A new medication cabinet has been purchased and is secured to the wall in the office. A lockable box, for controlled drugs, has been bolted to the inside of this cabinet. A lockable medicines case has been purchased and is used when medicines are administered away from the point of medicines storage. Cleveland House DS0000066298.V340116.R01.S.doc Version 5.2 Page 18 Medicines can therefore be secured in the case of the carer having to deal with an emergency. Therefore medication is securely stored. The medication file contained photographs of each individual and a record of any allergies. There was also a list of staff that are able to administer medication and also their signatures. All of the residents have had medication reviews. This is good practice. Examination of the MAR (Medication Administration Record) found that these had been appropriately completed. Guidelines/protocols are in place for the administration of PRN (when required) medication so that staff are clear as to when and how to administer this medication. Items on the medicines administration record (MAR) charts that are currently not prescribed have been endorsed by an authorised carer to clearly indicate the discontinuation. Endorsements have been signed and dated by the person making the entry. In order to avoid the risk of crosscontamination of blood-borne infections e.g. Hepatitis, HIV, a stock of granules containing sodium dichloroisocyanurate (Presept or equivalent) is now available to deal effectively with any blood spillage. These were all requirements from the pharmacist inspection. One resident is prescribed a controlled drug. This is appropriately stored and the necessary records and checks made. These records were checked as part of the inspection and found to be correct. Overall the system for the administration of medication has improved and residents are receiving their medication safely. Cleveland House DS0000066298.V340116.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): 22 & 23 People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. There is a complaints procedure, available in a user-friendly format that is followed in the event of any formal complaints being made. However all complaints need to be recorded and monitored. This will give a more accurate picture of the quality of the service provided and help to identify any patterns at an early stage so that prompt action can be taken. Most staff have now received adult protection training to ensure that they are clear about what constitutes abuse and what to do if abuse is seen or suspected. Prompt action is taken if there are any concerns around safeguarding residents. This helps to safeguard residents. EVIDENCE: The complaints procedure is in a pictorial format to help residents understand how to complain. This contains photographs of the manager and service manager. However due to the degree of their disability it is unlikely that some of the residents would be able to make a complaint without support. There was one recorded complaint made by the sister of a resident. This was appropriately dealt with and the complainant was satisfied with the actions taken. However the inspector is aware of other issues that have been raised by relatives and/or residents and these have not been recorded. For example the residents had been unable to watch the television in the main lounge for a few months, a resident did not have any curtains at his bedroom window, residents in their nightwear at 5pm. This was discussed with the manager and Cleveland House DS0000066298.V340116.R01.S.doc Version 5.2 Page 20 deputy and they said that they only record more formal complaints. They were advised that all complaints/dissatisfaction must be recorded along with any action taken. This will give a more accurate picture of the quality of the service provided and help to identify any patterns at an early stage so that prompt action can be taken. It will also assist to demonstrate that there is an open culture at the home that allows people to express their views and concerns and to be confident that these will be listened to. The organisation has a protection of vulnerable adults procedure and the manager was aware of the action that needs to be taken in the event of an allegation or suspicion of abuse. The majority of the staff team have received protection of vulnerable adults training and the rest will be receiving this in the near future. There have not been any recorded incidents of restraint being used for some time. However most staff have received “Digman” training, which focuses on the dignified management of challenging and aggressive behaviour. Since the last key inspection there have been a number of safeguarding issues that have arisen. These have been appropriately dealt with by the organisation and there has been full co-operation with the process. The organisation has responded quickly and taken action to safeguard residents. A random selection of residents’ finances was checked and cash amounts held agreed with records. Receipts were on file. Residents’ monies are securely stored and checks are made at each handover. At the time of this inspection there is an ongoing investigation with regard to one resident’s finances but at this time the service is not implicated in this. Overall systems are in place to safeguard residents from abuse Cleveland House DS0000066298.V340116.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): 24, 25, 26, 27, 28 29 & 30. People using the service experience adequate quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. The residents live in a clean home that is suitable for their needs. Ongoing improvements are making it more homely and have given residents a choice of communal spaces. However repairs are not always dealt with promptly and this can affect the quality of the service that residents receive. EVIDENCE: The house is in South Woodford and is near to the local shops, bus routes and a train station. The communal areas comprise of a combined lounge diner, a quiet room with TV, a garden area, kitchen and laundry. Each resident has a single bedroom with an ensuite toilet and hand basin. There are enough baths, showers and toilets to meet the residents’ needs and none of the current residents need any special adaptations. Since the last inspection some further decorating and refurbishment