Inspection on 09/09/05 for Egmont Road (31)

This inspection was carried out on 9th September 2005.

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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Egmont Road (31) 08/12/06

Egmont Road (31) 25/11/05

Egmont Road (31) 07/03/05

Egmont Road (31) 29/07/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Egmont Road (31) 31 Egmont Road Sutton Surrey SM2 5JR Lead Inspector David Pennells Unannounced Inspection 9th September 2005 10:45 Egmont Road (31) DS0000046244.V249237.R01.S.doc Version 5.0 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 Egmont Road (31) DS0000046244.V249237.R01.S.doc Version 5.0 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. Egmont Road (31) DS0000046244.V249237.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Egmont Road (31) Address 31 Egmont Road Sutton Surrey SM2 5JR 020 8661 5534 020 8661 5694 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) Care Management Group Limited Mrs Lesley Somerville Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Egmont Road (31) DS0000046244.V249237.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. A variation to allow one specified service user aged 17 to be accommodated during his transition to adulthood. 07/03/05 Date of last inspection Brief Description of the Service: 31 Egmont Road is owned, managed and staffed by the Care Management Group (CMG). The project has been open since August 2003 and is registered with the Commission to provide residential care for up to six adults (generally 18 - 40) with learning disabilities - who may have challenging behaviour, autism and / or other complex needs. The home itself is a large semi-detached house (attached to a separate ‘sister’ CMG home) situated in a quiet suburban area of Sutton and within easy walking distance of local shops, leisure facilities and having access to good public transport links. Accommodation within the home comprises of six single occupancy bedrooms all with en-suite facilities (toilet, basin and shower). Communal space is composed of a main lounge, a separate dining area, kitchen, laundry, office, sensory room and a conservatory. A garden is provided at the rear with its own patio area directly off the conservatory at the house level. There are sufficient numbers of additional communal bathroom / shower and toilet facilities located throughout the home, in addition to the en-suite facilities. A vehicle is provided for use by the home. There is a hardstanding at the front of the home for the parking of two vehicles off-road, with free (though scarce) parking available on street. Egmont Road (31) DS0000046244.V249237.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was conducted across the working day from mid-morning to late afternoon. The inspector was able to discuss the requirements and recommendations from the last inspection visit, as well as reviewing the present conduct of the home – including records and care notes - and also verifying information supplied to the Commission contained in the preinspection questionnaire which was completed by the manager. Time was also spent with service users and staff, as well as touring the building. What the service does well: What has improved since the last inspection? The home has addressed a number of requirements set at the last visit in march regarding cooked food temperature monitoring, creating a policy on pressure relief, ensuring accurate medication administration, providing ‘white board’ communication channels, and ensuring that fire tests and records are as accurate and concise as possible. Egmont Road (31) DS0000046244.V249237.R01.S.doc Version 5.0 Page 6 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. Egmont Road (31) DS0000046244.V249237.R01.S.doc Version 5.0 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 Egmont Road (31) DS0000046244.V249237.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 & 4. Prospective service users can be confident that they will have the opportunity to find out about the home, to visit (including staying for short periods) and – through adequate assessment and consultation - be assured that the home can meet their needs prior to making a firm decision to stay. EVIDENCE: Referrals to the home require full and concise information to be provided; admissions are based on a full needs assessments undertaken by the registered provider at a regional level, by the home’s manager, and a care manager from the relevant placing Local Authority. The introductory phase gives the staff the chance to ensure that they are able to offer an appropriate service, along with assessing compatibility with other service users in this small community of six distinct personalities. One new service user had been admitted to the home in May 2005. The inspector took the opportunity to ‘map’ this service user’s progress through the first few weeks of their stay. The service user had arrived at the home relatively quickly after referral, but the detail held was full and comprehensive. The initial contract had been signed seven days after admission, and a review had been held six weeks later. Another review was due to be held soon after the inspection visit. The home has an experienced staff team who clearly have the relevant knowledge and skills to meet the social, health and welfare needs of the Egmont Road (31) DS0000046244.V249237.R01.S.doc Version 5.0 Page 9 service users. The entire staff team have received training in understanding and working with people with autism / challenging behaviour last year. Staff members use Makaton and Sign to communicate with certain service users. The manager has devised individualised communication ‘passports’ for each service user to identify their preferred modes of communication. The home scored a ‘4’ against Standard 4 in last year’s inspection audit – the creativity and innovation at the home seeking to settle a service user is undoubted – though not so clear as to merit the same marking this year. Recent admissions have all been given the opportunity to visit the home on numerous occasions, in order to meet the other service users and staff. The current scale of charges extends from £1400 to £3386 per week – reflecting the very high staffing ratios required to work with this client group. Some service users have significant amounts of 1:1 time, this inevitably and significantly pushing up the charges. Egmont Road (31) DS0000046244.V249237.