Inspection on 07/10/08 for Earlham House

This inspection was carried out on 7th October 2008.

CSCI found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Earlham House 04/04/07

Earlham House 11/05/06

Earlham House 06/12/05

Earlham House 09/12/04

Earlham House 24/06/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Earlham House 7 Earlham Grove London N22 5HJ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jane Ray     Date: 0 7 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: Earlham House 7 Earlham Grove London N22 5HJ 02088813064 F/P02088813064 earlhambridie@btinternet.com/earlhamrobert@ btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Bridie Clayton,Dr Peter Theodore Clayton care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: One specified service user who is over 65 years of age may remain accommodated in the home. The home must advise the registering authority at such times as the specified service user vacates the home. Date of last inspection Brief description of the care home Earlham House is a privately owned care home for adults who have continuing mental health problems. The home is registered to provide care for seven adults between 18 and 65 years. The care providers are Dr and Mrs Clayton. The home is a large semidetached property with accommodation spread over three floors. The home has recently been extended and in addition to the seven bedrooms provides communal space that consists of a comfortable lounge, which offers access to a raised patio and garden. There are two bedrooms on the ground floor both with en-suite bathroom facilities. The other bedrooms are upstairs. The office is located at the top of the house and this is also where staff sleep-in at night. The home is situated near to Wood Green, North London and is near to shops and other amenities. There are good public transport links to the home. The stated commitment of the service is to treat Care Homes for Adults (18-65 years) Page 4 of 35 Over 65 0 7 Brief description of the care home residents as individuals with individual needs and needing individual care. We strive to promote independence and ensure privacy and dignity is maintained. A copy of this report can be obtained direct from the provider or via the CSCI website (web address can be found at page two of this report). Care Homes for Adults (18-65 years) Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. The inspection took place on the 7 October 2008 and was unannounced. The inspection lasted for six hours and was the key annual inspection. The inspection looked at how the home was performing in terms of the key National Minimum Standards for Younger Adults and the associated regulations. The inspector was able to observe the support given to six of the current residents and also spend time talking to them. The inspector was also able to spend time talking to the manager, deputy manager, assistant manager as well as the one care staff who Care Homes for Adults (18-65 years) Page 6 of 35 was working. The inspector did a tour of the premises and also looked at a range of records including resident records, staff files and health and safety documentation. The home had provided the inspector with a very comprehensive self assessment questionnaire (AQAA) prior to the inspection. The inspector also received fourteen surveys completed by 7 residents, 6 staff members and 1 care professional. At the time of the inspection there were seven people living in the service. The current range of fees in the home is from 650 to 900 pounds a week. What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Adults (18-65 years) Page 8 of 35 A number of good practice recommendations were made at this inspection. The first was to further develop the key-working system so there is greater consistency of care. There is also a need to complete a training analysis of the whole staff team to ensure refresher training takes place in a timely manner including safeguarding training. This is to ensure staff skills are kept updated in all areas. Supervision would also benefit from taking place more regularly. It is also recommended that residents play a more active role in staff recruitment and actually participate in the interview process. In terms of staff recruitment the home must ensure all staff have current permission to work in the country. The quality assurance survey that includes seeking the views of relatives and care professionals is now due to be carried out as it is over a year since this exercise took place. The medication administration records should be reviewed to ensure the instructions are accurate and reflect what is said on the box or bottle so there is complete clarity about what medication residents should receive. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 35 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can be assured that their individual needs will be assessed and that the staff have the skills and ability to meet these needs. New people moving to the service will be able to visit the home and have access to information in an appropriate format to tell them about the home. Contracts between the home and the resident are in place and so there is clarity about what the home will provide. Evidence: Earlham House has a very low percentage of failed placements and those who have been transferred elsewhere have either wanted to come back or still visit years later and attend our parties and discuss any difficulties they are experiencing now and on some occasions they have sought advice from the registered manager and requested that she contact their care co-ordinator. It is a harmonious house and we think that this is due to good assessment of need and predicted compatibility prior to admission. (Extract from the AQAA prepared by the home) The staff are great, they got me off the booze and I even gave up smoking nine Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: months ago. (Quote from a resident) The service has a statement of purpose that includes all the necessary information and this was inspected. The home provides prospective and new residents with a service user guide to give them information about the service. This includes details about the