Inspection on 15/05/08 for Eleni House

This inspection was carried out on 15th May 2008.

CSCI found this care home to be providing an Good 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

Eleni House 05/06/07

Eleni House 04/12/06

Eleni House 08/12/05

Eleni House 30/11/04

Eleni House 13/05/04

Eleni House 13/05/04

Similar services:

Claremont House

Coopers Mill Ltd

Sun Court Nursing Home

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Paradise Lodge

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Upaya Ananda

15 Bramble Close

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 Eleni House Boxted Road Colchester Essex CO4 5HF Lead Inspector Deborah Kerr Unannounced Inspection 15th May 2008 09:15 Eleni House DS0000017810.V365269.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Eleni House DS0000017810.V365269.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Eleni House DS0000017810.V365269.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Eleni House Address Boxted Road Colchester Essex CO4 5HF 01206 842457 01206 842457 manager_eleni@careaspirations.com 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 Aspirations Limited Mr Joseph Francis Walker Care Home 8 Category(ies) of Learning disability (8), Physical disability (8) registration, with number of places Eleni House DS0000017810.V365269.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may accommodate 8 people under the age of 65 years with a learning disability who may also have a physical disability 5th June 2007 Date of last inspection Brief Description of the Service: Eleni House provides care for eight adults with a learning disability who have a range of complex needs, such as epilepsy and self-injurious behaviour. Eleni House is a purpose-built bungalow, built in 1997. It is one of several units grouped together on the outskirts of Colchester. It has eight single bedrooms, four of which provide en-suite facilities. The accommodation is spacious, with good access for wheelchair users and includes a lounge, separate dining room, sensory room and recently added spa pool. Attached to the unit is a sensory garden. The home has a mini bus and a pool car for service users. The weekly charge for a room at Eleni House is between £879.81 and £1435.32. This was the information provided at the time of key inspection, people considering moving to this home may wish to obtain more up to date information from the care home. An extra charge is made for hairdressing, toiletries and chiropody. Eleni House DS0000017810.V365269.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was a key inspection, which focused on the core standards relating to adults, aged 18-65. The inspection was unannounced on a weekday, which lasted eight and a quarter hours. This report has been written using accumulated evidence gathered prior to and during the inspection, including information obtained from 1 relative and 1 staff ‘Have Your Say’ surveys and the Annual Quality Assurance Assessment (AQAA), issued by the Commission for Social Care Inspection (CSCI). This document gives providers the opportunity to inform the CSCI about their service and how well they are performing. We (CSCI) also assessed the outcomes for the people living at the home against the Key Lines of Regulatory Assessment (KLORA). We (CSCI) also carried out a safeguarding thematic probe. This is how we gather additional information on a particular theme from a key inspection. This thematic inspection focused on issues surrounding ‘safeguarding’. We looked at the National Minimum Standards (NMS) for protection to assess whether people who use services are protected from abuse, and recruitment to assess whether people who use the service are supported and protected by the recruitment policy and practice. A tour of the premises was made and a number of records were inspected, relating to people using the service, staff, training, the duty roster, medication and health and safety. Time was spent talking with people who live in the home and three members of staff. The manager of the home was available during this inspection and fully contributed to the inspection process. What the service does well: Eleni House offers individuals with complex needs, involving some extreme challenging behaviours, the opportunity to take part in society and to participate in activities that fulfil their needs. The home provides facilities, with good sized rooms, which are personalised, pleasantly decorated and well maintained. When entering the home there is a friendly, happy and relaxed atmosphere. During the inspection the manager and staff demonstrated an excellent knowledge of the needs of each person living in the home. Feedback about the service, provided in a relatives and staff survey and through conversations with people living at the home was positive. Comments included “staff work well together to meet the needs of the people living in the Eleni House DS0000017810.V365269.R01.S.doc Version 5.2 Page 6 home” and “people are treated as individuals” and “the home actually help and support people feel independent, in terms of living their life and by helping them improve their personal skills”. They also commented that the home respond properly to any issues raised about people in their care. An area the home manages well is to support individuals to manage their own health and well being. An individual has had input from