Inspection on 04/05/07 for Cromer House

This inspection was carried out on 4th May 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 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cromer House 17/06/09

Cromer House 17/05/06

Cromer House 12/09/05

Cromer House 19/05/05

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Cromer House 15 Redan Street Ipswich Suffolk IP1 3PQ Lead Inspector Julie Small Unannounced Inspection 4th June 2007 09:30 Cromer House DS0000062387.V342330.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 Cromer House DS0000062387.V342330.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. Cromer House DS0000062387.V342330.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cromer House Address 15 Redan Street Ipswich Suffolk IP1 3PQ 01473 226399 01473 226396 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) www.caringhomes.org Consensus Support Services Ltd Mr James Boyd Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Cromer House DS0000062387.V342330.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th May 2006 Brief Description of the Service: Cromer House is owned and operated by Consensus Support Services Ltd. It provides 24 hour support for up to ten residents with learning disabilities. All bedrooms are single with en suite facilities. The home is situated near the centre of Ipswich with good access to community facilities and public transport. The inspector was informed at the inspection dated 4th June 2007 that fees for the home ranged from £1,400 to £1,750 per week. Cromer House DS0000062387.V342330.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on Monday 4th June 2007 from 9.30 to 17.15. The inspection was a key inspection which focused on the core standards relating to adults and was undertaken by regulatory inspector Julie Small. The report has been written using accumulated evidence gained prior to and during the inspection. The home’s acting manager and deputy manager were present during the inspection and provided the requested information promptly and in an open manner. The acting manager informed the inspector that service users were referred to as residents, this term will be used throughout the report. During the inspection a tour of the building and observation of work practice was undertaken. One resident and three staff members were spoken with. Records viewed included three resident’s, three staff recruitment, training, fire safety and accident records. Further records viewed are detailed in the main body of this report. Prior to the inspection an Annual Quality Assurance (AQAA) questionnaire and staff, visitor and resident’s surveys were sent to the home. The AQAA was returned to CSCI (Commission for Social Care Inspection), two service user, four staff and eight relative/visitor surveys were returned. What the service does well: Interaction between staff and residents was observed to be friendly, positive and professional. Residents were consulted with regarding aspects of their lives including what they wanted to eat and what activities they participated in. There were house meetings where residents could discuss their preferences and issues they may have. The home was clean and well maintained and there were efforts made to ensure that there was a homely environment. There was a good range of activities available for residents to participate in if they chose to. Care plans were detailed and clearly explained the support which should be provided to individual residents. Cromer House DS0000062387.V342330.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cromer House DS0000062387.V342330.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cromer House DS0000062387.V342330.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents can expect that they have the information they need to make an informed choice about where to live and their individual needs are assessed. EVIDENCE: The home’s Statement of Purpose was viewed and included details and qualification of staff and management, the aims and objectives of the home, the age range and gender of residents, the range of needs that the home intended to meet, the number and size of rooms and what services are provided at the home. The fire procedure and the complaints procedure were included in the Statement of Purpose. The Service User’s Guide was viewed and was in an accessible format for residents, which provided pictures and text. The Service User’s Guide included details of the service which the home provided to residents and the terms and conditions of the home. The Statement of Purpose and Service User’s Guide was present in each resident’s records, which were viewed. Cromer House DS0000062387.V342330.R01.S.doc Version 5.2 Page 9 Three resident’s records were viewed and each included an assessment of need completed by the placing authority and an initial assessment which had been completed by the home prior to the resident moving in. The initial assessment included details of the resident’s health, background, diet, mobility, personal care, cultural needs, religious observance and behaviours. Each initial assessment included a section called ‘proposal of the service’ which identified how the home proposed to meet the assessed needs of the resident. The acting manager said that when the home receives a referral for a prospective resident, they visited the person in their home with a member of the senior management of the organisation, such as a regional manager, and completed a needs assessment. A resident was spoken with and said that before they moved into the home, they visited before they decided they wanted to move in. Two resident’s surveys were viewed and both answered yes to the questions, ‘were you asked if you wanted to move into the home?’ and ‘did you receive enough information about this home before you moved in so you could decide if it was the right place for you?’ The relative/visitor survey asked ‘do you get enough information about the home to help you make decisions?’ Three answered always and five answered usually. Cromer House DS0000062387.V342330.