home, location, staffing, the clients, the commitment to residents, the admission process, complaints procedure and feedback on the service. This guide is in a clear format and includes photos of the home. Residents in their completed surveys said they had received enough information about the home before they moved in. We looked at the assessment for the resident who has moved into the home since the last inspection. They had a comprehensive assessment provided by appropriate care professional. The home staff team have also completed their own assessment. This assessment is very holistic and reflects the ethnicity and diversity needs of each person. The care provider has prepared a contract document between the home and the resident stating what the home will provide. One contract for the most recent resident to move to the home was read and was appropriately signed. The inspector spoke at length to the resident who had moved most recently to the home. She said that she had visited the home and done a sleep-over as part of the process so she could meet the staff and other residents. The current needs of the people who live in the home were discussed with the manager and care staff. They have very specific individual needs linked to their mental health and in some cases issues of alcohol abuse. The staff spoken to had a very good understanding of the individual needs of the residents. In addition it was observed that the staff were supporting the residents with great skill and sensitivity. The staff said they felt they had been supported to have a better understanding of mental illness through training, experience, advice from the management team and from reading relevant literature provided by the manager. The residents also feel very much at home and have a positive relationship with the staff team. Care Homes for Adults (18-65 years) Page 12 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home can be confident that they will be supported to participate in the development of a holistic individual care plan and risk assessments. This will facilitate the residents to have control of their lives. Evidence: Service users are consulted about a wide range of issues that concern them and encouraged to participate in the daily running of the home through consultation. This takes the form of informal discussion, service user surveys and occasionally formal residents meetings. Our service users are encouraged to live independent lifestyles wherever possible, and this includes being able to take responsible risks. They all have a front door key and may come and go as they please, with outside activities and independent lives being actively encouraged. A comprehensive risk assessment is included in their care plan that allows a good balance between individual freedom to take risks and personal safety by providing reasonable risk management strategies such as training and information provision to allow the service users to live as fulfilling Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: a life as possible. (Extract from the AQAA prepared by the home) The home are very good at engaging each client on their own terms, with respect and dignity. They are good at connecting with hard to reach clients, but somehow these clients fully trust the staff. It is quite a rare quality (Extract from a care professional survey) We treat the service users as individuals. They are encouraged to develop their independence through rehabilitative work and by giving them the necessary information, support and guidance to make their own decisions even if it sometimes includes an element of risk taking. (Extract from a staff survey) We inspected care plans for four people currently living in the service. We also spoke to the manager, care staff and residents about the care plans. All of the people whose records were inspected had comprehensive holistic care plans in place. These were clearly laid out and covered all aspects of each persons needs and were written using appropriate language. The residents were being supported to be as fully involved as possible in the preparation of their care plans. One resident had been able to write his own care plan with the support of the manager. Another resident was discussing her care plan with her key-worker in small sections so she was able to concentrate on the details as much as possible. All of the residents had been supported to have a CPA or review meeting with their care team. It could be seen that the residents changing needs had been reflected in their care plans, for example where they were able to be more independent in an area of their lives. Each resident had a named key worker. The residents were asked about their keyworker but were not sure who this person was, saying they speak to any of the staff who are working. One member of staff explained that as a key-worker she is learning to update care plans and also help residents with their shopping. The manager acknowledged that further work was needed to embed the key-working system and that this is underway. We read the risk assessments for the same four people who live in the service. It was possible to see that an effort had been made to identify areas of personal risk and look at how this can be managed without placing unnecessary restrictions on people. The risk assessments had been prepared using one main format that was clear and easy to follow. Risk management plans gave clear guidance to staff. Each person living in the home had individual guidelines as part of their care plan and risk assessments about how they should be supported if they are anxious or distressed. These were clearly written and gave appropriate guidance to the staff. Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: We observed the people living in the home and their interaction with each other and the staff. It was positive to note that they felt very comfortable making decisions about what they wanted to do and able to ask the staff for support where this was needed. The staff were also very aware of consulting the residents about all aspects of their daily lives. The manager told the inspector that one of the residents has been supported to have an independent advocate from the local IMCA service as he was saying that he wanted to move on from the home, but care professionals did not feel he was ready. The residents spoke about the resident meetings, which take place occasionally. The residents knew there was a meeting coming up shortly and some of the topics that were going to be discussed. They did however say that they found the staff very approachable and felt able to make decisions about their lives. One resident said, I can always go to one of them and discuss whatever. Care Homes for Adults (18-65 years) Page 15 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the homes are supported to develop their daily living skills and are also enabled to follow their own routine as part of the process of achieving greater independence. The home supports the residents to enjoy a range of activities based on their individual interests. Residents are supported to eat a healthy and varied diet. Evidence: Service users are encouraged to maintain links with their families and friends, whom we encourage to come and visit to have lunch at the home, or just to visit as often as possible. In those instances where the family member/friend is unable to visit the home, the service user is encouraged and, if necessary aided, to visit, bringing lunch so the visited person would not have to provide refreshements. The home is in a road of approximately fifteen houses where everybody knows everybody. New service users are introduced to our neighbours and have developed good relationships in a small Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: close knit community that also includes the local police whom some of the service users invite into the home. We see this as very positive because neighbours and local police talk to us and some service users were quite frightened initially when police visit as some had past memories of being admitted to psychiatric hospitals under the mental health act with police involvement.(Extract from the AQAA prepared by the home) The people living in the home were observed assisting with domestic activities in the home such as cooking and cleaning their bedrooms. The staff and the residents all talked about how the residents were developing their independent living skills. One resident talked about how he cleaned his room but also helped to tidy the lounge at the end of this day, which was a responsibility he enjoyed. Another resident said that whilst staff mainly prepared the evening meal, the residents help with the lunches. This resident made lunch on the day of the inspection. The residents were observed preparing themselves drinks. This is made easier as there is a kettle and variety of drinks available at a tea bar in the lounge. The residents do different activities during the day. One person attends a supported employment service. Another resident attends a service where there is a focus on learning new skills. He explained that he has started a literacy and numeracy course. On the day of the inspection two of the residents went together to central London. One resident explained that he is Greek-Cypriot and occasionally goes to a drop in centre for Greek-Cypriot people. Another resident explained that she has tried a number of activities and thinks she wants to go twice a week to an Irish centre when a place becomes available, which again reflects her cultural interests. One resident talked about how he likes to watch films in the home and it was observed that there is a pool table available. A newspaper is provided for the residents to read. The two cats who live in the home were observed to give the residents a lot of pleasure. From reading the daily notes for four people it was seen that some of the residents make good use of local community facilities, going shopping, to the cinema, out for meals, using the library. The residents said they had freedom passes, which enabled them to use public transport free of charge. The home is also opposite a park where residents can enjoy the open space. Some of the current residents have regular contact with their relatives and have arrangements in place to see them. Relatives and friends are welcome to visit the home and residents also go to see them. One resident talked about how her family come to visit her regularly. She also had a visit from a friend during the inspection. Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: The manager explained that instead of having a holiday the residents have had a number of day-trips arranged by the home. These take place every fortnight and have included trips to the seaside, a riverboat trip and a visit to the zoo. It was observed that whilst staff ensured the residents took their medication at the correct time and maintained a routine, they did have flexibility around the times they went to bed or got up. We were able to observe people spending time in their rooms if they wanted to do so. The residents have their own keys to the front door and bedroom. The staff explained that the home has a five-week menu that is constantly being reviewed. It was observed that there was fresh food available in the home. The staff explained that the bulk of the food is ordered on line ands delivered to the home but milk and fresh produce is also bought locally. Three of the residents in the home are diabetic and so there is an emphasis on healthy eating. Where a resident does not like what is on the menu, an alternative is offered. One resident said they did not like pork, but said alternative meat is always offered. Care Homes for Adults (18-65 years) Page 18 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home are supported in a manner that protects their privacy and dignity. Each person is supported to access professional healthcare input based on their individual needs. The residents receive the correct medication but administration records need to be amended where the administration instructions are not correct. Evidence: All bedrooms are single and equipped with washing facilities which promotes independence in personal care and should a service user require assistance it can be provided in privacy. Service users are encouraged to remain independent and maintain their dignity by seeing to their own