the continence adviser to work out a plan to support them to manage their own continence. Additionally, an individual diagnosed as requiring a Percutaneous Endoscopic Gastrostomy (PEG) to be fitted if they continued to loose weight, has been supported through encouragement, determination and support form staff to maintain a steady weight, therefore resisting the insertion of the PEG. What has improved since the last inspection? What they could do better: Where people living in the home have been provided with a copy of terms and conditions of residence (contract) these need to be explained to the individual, signed and dated. Where the person is unable to sign, a relative, guardian or advocate should be involved in the process and sign on their behalf. Eleni House DS0000017810.V365269.R01.S.doc Version 5.2 Page 7 Care plans would be more meaningful and interesting to the people who use the service, if they were produced in a person centred way and in a format the individual can understand. Peoples activity plans needed to be revised to accurately show their chosen leisure and social activities, which reflect their hobbies and interests. It is recommended that the kitchen facilities are updated ensuring that all surfaces are ‘wipe clean’. The complaints and safeguarding policies and procedures need to be amended to reflect the change in the contact details of the Commission for Social Care Inspection (CSCI). Additionally, staff need to be informed of which organisations, including Social Services and CSCI, they should report allegations of abuse to outside of the line management structure within the home and Care Aspirations organisation. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Eleni House DS0000017810.V365269.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Eleni House DS0000017810.V365269.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,5, People who use the service experience good quality outcomes in this area. People considering moving into the home and their representatives will be provided with information, which clearly tells them about the service, so that they have the information they need to choose if the home will meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care Aspirations have developed a comprehensive statement of purpose and Service Users Guide, which are specific to the people who use this service. People considering moving to Eleni House are issued with a welcome pack, containing their own Service User Guide, and ‘How to Complain’ procedure and their terms and conditions (contract) of occupancy. The information is provided in an easy read format with appropriate language and pictures. The contracts stated where the person was unable to sign, a relative, guardian or advocate should sign on their behalf. However neither contact had been signed and dated to agree to the content and terms and conditions of living in the home. There has been a stable and compatible group of people living at the home for the last six years, therefore it was not possible to fully assess the admissions process. However, discussion with the manager and information provided in the AQAA confirmed no person is admitted to the home without having a full assessment of their needs and wishes undertaken. Eleni House DS0000017810.V365269.R01.S.doc Version 5.2 Page 10 The manager and company director of Care Aspirations will make an initial assessment to ascertain the individuals needs. All involved in placement are required to visit Eleni House, and if possible the prospective person is encouraged to participate in a short stay, to establish that the service can meet their individual needs and their compatibility with the other people living there. Eleni House DS0000017810.V365269.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9, People who use the service experience good quality outcomes in this area. People using this service know they will have their needs and personal goals reflected in their individual plans and will be supported to take risks as part of an independent lifestyle. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans are well organised, covering all aspects of the individuals health, personal and social care needs. Each person has a detailed pen picture providing a good account of their past, health, personality and behaviours. The plans contain good information of the actions staff need to take to support individuals, however more could be done to ensure the plan is written with the individual in a person centred way and written in a format they can understand. Care plans contained a ‘Pathway’ assessment completed by the individual’s key worker and Care Aspirations psychologist. These provide a profile of the individual’s personal and social skills, strengths, weaknesses and differing areas of dependency. These are used to help set objectives to support the individual to develop their skills and consider their future aspirations. Eleni House DS0000017810.V365269.R01.S.doc Version 5.2 Page 12 The preferred method of communication of people using the service is clearly recorded in their care plan, only one person living in the home is able to communicate verbally. Staff are aware of the communication needs of each person and were seen communicating with them, using signs and symbols, such as Makaton. Staff have received training around the risk assessment process. This was reflected in the risk assessments