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect that their assessed and changing needs are reflected in their individual plan, that they are supported to make decisions about their lives and that they are supported to take risks as part of an independent lifestyle. EVIDENCE: Three resident’s records were viewed and each contained an initial assessment of need and there were documents which updated the needs assessments with changing needs and preferences. The records included details of their diverse needs such as identity, self care, communication, spiritual, sexual and community presence and participation. There were individual plans of care which corresponded to the needs assessments. The care plans clearly included the detailed support that residents required and preferred in all aspects of their daily living, such as Cromer House DS0000062387.V342330.R01.S.doc Version 5.2 Page 11 bathing, eating, mobility and during the night. The plans detailed each resident’s individual strengths, wants and needs, likes and dislikes and goals. There were records which identified how, when and why the care plans had been updated and reviewed. Documents which identified the steps required to achieve their goals, the expected outcomes and review of goals were included. The care plans were also provided in a ‘bullet point’ format for reference. Staff had signed a document included in the care plans which stated that they had read them. There was a document in each resident’s record where parents could record their comments on the care plan. There were documents in the resident’s records including a ‘pen picture’ of each resident, others involved in their lives and history. There were records which were accessible to residents in both picture and text format. Behaviour plans were included in resident’s records, which included support they required with managing their behaviours. There were documents which identified the resident’s longer term changing needs and their future aspirations. Records of regular care review meetings were present which included participation by the resident, their family, their key worker and other professionals involved in their care. Resident’s meeting records were viewed which identified decisions they had made with issues such as what they ate, décor of the home and activities that they participated in. The AQAA stated that all residents are provided with person centred plans and that the home is committed to respecting cultural and religious differences. It stated that residents were provided with annual well person checks. During the inspection residents were observed to make choices throughout the day, which included meals and when they wished to eat, activities inside and outside the home. Each resident’s record included detailed risk assessments which identified the assessed risk and actions to minimise the risk and they were regularly updated. The risk assessments included issues such as swimming, using public and the home’s transport and going for a walk. One resident’s records included details of their unexplained absence from the home and the prompt actions taken. There were records which clearly identified actions staff must take if unexplained absences occurred, which included informing their family. The acting manager explained that one resident had left the home on a number of occasions when they initially lived at the home. They explained the work they had undertaken with the resident Cromer House DS0000062387.V342330.R01.S.doc Version 5.2 Page 12 and their family to minimise the risks and that there were no unexplained absences regarding the resident since the last incident, which was December 2006. One staff member showed the inspector a ‘multi media’ computer based document which was an ‘about me’ document. They said that they had just started compiling them with the residents and that they could act as a life story, which residents could take with them if they left the home. There were pictures and photographs of items which were important to the residents such as their family, foods, activities and television programmes. There were sounds and music on the system. The staff member said that the residents could look at them and choose what they wanted to go onto them as they wished. The relative/visitor survey asked if they felt that the home met the needs of their friend or relative. Six answered always and two answered usually. They were asked if the home gave the support to their friend or relative that was expected or agreed. Seven answered always and one answered usually. Comments included ‘very good care’, ‘I am very happy with the way Cromer House have handled (the resident’s) behaviour. They have worked hard’, ‘(the resident) is a lot calmer and in control and appear to be able to handle situations a lot better’ and ‘(the resident) receives a lot of support from Cromer House’. The staff survey asked if they were given up to date information about the needs of the people they support or give care to. Four answered yes and one provided the comment ‘the care plans are updated regularly and are available for all staff to look at’. The resident survey asked if they made decisions about what they did each day. One answered always and one answered both always and sometimes and commented ‘the home is fine’. Both said that they could do what they wanted to during the day, evening and weekend. The home maintained daily records on each resident, which included details of their attendance at college and if they had eaten. The home may benefit from increasing the details on the daily records, which would enable an audit trail if there had been any behaviour changes or signs of significant incidents. There were monthly records which were summaries of the resident’s wellbeing throughout each month. Cromer House DS0000062387.V342330.R01.S.doc Version 5.2 Page 13 Cromer House DS0000062387.V342330.