has taken place and more photographs and pictures are on display and the home Cleveland House DS0000066298.V340116.R01.S.doc Version 5.2 Page 22 continues to become more homely. A new television has been purchased. However feedback from a relative was that there was not an appropriately placed electrical socket and that the television had not been in use for several months. Subsequently when a new socket was fitted there was not a suitable aerial. The relative concerned had raised this issue and finally reported the matter to a senior manager and then action was taken. In addition one of the sofas was broken. A new sofa had been ordered a couple of weeks previously and the home was awaiting delivery. Bedrooms are decorated and furnished to reflect individual tastes and likes. Residents were involved in choosing colours etc as far as possible. Since the last inspection some bedrooms have been redecorated and refurbished. One relative said, “my sons bedroom is lovely and homely”. However a social worker visited recently and raised concerns with regard to one residents bedroom. The social worker reported that there were not any curtains at the windows, there was a chest of drawers with broken drawers and this had a sharp corner, there was cracked glass in a picture above the bed, no lampshade, no TV or radio and the room was bare. In response to the social workers concerns the glass was removed from the picture and the chest of drawers from the room. At the time of the visit, about a week later the other issues in the bedroom remained the same. This was discussed with the manager and also a senior manager. They said that part of the problem was that the handyman had been on leave and then on Jury service. They did provide evidence that a new TV and new bedding had been purchased and a new bed ordered. They also said that the handyman had returned to work and would be decorating the room and dealing with the repairs (the curtain rail was broken). The manager also said that they did fix the curtains up at night to offer some privacy. It is not acceptable that it has taken so long to address some of the issues identified above, or that some were only addressed after the social worker raised concerns. The young man concerned has a ground floor bedroom that overlooks the street and his privacy and dignity has not been adequately respected. However at the time of the second visit it was evident that action has been taken to address the issues and therefore a specific requirement has not been made in relation to this. However a system must be in place to ensure that any repairs or breakages are noted and reported and that repairs are actioned in a timely fashion. This will ensure that the environment is safe for all that use the home, residents’ privacy is maintained and that equipment is in good working order. It was also noted that the maintenance department had, that day, sent an apology to the manager and to the residents for the delays in the fitting of the new socket and in getting the television working appropriately. At the time of the visit the home appeared to be clean and hygienic and received a satisfactory food hygiene report in March 2007. Cleveland House DS0000066298.V340116.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): 32, 33, 34, 35 & 36. People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Staff are receiving the necessary training to give them the skills to meet residents’ current needs and provide an appropriate service for them. Staffing levels are sufficient to allow for this. Residents are supported and protected by the organisations recruitment practice. Staff need to receive more regular formal supervision and more frequent staff meetings are needed to ensure that staff have the opportunity individually to discuss their own development and any problems and developments within the service. EVIDENCE: At the time of the random inspection in May 2007 staff were working a lot of double shifts and in some cases working nine or ten long days without a break. In addition to this, the rota, staff and residents confirmed staff shortages on Cleveland House DS0000066298.V340116.R01.S.doc Version 5.2 Page 24 some shifts, as appropriate cover could not be found for absent staff. There also seemed to be some confusion as to the levels of staffing that some of the residents require. In response to staffing requirements from that inspection more robust arrangements were put in place to cover staff absences and to ensure that there are sufficient staff on duty. In addition it has been confirmed that two of the residents receive 1 to 1 support for eleven hours each per day. At the time of this inspection the number of staff on duty reflected this. From examination of the rota and discussion with staff it was evident that the staffing situation has improved and that there are now sufficient staff on duty to meet residents needs. There are usually 5 staff, including a senior, on duty during the day and two waking night staff. Staffing levels are adjusted, if needed, to cover appointments and activities. Five new staff have been recruited and will commence employment as soon as the necessary checks have been completed. The manager said that they would stagger the start of the new staff and gradually decrease the use of the bank and relief staff. There has been some teamwork issues within the staff team and a teambuilding day was organised earlier this year. There have also been a lot of staff changes. As part of a review of the service staff were interviewed and asked for feedback about the service and any outstanding issues and concerns. Most staff reported that relationships had improved significantly and this was confirmed during discussions with staff. The organisation operates an appropriate recruitment procedure. Jobs are advertised, application forms completed and interviews held. Staff records are held centrally at the organisations head office in line with an agreement made with the Commission. However copies of the necessary information was available in the file held at the home and two files were examined during the inspection. The files contained copies of the application form, short-listing criteria and interview score sheet. There was also evidence that the necessary checks had been carried out. Therefore the recruitment procedure offers safeguards