seen, which have a ‘can do’ approach, addressing safety issues, whilst aiming for positive outcomes for the people using the service. The assessments reflect where people are provided with opportunities to make choices and are supported to do what they want to do, allowing them to be as independent as they can be. Where a risk has been identified a corresponding support plan has been developed to provide strategies to manage the risk. A previous recommendation was made for a system of cross-referencing to link the risk assessment with the support plan. A title index has been developed linking the two, for staff to follow. Plans include supporting people whose behaviours can be challenging to others or them selves as a result of self-neglect or self-injury. The support plans identify triggers, which may lead to agitation, distress and reflects that staff need to be aware that behaviour can also be an indicator that the individual is unwell or in pain. Staff spoken with have a good understanding of what restraint is, and described using breakaway and deflection techniques when managing behaviours where people are likely to be aggressive or cause themselves harm. A behavioural management plan developed in conjunction with the psychologist, with clear boundaries, which works on a reward system is working well for one individual. If, they have three consecutive days of positive behaviour they are able to choose how and where they spend the fourth day. Their chart reflected the occasions of problematic behaviour has decreased. The individual was aware of and able to discuss their plan and described the benefits to them, including a recent trip to Walton on the train for fish and chips. The complex needs of people using the service make the process of offering choices difficult, however this is achieved through staff’s knowledge of the individual’s likes and dislikes and involves trial and error. Care plans contained good information about each person’s likes, dislikes, needs and wants. Discussion with staff and observation throughout the inspection confirmed they have a good understanding of the particular needs of each of the people living in the home. Additionally, people living in the home have access to an advocacy service, who visits on a monthly basis to hold surgeries and facilitate residents meetings. A schedule of dates was seen, accompanied by a brochure produced by the advocacy service providing information about them in an easy read format. Eleni House DS0000017810.V365269.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17, People who use the service experience good quality outcomes in this area. People who live in the home are supported to take part in educational, social and recreational activities, which are age appropriate and which meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA and verified at the inspection confirmed that each person living in the home has a weekly programme of activities within their care plan. These have been tailored to the individual and reflect how they spend their time, however other than information seen about trips out in the daily evaluation sheets, there is no record to confirm that these activities take place. The information recorded about activities in the daily evaluation sheets did not match the planned activities in the care plans of the two people being tracked as part of the inspection process. One plan identified that the individual attended Bounceability (trampolining) and Aqua Springs each week, however discussion with the manager confirmed Eleni House DS0000017810.V365269.R01.S.doc Version 5.2 Page 14 this was not happening due to the individuals behaviour, which made it inappropriate for them to use public facilities. In addition to individual activity plans there is a weekly schedule on display, which reflect the regular activities for all people living in the home, these include access to adult education classes, food shopping, day centre, trampolining, snoozelen, gateway club and visits to Aqua Springs. The daily evaluation sheets and observation during the day confirmed that people are supported to go out and take part in activities of interest to them. These included trips to the seaside, Country Park, garden centres, rides out in the minibus, pubs and cafes and walks to local shops. People were seen coming and going during the inspection, returning from food shopping, out for a walk and two people attended an external day centre in the afternoon. The home employs a high ratio of staff to service users, which enables them to support and encourage people to access activities on a one to one basis within the home and the wider community. College participation has enabled one individual to make new friends outside of the service. Additionally, the ability to provide two staff to accompany one individual with extreme challenging behaviours has enabled them to participate in external activities, where previously this was not thought possible. An example provided is where the individual is supported twice a week to go to MacDonald’s for breakfast. The home has it’s own sensory facility on site, which is always accessible to people to use when they want to. They also have a Hydrotherapy pool, however this is currently out of action due to the need for repairs. Annual holidays are arranged and costed as part of the individual’s fee. Photographs on the walls confirmed people