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): 12, 13, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect that they are supported to take part in appropriate activities, maintain contacts with who they wish to, that their rights are respected and that they are offered a healthy diet. EVIDENCE: During the inspection two residents were at college, one resident returned and said that they grew flowers at college and that they had a good day. The acting manager confirmed that two residents attended school and that there was a teacher training day at the day of the inspection. Resident’s records viewed included details of each resident’s day provision, the choices they had made with regards to their daytime activities and records of the home’s contact with the colleges and schools which evidenced that their well being was monitored. Cromer House DS0000062387.V342330.R01.S.doc Version 5.2 Page 15 The AQAA stated that the company had purchased a farm premises which they intended to use to provide additional day service facilities for the residents as well as employment opportunities. It stated that residents were provided with the opportunity to participate in activities such as watching local football matches and that staff organised events to celebrate events such as birthdays. During the inspection four residents went to the cinema with staff and the residents remaining in the home did their own activities, which included reading a newspaper, art work, watching television and listening to music. A resident spoken with said that they had the newspaper delivered to the home and that they enjoyed doing art work. They said that there was plenty to do at the home and that they were going out the day after the inspection. They said that staff supported them to shop for art materials. They had a lot of papers and magazines piled in one area in the lounge. The acting manager was spoken with and said that they encouraged the resident to keep reducing the items, but that this was a gradual process as they became distressed if their belongings were moved. The acting manager explained that one resident enjoyed listening to music, but they often broke their music player. They said that they had found a player which was affordable and could be regularly replaced. Resident’s records viewed identified what each individual enjoyed doing and how they were supported to participate in their chosen activities. Activities included swimming, cinema, theatre, walking, shopping and eating out. There were records which identified support each individual required when socialising in the community. The AQAA stated that the home ‘had managed to procure a further people carrier to compliment the original house vehicle’. The acting manager said that each resident was provided with the opportunity to enjoy an annual holiday. They said that they used brochures and pictures to support residents with their choices. Comments made in relative/visitor surveys included ‘They make sure that the residents go out at some point every day even if it just for a ride. I think it is very important because (the resident) would sit in front of the television all day if allowed to’ and ‘Since (the resident) has moved into Cromer House (the resident) has made good progress. (The resident) goes out regularly for walks, shopping, cinema etc…’ A staff survey included the comment ‘the residents have access to a range of activities. The staff give a nice relaxed environment for the service users to live in’. Cromer House DS0000062387.V342330.R01.S.doc Version 5.2 Page 16 A resident spoken with said that they have regular contact with their family. Resident’s records viewed included details of contacts each resident maintains which included visits and telephone calls. The home had a cordless telephone, which residents could use. Staff spoken with said that they shared positive working relationships with resident’s families. The relative/visitor survey asked if the home helped their friend or relative to keep in touch with them. Five answered always, two answered usually and one answered sometimes. Comments included ‘Very helpful’, ‘I phone the home regularly to enquire how (the resident) is, also (the resident) key worker rings to speak to me if there are any problems, or a general call sometimes’ ‘The people are nice and very welcoming when we visit’ and (the resident) is not a person that phones a lot’. The survey asked if they were kept up to date with important issues affecting their friend or relative. Five answered always, two answered usually and one answered sometimes. A comment was ‘very much’. There was a comment in one relative/visitor survey which stated that they were concerned about the amount of support that a resident had been provided with to maintain contact with another family member. The acting manager was spoken with and explained that the home had worked closely with professionals involved with the individuals concerned and contact did take place, but it was more controlled and not as often to protect the well being of all parties involved. A relative/visitor survey stated that the home had not informed them, on an occasion, of their family member returning to the home from another residential placement. The acting manager was spoken with and said that there was a misunderstanding about which placement provided the information and they had apologised to the relative for the misunderstanding. The acting manager reported that if residents wanted a key to their bedroom, they were provided one. There was a clear procedure regarding keys in the home. A resident spoken with said that they shopped for and chose their own clothing and toiletries. During a tour of the building, the acting manager informed that inspector that resident’s permission must be sought before they showed the inspector their bedroom. All residents were introduced to the inspector and an explanation of what the inspector was doing in the home was provided. The Statement of Purpose and Service User’s Guide, which were viewed, clearly explained how resident’s rights were respected and included choice, to be called their preferred name and to have their privacy respected. Resident’s records included the form of address which residents preferred and staff were observed using an abbreviation of a resident’s surname when addressing them. Cromer House DS0000062387.V342330.R01.S.doc Version 5.2 Page 17 Their records stated that this was their preference. A staff member said that they did not respond to any other name. Interaction between residents and staff was observed to be positive, friendly and professional. The home’s menu was viewed and it was noted that there was a healthy diet provided. The acting manager said that residents and staff worked together in the preparation of meals and that residents may choose an alternative meal and this would be respected. There were records which identified what each resident had eaten on a daily basis. It was noted, through observation, that the meal provision was flexible and resident’s choices were respected. Four residents had gone to the cinema and decided to eat out at a pub. The remaining residents at the home discussed what they wanted to eat and decided on a take away fish supper. One resident said that they were really looking forward to their meal. They said that the food was good at the home and they always had enough to eat. The food storage was viewed and there was a good range of fresh vegetables and fruit. It was noted that there was a selection of branded foods available such as cereals and sauces. Cromer House DS0000062387.V342330.