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 & 10. The home maintains care plans and assessment documents designed to ensure that the needs of service users are met in a focused and individual way, with their rights to individuality and self-expression being protected, and the wishes and aspirations of the service user being taken into account. Service users can be assured that risk-taking will be an integral part of the support / protection plans put in place by the home, though attention must be paid to ensuring that such risk assessments are introduced / kept up-to-date at all times. Service users and relatives/friends can be assured that information about service users is kept in line with best practice and data protection legislation. EVIDENCE: Regarding the newest service user at the home, it was good to see ‘Guidelines and Introduction to X’ dated the day of admission and full risk assessments being in place within seven days of their admission. An induction checklist and questionnaire had been completed on the day of admission also – ensuring that adequate information was gathered to respond to specific needs immediately the home engaged with the service user. There was clearly Egmont Road (31) DS0000046244.V249237.R01.S.doc Version 5.0 Page 11 substantial information available for the guidance of staff and the benefit of the service user – and this, along with the Discharge Care Plan from the [previous] placement - was being refined to ensure that the full care plan – which was being developed – accurately reflected the situation. With regard to other service users, the manager of the home stated that the Unit was about to bring in a Self-Care Skills Audit (appearing to be a good format) and to also introduce a new format for daily reporting against this new care plan concept - thus ensuring the connectiveness between the goals and reporting systems. Current Care plans had been generated from assessments that contained a broad perspective of service users’ personal, social and health care needs. Plans referred to a service user’s likes / dislikes, as well as their individual priorities, with individual ‘Where I am going’ pages, which all contribute to ‘Action’ pages of focused goals and future challenges. All the plans inspected contained individualised procedures for staff to follow for service user assessed as likely to have challenging behaviour, focusing on positive intervention (e.g. communication support and de-escalation techniques - in preference to physical intervention.) The registered provider’s finance officer is Appointee with regard to benefit issues for all six current service users. Services users monies are checked at each daily staff handover. A second member of staff - who witnesses any transaction - countersigns all incoming and outgoing payments undertaken by the home. Risk assessments are provided for each service user within the home specifically created to reflect the assessed situation for that individual. Risk assessment is clearly an important part of the ethos / thinking of the home, and is well covered in the associated documents. Assessments are in place for all service users, and cover many and various aspects of their needs, including personal hygiene, community presence, and behaviours likely to challenge the service. Each risk assessment identifies the risk; possible consequences of risk; and minimising action required. The home also has a missing persons procedure and associated risk assessments that enable staff members to respond promptly to unexplained absences of any service user. Four service users were specifically adjudged to exhibit ‘extreme behaviour’. The home ensures that all staff members are regularly updated in issues of restraint – the Company’s ‘Dignified Management of Conflict’ training covers how to deal with challenging behaviour and appropriate techniques to address such issues when they escalate. Four incidents - where the ‘DigMan’ technique was invoked - were fully documented, and all such events reported to the Commission at the time of the incident. Egmont Road (31) DS0000046244.V249237.R01.S.doc Version 5.0 Page 12 The home has a corporate confidentiality policy that is displayed on the home’s notice board. The home has recently – through the parent company - renewed the Data Protection notification; this being an important commitment for the home, keeping, as it does, significant personal records on file. Egmont Road (31) DS0000046244.V249237.R01.S.doc Version 5.0 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 15, 16 & 17. Service users can be assured that the service provides opportunities for them to engage in activities both within and outside the home, and to adopt a lifestyle best suited to the individual. Relatives / friends can expect a positive welcome from the