have enjoyed caravan holidays and visits to Centre Parks. The kitchen is of a good size and accessible to all people living in the home. A previous recommendation was made for refurbishment of the kitchen to replace cupboard fronts and wipe clean surfaces, which are showing signs of wear and tear. Discussion with the registered manager confirmed that this issue is raised at regular health and safety meetings and that they are waiting for agreement to refurbish the kitchen. Menus spanning a four-week rota were displayed on the wall in the kitchen. The manager produced photographs of different foods and dishes, which they are in the process of developing to help people with limited communication to make choices about what they want to eat. Staff on duty undertake shopping and meal preparation. They are aware of the dietary needs of people, including where individuals had been prescribed special diets by the speech and language therapist. Nutrition records confirmed meals are varied and list where people have extra snacks and drinks throughout day. The lunchtime meal was observed. Food in Eleni House DS0000017810.V365269.R01.S.doc Version 5.2 Page 15 the home is of a good quality, mostly home cooked and well presented. The mealtime was a relaxed and social occasion. Where individuals required encouragement or assistance to eat their meal, this was done sensitively and respectful of individual’s dignity. Eleni House DS0000017810.V365269.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, People who use the service experience good quality outcomes in this area. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA and verified at the inspection confirmed that people living in the home are supported to have access to health care services within the home and in the local community. Were required, additional advice and support has been sought from specialists, such as the speech and language therapist and neurologist. Additionally, Care Aspirations employ their own psychologist who has undertaken assessments, which identify individual’s specific health and behavioural needs. Care plans contained individual health action plans, supported by risk assessments. These contained clear information of individuals’ health needs and how these were to be met. Observation and discussion with staff confirmed that they are fully aware of the individual needs of people using the service and were able to provide a verbal account of each person’s health and well being. Eleni House DS0000017810.V365269.R01.S.doc Version 5.2 Page 17 Where possible, people who use the service are supported and helped to be independent and take responsibility for their own personal care needs. This was demonstrated during the inspection. A continence adviser visited to work out a plan to support an individual to manage their own continence. It was evident from discussion and records that the home is proactive in obtaining appropriate medical attention for individuals with health issues. An individual with eating problems had been assessed by the speech and language therapist. The individual has been diagnosed with dysphasia and are at risk of choking. A Gastroscopy examination and a multi disciplinary meeting held with all people involved in the individual’s care, identified that a Percutaneous Endoscopic Gastrostomy (PEG) would need to be fitted if the individual continued to lose weight. This would ensure they received a balanced liquid diet directly into the stomach via a tube. This is an area the staff have managed well, through encouraging and supporting the individual to eat their meals and using a thickening agent in their drinks, the individual is maintaining a steady weight, therefore resisting the insertion of the PEG. This was evidenced through nutritional screening and monitoring records. Records showed that individuals diagnosed with epilepsy have regular checks by neurologist to monitor seizures and assess where medication changes may be required. Staff were observed assisting people to their bedrooms or bathrooms to support them with their personal care, in privacy. Information provided in the AQAA and verified through discussion with staff confirmed they are aware of the need to treat people with respect and dignity when delivering personal care. Respecting privacy and dignity is discussed as part of staff supervision, with quarterly objectives set relating to their key client’s health care. These issues are also covered as part of the initial induction training. Additionally, where possible, the manager takes in to account the ratio of male and female staff to ensure gender appropriate care is provided. The home has an efficient and comprehensive medication policy and procedures in place for ordering, storing, and administering medicines. The practice of administering medication is generally safe and well managed. Medication Administration Records (MAR) were inspected and were found to be completed correctly, with no gaps. Individual photographs were attached to the records to avoid mistakes with the person’s identity. Staff had made good use of the reverse of MAR to reflect when PRN (as required) medication had been given, the reason why and the amount. Medication is locked in a storage cupboard within a locked room to which only seniors hold the key. Senior staff at the end of each shift conduct an audit check of PRN medications, during handover. A check of two peoples Lorazepam, PRN medication was found to be accurate. Eleni House DS0000017810.V365269.R01.S.doc Version 5.2 Page 18 No person living in the home is currently prescribed controlled drugs. Should controlled drugs be prescribed for one or more persons it is a legal requirement that the home has a separate metal cupboard of specified gauge with a double locking mechanism, which is fixed to a solid wall, with either rawl or rag bolts. Where an individual has made a request to stop taking some of their medication. They are being supported through the use of an Independent Mental Capacity Advocate (IMCA) and GP to determine their capacity to make an informed decision about the consequences for not taking their medication. Eleni House DS0000017810.V365269.