to residents. From discussions with staff and looking at records it was apparent that the organisation had been providing a lot of training to staff. New staff have had a formal induction and other training has included protection of vulnerable adults, first aid, makaton, autism, food hygiene, equal opportunities and report writing. Five staff have achieved NVQ level 2 or above and three are working towards this. Therefore the staff team are being provided with the training and skills that they need to meet the needs of the residents. Staff spoken to confirmed that they have been receiving supervision and copies of supervision contracts and notes were in staff files. The review found that whilst supervisions are carried out the frequency varied. In some cases staff were only receiving supervision every three months and supervision Cleveland House DS0000066298.V340116.R01.S.doc Version 5.2 Page 25 appeared to be patchy for night staff and regular bank staff. The review recommended that all staff receive supervision at least every 6 weeks, including night and bank staff and the management team will implement this. This will be monitored during the course of future inspections. Staff meetings have been held and the review recommended that the frequency of these be increased to monthly to improve communication. One member of staff said that she felt that her opinions were listened to and valued. Cleveland House DS0000066298.V340116.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42. People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. The residents are benefiting from the management and development of the home. The registered provider monitors the service to check the quality of the service provided to residents. The residents are living in a safe environment but a system is needed to ensure that repairs are dealt with in a timely fashion so that they do not present risks to residents. Cleveland House DS0000066298.V340116.R01.S.doc Version 5.2 Page 27 EVIDENCE: The manager started at the home in November 2006. She has a lot of experience of working with people with learning disabilities and of residential services. She has registered for the RMA (Registered Managers Award). The manager has the necessary experience and qualifications to manage the service. The manager has obtained the forms to be registered with the Commission and is in the process of completing the from for a CRB (Criminal Records Bureau) check. The manager was reminded that this must be completed as soon as possible as she has been in post for some time and should already have applied for registration. An application must be submitted to the Commission for the manager’s registration within the required timescale. Although there have been a lot of problems and difficulties at the home the indications are that the service is developing and improving. The manager and the organisation have addressed concerns and there has been a commitment to provide an improved service to the residents. As previously stated in this report the organisation carried out a comprehensive review of the service. The findings of the review was that there had been a significant improvement in the service provided at Cleveland House but that there were still areas where further work is needed. The findings will form the basis of a development/action plan for the service. The review found that there was positive feedback about the support provided by the home manager. Feedback from staff, to the inspector, was that the service to the residents continues to get better and that residents are doing more for themselves. One member of staff said that there had been a lot of ups and downs but things were changing for the better. Another member of staff said that the manager and the deputy were promoting change and getting staff to work differently with residents. The staff team carries all of the necessary health and safety checks out regularly. For example fire call points are tested weekly, as are hot water temperatures. Fridge and freezer temperatures are tested daily. Regular fire drills take place and these are recorded. Appropriate servicing is carried out on the fire system and fire equipment. In general a safe environment is provided for the residents, however, as previously stated repairs are not always dealt with promptly and this could affect the safety of the environment. Please see the section on the environment for the requirement relating to this. The quality of the service provided to the residents is monitored by the manager and by the organisation. The service manager carries out monthly monitoring visits to assess how effectively the home is operating to meet its stated aims and objectives, and reports are written. These indicate the action Cleveland House DS0000066298.V340116.R01.S.doc Version 5.2 Page 28 to be taken when deficiencies are identified. Copies of these reports were available in the home. Cleveland House DS0000066298.V340116.R01.S.doc Version 5.2 Page 29 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 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 2 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 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 3 3 X 3 3 3 X X 3 X Cleveland House DS0000066298.V340116.R01.S.doc Version 5.2 Page 30 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 YA22 Regulation 22 Requirement All complaints/dissatisfaction must be recorded along with any action taken. This will give a more accurate picture of the quality of the service provided and help to identify any patterns at an early stage so that prompt action can be taken. A system must be in place to ensure that any repairs or breakages are noted and reported and that repairs are actioned in a timely fashion. This will ensure that the environment is safe for all that use the home and that residents’ privacy is maintained and equipment is in good working order. An application must be submitted to the Commission for the manager’s registration. Timescale for action 30/09/07 2 YA24 23 31/10/07 3 YA37 8 15/10/07 Cleveland House DS0000066298.V340116.R01.S.doc Version 5.2 Page 31 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 Cleveland House DS0000066298.V340116.R01.S.doc Version 5.2 Page 32 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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