personal care needs. If a service user requires specialised equipment to facilitate their personal care, such as a hydraulically operated bath chair, this is available and maintained. If assistance is required, this is provided tactfully in private by a person with whom the service user feels comfortable. Where a service user is disinclined to attend to their personal hygiene they are given advice and educated as to the value of maintaining a good standard of personal hygiene and of the consequences to themselves and others of not doing so. Support and training is given where necessary. We are flexible about times and preferences regarding general Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: bathing, some service users like to take a bath at night where others prefer mornings or afternoons, either way they can be accommodated. There is constant hot water available which aids flexibility in this area of care. Should a service user be incontinent, it is never seen as a problem for the staff and is handled with sensitivity to maintain the dignity of the service user and we explore reasons for incontinence, such as excluding urinary tract infections, drinking habits and will involve a specialist continence advisor who will give advice to the service user and staff. Continence training is available to staff. (Extract from the AQAA prepared by the home) My client often refuses to engage with health services due to the nature of his illness. However staff do eventually find a way with him to allow the GP to examine him. (Extract from care professional survey) We observed during the inspection that the residents attend to their own personal care, but where some prompting is needed this takes place in a sensitive and encouraging manner. We also observed that the residents were all dressed in an appropriate manner. One resident talked about how she had been supported to buy new clothes We looked at the healthcare records for four of the people living in the home. Everyone was registered with the GP and had regular health checks. Everyone had been encouraged and supported to visit the dentist, optician and podiatrist. All the residents had input from the local mental health care professionals. The staff understand the importance of monitoring each persons mental health and contacting the care professionals if there are any issues to address. The residents have been supported to check their weight and blood pressure on a monthly basis. Where there are other healthcare needs such as diabetes residents are supported to attend outpatient clinics. Residents are also supported to access preventative healthcare such as well women checks and flu vaccines. We looked at the medication, administration records and staff training records. The home uses a blister pack system. The medication is stored in medication cupboards in each persons own bedroom. The temperature of the medication cupboards is monitored and these are at a satisfactory level. One resident who is preparing to move to more independent living has been supported to administer his own medication. The medication and administration records for three other residents were inspected. These record when the medication is delivered to the home and returned to the pharmacy so a clear audit trail is available. Two residents had a medication listed on their medication administration record, which said it must be given two or four times a day but was in fact a medication that was given as required. One resident who was prescribed as required diazepam had clear instructions on the medication Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: administration record stating when this should be administered. The training records were inspected and all of the staff who administer medication had completed the medication training. Care Homes for Adults (18-65 years) Page 21 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home have access to an appropriate complaints procedure and feel able to raise any concerns. Procedures and training on safeguarding vulnerable adults are in place. Systems have been implemented to ensure residents personal monies are being managed appropriately. Evidence: The staff and management have created an environment that empowers service users to discuss any issue or concerns they may have without fear of recrimination and allows emergent problems to be dealt with effectively without having to resort to making a formal complaint. The formal complaints procedure is made available to all residents in a format they can understand and they are aware of the procedure in place for complaints, which is displayed prominently in the home and included in the service users guide. (Extract from the AQAA prepared by the home) If there is a problem any time day or night, the staff are available (Quote from a resident) We looked at the complaints procedure and this was clear and easy to understand. The AQAA stated that there had been no written complaints since the last inspection. The surveys completed by the residents said they would know how to make a complaint. A member of staff spoken to during the inspection was familiar with the complaints Care Homes for Adults (18-65 years) Page 22 of 35 Evidence: procedure. There have been no adult protection issues since the last inspection. We looked at the staff training records and these show that all of the staff had either received safeguarding vulnerable adult training but some of this would benefit from being refreshed. We spoke to the care staff about the safeguarding adults procedure and they all displayed a good knowledge of the procedures and the importance of speaking to the manager about issues that arise. From discussions with staff and reading the risk assessments the staff said they feel prepared to cope appropriately with challenging situations as they arise. We saw the record for three of the people living in the home relating to their personal finances. The residents have a number of different arrangements in place according to their ability to manage their own finances and agreements reached with placing authorities about the management of monies. All the residents have their own building society or post office account. Some of