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect that they are provided with personal support in the way they prefer and require. There was some good practice regarding medication. However, there were some instances of administered medication which had not been signed for, closer monitoring of the recording of administered medication would ensure that residents do receive all prescribed medication. EVIDENCE: Three resident’s records viewed clearly explained the support each resident required and preferred with their daily personal routines, such as dressing, bathing, personal care, going to bed and getting up. Their likes and dislikes were included in the records. The records included evidence of where specialist support had been provided such as through communication and psychiatric professionals. The acting manager said that the resident’s preferences with regards to their daily living were respected and supported as far as possible. They explained that the staff team included gender mix, which provided female residents the Cromer House DS0000062387.V342330.R01.S.doc Version 5.2 Page 19 support of female staff with their personal care. The home had a policy regarding the provision of female care to female residents. There was no such provision for males, however, the acting manager said that male carers could be provided to male residents for personal care if required and that the balance of the gender of staff would, at the time of the inspection, be possible. There were clear records of healthcare appointments, such as doctor, dentist and optician, which residents had attended. Documents included the reason for the appointment and the outcomes. There was a comment in a relative/visitor survey, which stated that their relative’s care plan stated that chiropody should be provided every six weeks, but they were not as frequent as they should be. The acting manager was spoken with and said that there were times when residents refused a service and they could not force the resident to attend. However, they were still offered the appointments at the agreed timescales. There was a comment which stated that the home could improve on ensuring that more care be taken to iron clothing and keeping clothing tidy in wardrobes. The acting manager said that they had picked up this issue and staff were encouraged to work with residents to ensure that clothing was stored neatly. The home used an MDS (monitored dosage system) and when administering, staff removed from the blister pack directly into a small pot. The medication was stored in a metal secured cabinet which was attached to the office wall. There was a further secured storage facility for controlled medicines, the acting manager stated that there were no controlled medication at the home at the time of the inspection. The medication records viewed included a photograph of the resident and what medication they were prescribed and the reason for medication. Where there was PRN (as required) medication prescribed there were clear details of the procedures for administration. The MAR (medication administration records) charts were viewed and the period for June 2007 had been signed by staff when medication was administered. The period for May 2007 was viewed and it was noted that there were six gaps. Two of the gaps were for fibre liquid, which was prescribed for one service user. There was no further recorded information which could explain if the medication had been administered and if it had not, reasons for the non-administration. The previous MAR charts were viewed and there were no gaps identified. The acting manager could provide no explanation for the gaps in the MAR charts, and said that they may have been identified through audit, no evidence was seen that showed actions taken. A staff member was spoken with regarding the ordering and disposal of medicines. They had a clear knowledge of their role and responsibility with regards to ordering medication and disposing of medication, for example if medication was dropped on the floor or a resident refused to take it. They Cromer House DS0000062387.V342330.R01.S.doc Version 5.2 Page 20 could not provide an explanation of methods of auditing the medication which could identify reasons for gaps. They said that they would know if they administered all medication at all times. It was noted that the gaps for the administration of medication were not usual practice and there was no evidence that there were any adverse outcomes to residents. However, a clearer method of recording issues must be undertaken. The record keeping in the home was generally good. The MAR charts included a list of signatures of staff who were responsible for administering medication. Three staff spoken with said that they had received medication training and this was confirmed by training records viewed. Cromer House DS0000062387.V342330.