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23, People who use the service experience good quality outcomes in this area. People using this service are supported to raise concerns and have access to a robust and effective complaints procedure. On going staff training and safeguarding procedures in place, protect people living at the home from abuse and protect their rights. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA and verified at the inspection confirmed that the home has a clear and effective complaints procedure and an appropriate adult safeguarding policy in place, which includes clear guidance of the procedures staff must take to report allegations of abuse. These will need to be amended to reflect the change in the contact details of the Commission for Social Care Inspection (CSCI). The complaints, comments and suggestions procedure describes the stages of making an informal and formal complaint. The service user guide includes an easy read and pictorial format of ‘How to complain’. The complaints, comments and suggestions log identified that neither the Commission (CSCI) or the home have received a complaint since the previous inspection. As part of this inspection we undertook a thematic probe, which focused on issues surrounding ‘safeguarding’. We looked at the National Minimum Standards (NMS) for protection to assess whether people who use services are protected from abuse, and recruitment to assess whether people who use the service are supported and protected by the service’s recruitment policy and practice. Our findings were that the manager has a good understanding of safeguarding and the procedures to follow if there is a suspicion or evidence that abuse or Eleni House DS0000017810.V365269.R01.S.doc Version 5.2 Page 20 neglect of any person living in the home has occurred. There knowledge comes from training, the organisation policies and procedures and experience of a previous safeguarding referral. The manager was also clear about the importance of using advocacy to support people who use the service to know and understand their rights. They explained they have recently supported an individual to access an Independent Mental Capacity Advocates (IMCA) to establish their capacity about making choices about medication. The manager and staff spoken with confirmed training in the Protection Of Vulnerable Adults (POVA) is regularly arranged and that it is an integral part of the induction process. Additionally, safeguarding and reporting of complaints is an ongoing item on the agenda for discussion at staff meetings and during supervision. Care Aspirations have purchased a training pack, which includes 18 modules, covering all aspects of working with people with learning difficulties. These include an introduction to mental health, challenging behaviour, psychiatric disorders and mental health problems. This training will ensure that staff have the knowledge, skills and understanding to deal with physical and verbal aggression to ensure the safety of people using their services. Staff spoken with were clear about their duty of care and what they would do if they had concerns about the welfare of a person living in the home, however they were not clear about who they should report allegations of abuse to outside of the line management structure within the home and Care Aspirations organisation. The service has robust recruitment procedures are in place. Staff files seen confirmed that all newly employed staff are subject to Criminal Records Bureau (CRB) and Protection Of Vulnerable Adults (POVA) check. Eleni House DS0000017810.V365269.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28, 29, 30, People who use the service experience good quality outcomes in this area. The physical design and layout of the home provides the people who live there with a safe, well-maintained and comfortable environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA and verified at the inspection confirmed that Eleni House provides a homely atmosphere within safe, comfortable and warm accommodation, which is well maintained to a good standard. Communal rooms are spacious and well furnished with modern equipment and domestic style furniture, carpets and curtains. The premises are bright, cheerful, airy and free from any unpleasant odours. The physical environment is appropriate for the needs and requirements of the people living there, with wheelchair access throughout. There is a selection of communal areas, consisting of a kitchen, lounge and a sensory room. All areas of the home, including bathrooms and toilets have appropriate aids and equipment to encourage maximum independence