the residents place their cash with the home for safekeeping and then take their money on a weekly or daily basis. The records show their cash deposited with the home and they sign when they take their money. For one resident, the manager acts as her agent. This arrangement is recorded in her care plan and there is evidence that this has been agreed with social services. As this resident does not often leave the home the staff have to buy items on her behalf and this expenditure is recorded and receipts obtained. Care Homes for Adults (18-65 years) Page 23 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home benefit from a comfortable and homely environment, which is maintained to a high standard. Evidence: Earlham House is a semi detached Victorian House situated on a residential street facing a park, it is registered to provide accommodation with care for seven people who are recovering from mental illness. The house is in a residential setting close to local shops, medical practices and very good transport links. All the service users have a single room that is furnished to suit the needs of the present service users and meet or exceed minimum standards for space and furnishings. Three rooms have en suite facilities. It is homely, clean and comfortable and service users have influence in the decoration and furnishing and are encouraged to personalise their rooms. Artwork produced by the service users is on display in communal areas of the home and in their rooms. Adaptations and aids are installed in the home and garden to enhance independence of less physically able service users. The communal areas are suitable for purpose, well equipped and well decorated, avoiding any institutional appearance. All decoration, fixtures, fittings and appliances are well maintained and replaced when necessary. Regular improvements to the building ensure that the best possible environment is achieved for the service users from the property. (Extract from the Care Homes for Adults (18-65 years) Page 24 of 35 Evidence: AQAA prepared by the home) The service consists of a recently extended and modernized large semi detached house. The home is clean, bright, safe and comfortable. The shopping centre at Wood Green is a short distance away and there are local shops available very close to the home. The bedrooms are single and appropriately furnished. We were shown two bedrooms by residents and these had been personalized to reflect their individual taste. Bathrooms and shower rooms are easily accessible from all the bedrooms and the two ground floor bedrooms have en suite facilities. The home has adequate communal space consisting of a kitchen and lounge. The home also has an attractive enclosed garden with a raised covered patio that is accessible from the lounge. An outside designated smoking area is provided and residents are asked not to smoke in their rooms. The top floor of the house is the office and staff sleep in area. The house was clean and tidy. It was also well maintained. Care Homes for Adults (18-65 years) Page 25 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are supported by a committed and stable team of staff. Residents are safeguarded by staff having all the appropriate recruitment checks. The staff are receiving a range of training and are supported by supervision sessions. This enables them to work to a high standard and deliver good care. Evidence: When a staff vacancy arises, the recruitment procedure follows best practice guidelines for equal opportunities and meets all standards required by the National Minimum Standards for Care. All vacancies are advertised in the Job Centre in addition to local newspapers. Prospective employees are issued with a job description and a description of the home and its ethos before interview. They are introduced to service users to talk before the interview, to allow the service users to form an opinion and they are consulted afterwards. A new member of staff will not be selected unless it is felt that they will get on well will service users, have very good communication skills and appropriate job specific skills. The most important factor considered in selection is how well they will be able to meet the needs of the service users rather than any business need. All staff must have satisfactory references, enhanced CRB and POVA checks before they are allowed to start work. (Extract from the AQAA prepared by the home) Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: I am very happy to work at Earlham House. My manager is very nice and always up to date. (Extract from staff survey) I am comfortable with the new staff (Quote from resident) We checked the rota for the home and this showed that there is a team of ten regular staff working at the home. The staffing structure consists of the manager, deputy manager, assistant manager and a team of carers. During the day there are one or two care staff on duty and the manager and assistant working weekdays from about 9am to 5pm and at night there is one sleeping in member of staff from 7pm onwards. There is also a cleaner who works from 9am to 2pm five days a week. Three care staff have joined the team in the last year. The manager explained that 5 staff have completed an NVQ in care at different levels and 3 staff are studying towards the qualification. We looked at the recruitment records for staff who had started working at the home since the previous inspection. It was found that all the staff had two references, criminal record bureau disclosure which includes a POVA check and ID. One member of staff did not have a record of current permission to work in the country. The staff all had completed and signed contracts of employment once they had completed their probationary period. The manager explained that one of the residents had sat in on the recent staff interviews but had observed rather than asking questions. We inspected the training records. We looked at the induction records for the three new staff, one had completed the skills for care induction standards and the manager explained that the other two staff were working through this induction. One carer explained how she had helped with the induction of the new staff. Each member of