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect that their views are listened to and acted on and that they are protected from abuse. EVIDENCE: The homes complaint’s procedure was viewed and it was detailed and included contact details of CSCI (Commission for Social Care Inspection), it was provided in text and picture format. The complaints procedure was included in the Statement of Purpose and the Service User’s Guide. Complaints records were viewed and the records detailed the concerns, actions taken and of the individual raising the concern was happy with the outcomes. Eight relative/visitor surveys said that they know how to make a complaint. The surveys asked if the home had responded appropriately if they or the resident had raised concerns about their care. Seven answered always and one answered usually. A comment was ‘the staff are always very helpful’. One survey stated that there was one concern that they had raised and the management dealt with the matter immediately and kept all involved informed. The inspector was aware of the incident as they had been notified during the investigation and the appropriate actions had been taken to protect the individuals involved. The resident surveys asked if they know who to speak to if they were not happy. One answered yes and one answered no and commented that they Cromer House DS0000062387.V342330.R01.S.doc Version 5.2 Page 22 would speak to a staff member. They were asked if they know how to make a complaint. One answered always and one answered sometimes. The staff survey asked if they knew what to do if a resident, friend or relative had concerns about the service. Four answered yes and one commented ‘I would offer them the chance to speak to management about any concerns’. A staff member was spoken with and explained the procedure for supporting residents and their representatives if they wished to make a complaint. They explained actions they would take if they had a concern of abuse of a resident. Training records evidenced that staff were provided with POVA (protection of vulnerable adults) training and through the induction training process. Staff were provided with training on managing aggression and breakaway techniques. There were records which identified that when staff received the in house induction to the home they were provided information regarding the home’s policies and procedures, which included the POVA procedure. The staff survey asked ‘do you know the procedure for safeguarding adults, sometimes called POVA?’ four answered yes. The home had the local authority guidelines for POVA. Resident’s records viewed included details of actions the home had taken to protect them from potentially abusive situations and plans for supporting them in managing their behaviour. The home maintained records of resident’s spending of personal monies, which included the dates, what the money was spent on and the receipts for the transactions. The AQAA stated that the home had policies on the disclosure of abuse and bad practice (whistle blowing), dealing with violence and aggression, bullying and safeguarding adults in the prevention of abuse. Cromer House DS0000062387.V342330.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to live in a clean, hygienic, homely and safe environment. EVIDENCE: A tour of the building was undertaken and it was noted that the home was clean and well maintained. The acting manager pointed out areas on the ground floor which had been redecorated and said that there was a rolling programme of redecoration for the home. The lounge was large and comfortable, there had been new seating purchased in the room. One resident said that they had bought their own arm chair from their previous accommodation. The television was safely secured in a wooden cabinet with a Perspex front. The inspector noted that the Perspex would benefit from cleaning. The assistant manager confirmed that they had planned Cromer House DS0000062387.V342330.R01.S.doc Version 5.2 Page 24 to do this and that it had been noted when the usual television had broken which was originally stored in the cabinet. In the dining room some of the bulbs in the chandelier needed replacement. Records of reporting required maintenance of the home and when the work had been completed were viewed. The acting manager said that reports were made on a weekly basis. However, if the repairs were required urgently then they would be reported sooner. The acting manager said that the residents worked with staff in the home with undertaking housekeeping duties. During the inspection a resident was observed vacuuming, with the support of a staff member. The resident’s survey asked if the home was fresh and clean. One answered always and one answered sometimes. There were no offensive odours in the home. The laundry was seen during a tour of the building, there was a stock of disposable gloves and hand washing facilities, including disposable towels and hand wash liquid. The acting manager explained the laundry procedures. There were two different coloured bags provided to each resident, and soiled clothing was put in one coloured bag and other clothing in another. The acting manager confirmed that resident’s clothing was not mixed during the laundry process, which ensured that residents received their own clothing. The AQAA stated that they had a policy for the prevention and management on infection control and that all staff had been provided with infection control training. Cromer House DS0000062387.V342330.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect that they are supported by competent, trained and qualified staff and that they are protected by the home’s recruitment procedures. EVIDENCE: Three staff recruitment records were viewed and all contained a POVA check, job application form, job description, terms and conditions and two written references. Two records contained CRB (criminal records bureau) checks. One staff recruitment records did not contain a CRB check, however, documentation evidenced that it had been applied for and a POVA check had been made. The acting manager said that the staff member had a POVA check and they did not work alone or provide any personal care until the satisfactory CRB had been received. Two records did not contain identification such as copies of a birth certificate or passport. The acting manager said that these items had been provided when applying for their CRB and that copies of the documents were kept in the home’s personnel department. The home must ensure that all documents laid down in Schedule 2 of the National Minimum Cromer House DS0000062387.V342330.R01.S.doc Version 5.2 Page 26 Standards relating to adults be maintained in the home and available for inspection. Three staff spoken with said that they had been supported by the home to complete a care NVQ (National Vocational Qualification) while working at the home. One had achieved an NVQ level 3 and two had achieved an NVQ level 2. The AQAA stated that 38 of permanent care staff had achieved a minimum of NVQ level 2. A staff member confirmed that a further six staff were working on their NVQ level award. When they have completed their awards they would have met the target of 50 staff to have achieved a minimum of NVQ level 2 by 2005. Staff spoken with had a