home, within the context of respect for a service user’s own choices and decision-making. Service users can expect to be provided with a good standard of nutritious and wholesome food – meeting dietary needs and ensuring that mealtimes are a pleasant and enjoyable time. EVIDENCE: Egmont Road (31) DS0000046244.V249237.R01.S.doc Version 5.0 Page 14 Planned weekly activities timetables were currently in place for a number of service users. Daily diary notes showed that service users are being provided with numerous opportunities to participate in a wide variety of stimulating social and recreational activities - both at the home and in the wider community. Service users are supported to participate in a wide variety of individually appropriate activities - which may include regular attendance at a local day centre, educational centres and other individual locations. Individual assessments make it clear that it would be inappropriate for any of the current service users at the home to take up opportunities for paid / voluntary employment. The home is clear in its Statement of Purpose that visitors and especially family contacts are welcome to the home on an unrestricted basis. The majority of service users have active engagement with their loved ones, and varied plans for the individual service user visiting the relatives are also in place. At least half of the current community of service users ‘go home’ regularly - varying from monthly visits to day visits a few times a year. The principal rule at the house is flexibility to accommodate each service user and their preferences /behaviours; priorities are established as the day goes on. Service users have free access to the communal areas in general, though some limits are imposed on access to bedrooms - dependent on risk assessments. Staff members are always freely available – with (evidently) sensitised ears listening out for any ‘incident’. The Unit had already enabled the accessing of a ‘Freedom Pass’ for the new service user, and a programme of external activities was being evolved. The home’s activity book evidenced a wide variety of activities planned and enjoyed by service users. Holidays at Clacton-on-Sea – including visits to Colchester Zoo were being looked forward to. Four of the six service users’ relatives / friends replied to the Commission’s questionnaire and indicated (though one with ‘reservations’ – perhaps connected to paucity of funding levels by the sponsoring local authority) a general belief that their loved on was being satisfactorily cared for. The inspector again observed several service users and staff preparing for meals - which service users also evidently enjoy. Safe catering records were seen - such as refrigerator temperature checks, and food probe temperatures of cooked items - to ensure that food is cooked / served to the service users at the appropriate ‘safe temperature levels’. Staff confirmed that at times staff members still lock the kitchen door when it is not in use; the overriding need to ensure safety - to both service users and staff - requires this approach. Although the service users’ right to access food and drink when they choose is ‘impeded’, it is clearly not in the service users‘ best interests not to lock the kitchen door - for a number of overriding safety Egmont Road (31) DS0000046244.V249237.R01.S.doc Version 5.0 Page 15 factors. Staff members do take positive steps to ensure continuous access to drinks, etc. Egmont Road (31) DS0000046244.V249237.R01.S.doc Version 5.0 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Service users can be assured that their personal, health care and emotional needs will be recognised and met by the home’s assessment and care planning programme. The systems adopted by the home regarding medication ensure the safety and consistent treatment and support for each service user. EVIDENCE: Service users require varying degrees of support from staff in respect of their personal care; only one service user being capable of undertaking all personal care tasks for themselves. The routine of the house is flexible - bending to the will of the service users. Each service user is clearly their ‘own person’ and their clothes, hairstyles and appearance reflects their gender and ethnic / cultural background. All service users have a Keyworker with whom they have regular contact - and who is instrumental in preparing input to a service user’s reviews. The home has individualised guidelines for staff to follow in respect of service users personal care needs, as set out in their care plans. Each service user is clearly their ‘own person’ and their clothes, hairstyles and appearance reflects their gender and ethnic / cultural background (African / Caribbean and mid-European and white English service users are resident). Egmont Road (31) DS0000046244.V249237.R01.S.doc Version 5.0 Page 17 Service users have access to the local GP services; five are under one GP, whilst one service user accesses a GP at another surgery. Specialist dental input is gained via Orchard Hill and optical services are also either local community or specialist-worker based. The home uses a recognised monitored dosage system (MDS) and is in regular contact with the pharmacist (Boots) to seek advice about the home’s medication practices. The supplying Pharmacist undertook a satisfactory Pharmacist’s visit on 09/03/05. Records are generally well maintained for all medicines received / administered in the home, as well as those returned to the dispensing pharmacist. A detailed instruction sheet - giving clear criteria for the use of ‘as required’ (PRN) medication - is well in place. Management, team leaders and seniors administer the medication at the home. Egmont Road (31) DS0000046244.V249237.