and comfort and which promote the safety of the people who live there. Eleni House DS0000017810.V365269.R01.S.doc Version 5.2 Page 22 A previous recommendation was made for the kitchen units, which are ‘tired’ with damage to ‘wipe clean’ surfaces to be replaced. This has not yet happened however the manager confirmed this issue is discussed at health and safety meetings and is part of the ongoing plan of maintenance. All communal areas and people’s personal rooms have been redecorated. There are further plans to purchase new furniture for the lounge and dining room and install more sensory equipment. The manager and staff have made considerable effort to ensure bedrooms are suitable for the needs of their occupants, with appropriate furniture and fittings. Where individuals have previously not wanted to sleep in a bed, with proper bedding, they have been encouraged to do so by introducing a mattress on the floor. The individuals have now accepted slightly raised beds off of the floor, and duvets and pillows. Additionally, where an individual has a history of self-injurious behaviour, to prevent them hitting their head against the wall, these have been covered with soft padded material, which blend in with the colour scheme. Rooms have appropriate lighting, safe radiators, individual bedding and colour schemes. Four rooms have en suite facilities. Risk assessments have been completed for the use of bed rails, where individuals have been identified at risk of injury through falling out of bed. Personal effects reflect people’s hobbies and interests. Some of the bedrooms open out onto a patio area, which have a range of tables and chairs for people to use and eat their meals outside in good weather. All plants in the garden are edible to ensure the safety of people, when using the garden. Random testing of water temperatures reflected that the water supply is within the recommended 43 degrees centigrade, which minimises the risk of people living in the home scolding themselves when washing their hands, taking a bath or shower. The laundry facilities seen were clean and tidy with appropriate equipment to launder clothing and bedding, including a commercial washing machine with a sluice programme for dealing with soiled linen. Appropriate hand-washing facilities of liquid soap and towels are situated in all en suite and bathroom facilities where staff may be required to provide assistance with personal care. Eleni House DS0000017810.V365269.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36, People who use the service experience good quality outcomes in this area. Staff in the home are trained, skilled and in appropriate numbers to support the people who live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Examination of the duty rota and ‘daily duty record’ confirmed that the normal staffing ratio is a senior and six carers between the hours of 7:45am to 9:15pm each day, supported by a housekeeper between the hours of 8:30am to 8:15pm. However the rota reflects numbers are flexible to meet the needs of the people living in the home. Three waking night staff cover the hours between 8:45pm to 8:15am. Staff spoken with confirmed there is a high ratio of staff to service users. Staff said they enjoy working at the home, people are friendly and there is a good atmosphere. Eleni House provides placements for student nurses. The day of the inspection was the last working day of a student nurse who described working at the home as an enjoyable and valuable experience. They were impressed about how well people living in the home were looked after, offered choice and treated as individuals. They described the support they had received from both staff and the manager during their placement as excellent. Eleni House DS0000017810.V365269.R01.S.doc Version 5.2 Page 24 The AQAA identified that full staff checks are carried out prior to appointment to safeguard the people living in the home. A previous requirement was made for evidence to be made available to show that checks are carried out on all new staff before they start work. Staff files examined identified that all the relevant documents and recruitment checks, required by regulations, to determine the fitness of the worker had been obtained prior to commencing employment. Information obtained in AQAA, ‘Have Your Say’ surveys and discussion confirmed that staff felt they had been recruited fairly and that they receive good training and support to ensure they have the skills and knowledge to do their jobs and to meet the different needs of the people living in the home. Each member of staff has an individual development plan, which reflects training completed and planned. This is discussed as part of the supervision process and outlines staff’s roles and responsibilities and identifies new training needs. Most recent training has included person centred planning, advocacy, food hygiene, risk assessment and risk management, fire safety, moving and handling and safeguarding adults. Further training is planned to cover all aspects of working with people with learning disabilities. Night staff and senior staff responsible for administering medication have received training to use the Monitored Dosage System (MDS) and about drugs and common side effects. The AQAA reflects an area, which the home wishes to improve, is to provide medication training to all care staff. Care Aspirations have introduced their