staff had an individual training record. The assistant manager explained that training is being booked for the next few months, mainly accessing training provided through Haringey social services. This covers a number of topics including person centred care, cognitive behavioural therapy and equality and diversity in addition to the mandatory training. The staff said that the training they had received was a good standard and very useful for their work. A number of the surveys completed by the staff spoke very positively about the training they receive. The current recording of staff training makes it hard to work out when staff received their training and therefore when refresher training should take place. We looked at the supervision records for four staff. All the staff had received individual Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: supervision but this had not taken place on a regular two monthly basis. The senior staff are booked to attend training on supervision skills which should improve the standard of this area of work in the home. It was observed that the standard of communication is good in the home, with handovers between shifts. The staff mentioned that they find the senior staff very approachable. Care Homes for Adults (18-65 years) Page 28 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A residents benefit from a permanent manager who can provide effective leadership in the home. Health and safety measures are in place to safeguard the people living in the home. A comprehensive system of quality assurance helps to maintain and improve standards in the home. Evidence: The manager often gives support and will explain and discuss more about the work (Extract from staff survey) If a service user is concerned about anything they would be able to see the manager right away (Extract from staff survey) The manager ensures full compliance with all relevant legislation and regulations, including all mentioned in National Minimum Standards for Care and obtains all relevant certification, maintenance contracts and insurance. The manager ensures that all policies and procedures in the home are adequate, relevant, implemented in daily Care Homes for Adults (18-65 years) Page 29 of 35 Evidence: practice and reviewed in line with legal and sector developments. Health & Safety are a priority in the home, ensuring that the home is a safe living and working environment for staff and service users. Compliance with health and safety ideals is fostered through attendance at training, forms part of the central ethos of the home and is a serious consideration in recruitment. This is reflected in the very low level of accidents experienced in the home. (Extract from the AQAA prepared by the home) The service has a registered manager. The manager has completed the registered managers award and has nineteen years experience of managing care homes. It was observed that there was very open communication between the manager, the residents and the staff team. It was observed that the service was well organised, with all the appropriate records in place. The home had also provided a very comprehensive AQAA, which demonstrated a good knowledge of the care standards and how they can be put into practice. The company has questionnaires to seek the views of residents, relatives and other care professionals as part of a quality improvement exercise and these have been completed. The feedback from the previous year was inspected and was very positive and an action plan implemented to address any issues that had arisen. This information has been included as part of the service user guide. The questionnaires for this year have not yet been sent out. The manager is also introducing a new service user consultation tool that provides a way of seeking the views of the residents on specific topics over a period of time, to allow the information that is gathered to be more detailed. In terms of fire safety we looked at the fire safety risk assessment and emergency plan and this was complete. One resident who is hard of hearing has been supported to have an alarm that vibrates under his pillow in case of a fire at night. The fire alarm and fire extinguishers had been serviced. The fire alarm records show the alarm is checked weekly and the fire drills have been taking place quarterly. The training records show that fire safety training has been completed for the whole staff team and are refreshed every six months. The AQAA showed that all the health and safety maintenance checks had taken place. The staff training records show that staff have completed all the health and safety training including food hygiene, first aid and infection control. The timescale from previous training needs to be monitored to ensure refresher training takes place in a timely manner. Care Homes for Adults (18-65 years) Page 30 of 35 Evidence: Care Homes for Adults (18-65 years) Page 31 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 32 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 The registered person should further develop the keyworking system to ensure residents receive continuity of care. The registered person should ensure the instructions on the medication administration record are correct to ensure medication is administered as intended. The registered person should ensure staff have their safeguarding vulnerable adult training refreshed. The registered person should ensure that all staff have a record giving current permission to work in the country. The registered person should support residents to assist with staff recruitment by playing an active role in interviews. The registered person should prepare an ongoing summary of staff training so that training needs for the whole staff team can be identified and refresher training can be arranged as needed. The registered person should ensure that staff supervision takes place regularly. The registered person should carry out the quality assurance exercise again seeking the views of relatives and 2 20 3 4 5 23 34 34 6 35 7 8 36 39 Care Homes for Adults (18-65 years) Page 33 of 35 care professionals Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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