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Service users can be confident that their comments and complaints are responded to, with appropriate action taken. The home provides adequate support to service users to ensure that they are protected from harm and any form of abuse. EVIDENCE: The home’s Complaints Procedure is fully stated in the home’s Statement of Purpose, which is available to all the home’s service users and their representatives, in various formats that are appropriate to the various groups (e.g. using appropriate language, pictures / symbols). The procedure also includes information about how to contact the local area office of the Commission for Social Care Inspection, should the complainant wish to do so. Half of the relatives / friends responding to the Commission questionnaire indicated they were aware of the complaints process and half were not. Only one person had had to make a ‘minor’ complaint. CMG Procedures for dealing with suspicion or evidence of abuse, including Whistleblowing, were available. Sutton Council’s 2005 Vulnerable Adult Procedures are also kept at the home. The CMG Policy and procedure (2002) for ‘Alleged Abuse’ continues not to refer across directly into the local authority’s guidelines for dealing with adult abuse; the policy should directly refer to this, and a local (pan-Sutton CMG homes - relevant to the six homes in CMG ownership) should be evolved, tying in the best practice in this, and the local authority, document. Egmont Road (31) DS0000046244.V249237.R01.S.doc Version 5.0 Page 19 About half of the staff team have now undertaken the ‘Vulnerable Adult’ training – and the remaining staff are planned to take this course, thus ensuring that service users are supported by knowledgeable staff who can deal with any allegation of abuse sensitively and in a timely manner. It was questioned whether in fact the home could access a ‘block’ course at the home for the remaining eight staff who required this training still. A secured safe is now provided to ensure the safe local storage of valuables held in safekeeping for service users (see standards 6 –10 for comments relating to service users’ finances). Egmont Road (31) DS0000046244.V249237.R01.S.doc Version 5.0 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 – 30. Service users may expect the home to be clean and a pleasant & comfortable environment to live in, though the special needs aspects of the very individual service users resident at the home sometimes require more timely attention to accommodation issues. EVIDENCE: There have been no significant changes to the premises since its registration in August 2003. The home is in keeping with the local community, the home being an innocuous semi-detached house in a long, tree-lined residential street in Sutton. The home is ‘suitable’ for its stated purpose - brightly lit, with spacious but domestic space, and decorated to a good - but now deteriorating - standard (clearly a victim of enthusiastic ‘wear and tear’). Furnishings and fittings are of a good and need-fully robust quality. All bedrooms are clearly above the minimum national standard set for care homes and are -where appropriate - suitably furnished and all suitable facilities provided. It is acknowledged that one service user has minimal furnishings in their room, due to behavioural problems of dismantling all and every item of furniture / equipment in the room. Access to the ensuite facility is also restricted due to the problems of this ‘dismantling’ habit. Egmont Road (31) DS0000046244.V249237.R01.S.doc Version 5.0 Page 21 The home provides an ensuite shower / toilet and basin for each service user in their room and there is a toilet additionally available on the upper floor within the bathroom and a separate toilet on the ground floor. The communal toilets are lockable, and the locks can be overridden by a device - but only in the case of risk-assessed need. The inspector discerned a number of aspects that were unsatisfactory at the home with regard to managing the challenging behaviour of the service users. For instance, trelliswork at the end of the patio should be installed to prevent items being thrown in the direction of (often disturbed) next-door neighbours. Within the house, it was clear that at times it would be very beneficial and a health and safety advantage to exclude service users from the kitchen, especially whilst meals were being prepared. The need to re-establish / break through the kitchen/dining wall - to reinstate a previous hatchway to the dining room - would be of benefit and allow the safer management of service users. One service user at the house has sufficiently challenging behaviour that they only have a bed within their room and an opaqued protected window - due to destructive episodes. There is a significant need for a substantial extractor fan to be installed for this service user, to refresh the air in their room and to remove unwanted / unpleasant odours. In regard to this service user, there is also a need to create adequate storage space within the home to enable their clothing and items to be stored appropriately and safely. The current use of the immersion tank / electrics cupboard is not acceptable. It was clear that the top floor bathroom requires a new toilet seat - and the cistern needs to be boxed in to protect it from service user’s over-attention. The conservatory and office urgently still require blinds to ensure the provision of confidentiality and privacy to these areas, and protection