clear understanding of their roles and responsibilities and the needs of residents at the home. Interaction between staff and residents was observed to be positive and respectful. The relative/visitor survey asked if the staff had the right skills and experience to look after people properly. One answered always, four answered sometimes and comments made included ‘as far as I am aware’, the staff are all very experienced and the clients seem to be looked after very well’, the staff seem reasonably capable but one or two incidents have occurred to give concern these have been dealt with by management and generally the staff at Cromer House seem quite apt’, ‘they give so much help and support’ and ‘….the staff are all very lovely’. The resident survey asked if the staff treated them well and two answered always, one commented ‘the staffs is lovely’. The staff survey asked if staff were given relevant training. Comments included ‘now I am’, ‘yes training here is very regular’ and three answered ‘yes’. The survey asked if their induction covered everything they needed to know to do the job when they started. Four answered yes and one commented ‘yes, this was very informative’. Training records viewed evidenced that staff were provided with a relevant induction course, which was accessed from the local authority. Further training provided to staff included epilepsy, manual handling, medication, food hygiene, working with challenging behaviour, fire safety, autism and health and safety. A staff member spoken with said that the training they received was sufficient to support them in doing their job. The AQAA stated that the home had provided Makaton and understanding sexuality in learning disabilities training. Cromer House DS0000062387.V342330.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to benefit from a well run home, that their views underpin all self monitoring, review and development of the home and that their health, safety and welfare is protected. EVIDENCE: The home’s acting manager was spoken with and explained that the registered manager was working as a regional manager within the organisation. However, they maintained their registered manager status and worked closely with the home and regularly visited. The acting manager was an experienced staff member who was undertaking the daily management responsibilities in the home until the time that a permanent registered manager was in position. A staff member who was acting as deputy manager supported the management Cromer House DS0000062387.V342330.R01.S.doc Version 5.2 Page 28 responsibilities. Both the acting manager and deputy manager were spoken with and had a clear understanding of their roles and responsibilities. They had a range of care experience and had achieved an NVQ level 3 in care. The acting manager had achieved a management qualification and was hoping to work towards an NVQ level 4 in care. A staff member was spoken with and said that the management of the home was positive and that they felt they were well supported. The home had good systems of quality assurance in place, which they used in the self monitoring, development and review of the home. A staff member said that they had recently introduced a BILD (British Institute of Learning Disabilities) initiative in the home, which includes visits to the home and other homes by residents and their peers. They assess the quality of life and services provided. The AQAA stated that the home took part in the BILD quality network, and a report would be submitted providing recommendations for improvements. There were satisfaction questionnaires to staff, residents, family and other professionals who provided a service to the home. The outcomes were used in the annual quality assurance reviews. There was an annual review undertaken at the home, which scored outcomes of the service provided. Regular Regulation 26 visit reports were undertaken and the reports were available in the home. The records which evidenced that daily fridge and freezer temperatures were undertaken. Staff training records viewed evidenced that staff had been provided with health and safety related training such as manual handling, health and safety, food hygiene and fire safety. Newly appointed staff had been provided with a Skills for Care induction which included information of safe practices. Fire safety records were viewed and evidenced that regular fire safety checks were undertaken. The home had a fire risk assessment. Health and safety records viewed indicated that regular checks and servicing was routinely undertaken such as with electrical appliances, gas safety, fire alarm system, fire extinguishers and water were tested for legionella. Accident records were viewed for staff and resident’s accidents were recorded in incident reports, which were viewed. Environmental risk assessments were viewed and were made for all aspects of the environment to minimise risks to staff, visitors and service users in the home. All cleaning materials and substances were stored securely when not in use. Cromer House DS0000062387.V342330.R01.S.doc Version 5.2 Page 29 The AQAA stated that the home had written assessments on COSHH (control of substances hazardous to health). Cromer House DS0000062387.V342330.R01.S.doc Version 5.2 Page 30 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 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 4 X X 3 X Cromer House DS0000062387.V342330.R01.S.doc Version 5.2 Page 31 Yes 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 YA20 Regulation 13 Requirement Medication administration records must be signed to evidence that they have been administered or there must be some records explaining why if the medication is not administered Timescale for action 30/06/07 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. Refer to Standard YA6 YA20 YA24 Good Practice Recommendations It is recommended that daily records be developed and improved It is recommended that regular medication audits are undertaken to ensure that any irregularities are recorded and actions taken identified It is recommended that the ‘spent’ light bulbs in the dining room chandelier be replaced Cromer House DS0000062387.V342330.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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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