from the strong sunlight encountered. The installation of an air conditioning /heating unit –of a fixed and permanently wired variety is another issue brought forward from the last inspection visit. The premises were generally bright and clean – though the home would benefit from some redecoration – and a plan of such a decorating cycle should now be evolved. The home was clean and free from offensive odours at the time of the inspection. The laundry facilities are positioned away from any areas where food is stored, prepared or eaten. The home’s machine is capable of washing laundry at appropriate high temperatures (minimum of 65 oC). All maintenance and premises equipment servicing documentation was available for inspection at the time of the visit and checked off by the inspector. The only area of concern identified was the temperature outflows of hot water supplies; this is covered under Standard 42 in the final section of this report. Egmont Road (31) DS0000046244.V249237.R01.S.doc Version 5.0 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35. Service users can rely on the home providing adequate staff in sufficient numbers and duly competent and well-trained to provide a service that seeks to meet their identified needs. The home’s recruitment and staff support mechanisms are organised so as to ensure the safety, protection and wellbeing of service users. EVIDENCE: The relatives / friends questionnaire indicated that staffing was considered to be adequate at the home. The manager often is found ‘on shift’ supplementing the care staff input; this is essential for the level of intervention which is required in such a home with service users with unpredictable and challenging behaviours. Nine out of the fifteen current staff members are undertaking or have achieved NVQ Courses in care at Level 2 or above. It is therefore projected that the home should attain or exceed the required minimum level (50 ) by the end of 2005. Nine staff members also hold a current First Aid certificate. Other courses undertaken in the past year included: Health & Safety, Fire Safety, Food Hygiene, Dignified Management of Conflict, Staff Supervision, Keyworking, Managing a Team, Makaton, Counselling Skills, and The Protection of Vulnerable Adults. All staff have undertaken Fire Training, Future training Egmont Road (31) DS0000046244.V249237.R01.S.doc Version 5.0 Page 23 planned includes many of the above and also Health Action Planning, Autism, and Administering Rectal Diazepam. The manager has carried out an assessment for the entire staff team to identify staff training needs, and the deputy manager is now identified as ‘training champion’ to profile and develop training input to the home. There is just currently one support worker vacancy at the house – to replace a single worker who has left the home’s employ this year. The duty rota revealed that the core team of workers cover most available ‘extra’ hours that come free; thus ensuring a degree of continuity for the service users. The staff team is clearly focused on ensuring an excellent service to its service users. Agency cover has been provided to ensure that staffing levels are maintained – especially throughout the busy holiday period. As far as possible, these shifts have been covered by the same worker – to provide for consistency of approach and familiarity. Staff files hold letters from CMG’s Regional Director as proof that staff CRB checks have been carried out and are held at Head Office. More recently the inspector has verified the CRB records of all staff - at the CMG Head Office in Wimbledon. It is standard practice for CMG not to permit new members of staff to start work until two satisfactory references (one from their previous employer) and a Criminal Records Bureau check have all been obtained. Standard 36 was not inspected at this visit; at the previous inspection it was met – and indeed, it was exceeded and awarded a ‘4’ score - to reflect the excellence in providing support and supervision to staff on a one-to-one basis. Egmont Road (31) DS0000046244.V249237.R01.S.doc Version 5.0 Page 24 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40, 42 and 43. Service users and their relatives / friends can rely on the home being run well, and providing a professional service with the best interests of the service user being central to the care provision. The registered providers can be relied upon to take seriously issues raised for their attention – to the benefit and for the safety of those residing at the home. EVIDENCE: Lesley Somerville is the registered manager of the home. Mrs Somerville has been in operational day-to-day control of the home since it opened in August 2003, and has at least two year’s previous significant managerial experience working in another CMG home with service users with similar needs - backed up by another fourteen years of experience in care work. She is currently undertaking - and aims to have achieved - her NVQ at Level 4 in Management and Care (The Registered Manager Award) by the end of the year, to fully meet this standard. Egmont Road (31) DS0000046244.V249237.R01.S.doc Version 5.0 Page 25 The home will have a role to play within the CMG Quality audits each year and service user representatives and staff members are invited to attend a meeting where the quality of input at the homes is discussed. The registered provider also regularly interviews service users and their relatives on paper to elicit feedback about the quality of the service provision. It can also be confirmed by the inspector that reports compiled by the home’s Regional Operations Manager following monthly, unannounced visits to the home, are regularly being forwarded to the Commission, in accordance with Care Homes Regulation 26. CMG has a comprehensive set of policy and procedure manuals which cover the broad spectrum of needs identified under the headings of: Mission Statement / Staff Policies / Service Management / Service & Care Delivery / Health & Safety / Residents Welfare, and Emergency Procedures. The ‘missing’ policy document on ‘pressure areas’ has now been provided. Fire drills and fire alarm test records were examined and systematically kept, now evidencing which break glass / call point is tested. The following is a direct quote from the last inspection report: “The inspector raises under this standard [42] the extraordinary situation where, for three inspections running, the problems of high hot water outflows have been demonstrated and taken on board by the providing organisation but in the past never fully rectified. It is to be hoped that once and for all any risk of burns / scalds can be eliminated from the home through the careful and proper application of failsafe, tamperproof thermostatic mixer valves.” Extraordinarily, once again this situation has arisen – with shower outlets being identified running in excess of 50 degrees centigrade again. An immediate requirement notice was served on the home at the time of the visit requiring this problem to be immediately rectified. Since this requirement being served, the home has confirmed to the Commission that steps have been taken to, once and for all, resolve the problem - at source - at the home. The overall CMG management of the service clearly ensures the effective management, the financial viability and accountability of the home. The company has a business and financial plan and the company employs staff in human resources and staff training focuses, to enable the effective running and staffing of the establishment and enabling the effective running of this specialist group of homes. Insurance certificates for Employer’s Liability, and also for the motor vehicle kept at the house, was seen and in date - with adequate limits in place. Egmont Road (31) DS0000046244.V249237.R01.S.doc Version 5.0 Page 26 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 3 3 x Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 x 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 2 2 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 x 14 x 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score x 3 3 3 3 x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Egmont Road (31) Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 x 3 3 x 1 3 DS0000046244.V249237.R01.S.doc Version 5.0 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA24 Regulation 23(1) (2) Requirement Trellis work must be provided at the closed end of the patio to prevent the throwing of items into the neighbour’s garden. The sealed-up kitchen hatch to dining room must be reopened to allow safer management of service users and protection form danger. Timescale for action 15/11/05 2 YA24 13 (4) & 16(2)(h) 15/11/05 3 YA24 16(2)(c) & Vertical blinds must be provided 23(2)(i) to ensure that the office and conservatory are both protected from the excessive summer heat and to provide confidentiality and privacy to the home from neighbour’s intrusion (24). (Timescale of 15.09.04 not met – apparently the blinds were ready for installation, but pending funding.) 13(4) & 23(2)(p) 15/11/05 4 YA24 Freestanding electric heaters 15/11/05 must not be used within the home - due to the dangers of tripping over cables, and the lack of protection afforded to such heaters. Additional heating / air conditioning must be provided in DS0000046244.V249237.R01.S.doc Version 5.0 Page 28 Egmont Road (31) the conservatory from a hardwired, fixed and protected source. (Timescale of 30.07.04 not met.) 5 YA26 23(2)(p) An extractor fan must be installed in the service user’s bedroom where there are protected / ‘sealed’ windows due to unpredictable challenging behaviour. The provider must create an adequate space within the home to enable clothing and items of the above (5) service user to be stored appropriately and safely. The top floor bathroom requires a new toilet seat and the cistern must be properly boxed in. An immediate requirement notice served concerning the following: Hot water outflows in all bathrooms and showers must be fixed to a maximum level of 43 degrees. (Timescale of 07.08.04 and subsequently of 07.03.05 not met). 15/11/05 6 YA26 23(2)(e) 15/11/05 7 YA27 23(2)(j) 15/11/05 8 YA42 13(4) & 23(2)(n) 16/09/05 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 Refer to Standard YA23 Good Practice Recommendations It is strongly recommended that the provider’s policy with regard to adult abuse be amended to accurately tie in the approach required locally under the jointly agreed (and now newly-revised 2005) London Borough of Sutton Vulnerable Adults Procedure Guidelines. DS0000046244.V249237.R01.S.doc Version 5.0 Page 29 Egmont Road (31) 2 3 4 5 YA23 YA24 YA31 YA37 It is suggested that the remaining Vulnerable Adult Protection training be undertaken in a ‘block’ at the home. A plan of a house decorating cycle should now be evolved. A minimum of 50 of the care staff team must be qualified - nominally to NVQ Level 2 in Care - by 2005. The home’s manager must be qualified to NVQ Level 4 in Management and Care - by 2005. Egmont Road (31) DS0000046244.V249237.R01.S.doc Version 5.0 Page 30 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 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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