own induction training programme, which meets the requirements of the Skills for Care Induction Standards. Informaton in staff files confirmed that new employees had completed the induction training. Completed workbooks had been signed off by the manager confirming that they were satisfied that the staffs understanding of work they had completed, and that it was of an accpetable level. Staff confirmed their induction was good and that they were mentored, working in pairs for first six months. Information provided in the AQAA and verified at the inspection confirmed that Care Aspirations provide staff with the opportunity for completing a National Vocational Qualification (NVQ). The home employs a total of twenty-eight staff, eight have completed NVQ Level 2 or above, with ten staff currently working towards completion. These figures reflect that when staff have completed their award, the service will have reached the National Minimum Standard (NMS) target of 50 of care staff to hold a recognised qualification. Records indicated that regular supervision takes place, this was confirmed in conversation with staff. Documentation reflects that sessions include discussion of general work objectives, performance and development and identify training needs. Additionally staff felt the manager was very supportive and was always available, if issues or problems arise. Eleni House DS0000017810.V365269.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41, 42, People who use the service experience good quality outcomes in this area. The management of the home is based on openness and respect and monitored and improved through an effective quality assurance system. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA and verified at the inspection confirmed that the registered manager has the required qualifications and experience and is competent to run the home. The manager completed the AQAA when we asked for it, which provides clear and relevant information. The AQAA lets us know about changes they have made to the service and the areas, which need to be improved and clearly shows how they are going to do this. The manager leads and supports a strong staff team who have been recruited and trained to a good standard. Staff confirmed they have regular supervsion and meetings. Eleni House DS0000017810.V365269.R01.S.doc Version 5.2 Page 26 The minutes of the most recent staff meeting were seen on display on the notice board in the corridor, covering a range of issues and reflected where staff have the opportunity to share in the way the service delivery is planned and actioned. The manager communicates a clear sense of direction and provides a role model for staff. During the inspection they demonstrated an excellent knowledge of the needs of each person living and working in the home. Care Aspirations continued to have suitable processes in place for monitoring the quality of care at the home, including a monthly audit of the service, undertaken by another manager within the organisation and a separate monthly monitoring visit from the Responsible Individual. Care Aspirations operate an external quality assurance system ‘BenchmarQ’. This system incorporates surveys from family members and other representatives of the people that live at Eleni House, however, the manager was not aware if the survey has been conducted yet, for this year. Care Aspirations are currently working towards obtaining the Health Quality Service Accreditation programme, which measures stringent standards, of how the they operate as an organisation. Records examined and information provided in the AQAA confirmed the home takes steps to safeguard the health, safety and welfare of people living and working in the home. The most recent Gas and Electrical Safety Certificates, including Portable Appliances Testing (PAT) were seen and records showed that all equipment including electrical maintenance of all air extraction fans, fire alarm system, emergency lighting, assisted baths and hoists are regularly checked and serviced. The fire logbook showed that the fire alarm is tested weekly using different zones and regular fire training and drills take place, with a record of the staff in attendance and outcomes of the drill are recorded. The home’s maintenance folder contained appropriate procedures and provided evidence of routine, internal monitoring of systems to ensure compliance with health and safety requirements. This includes checking the temperature of hot water and Legionalla checks. Fridge temperatures are being recorded and the temperature at which food is served, in line with food safety standards. Care plans contained detailed incident and accident report forms, the recording on the forms is good with detailed information about the incident. These are reviewed by the manager to assess how further incidents can be avoided. People who use the service are supported to obtain, secure and spend their personal money. One individual is able to manage their own bank account, another individual has their finances managed through an independent advocacy service. Where people are not able to manage their own financial arrangements the manager oversees their building society accounts. Records of two people being tracked as part of the inspection showed a clear audit trail of all financial transactions. Monies held for each person were checked against the balance sheets and were found to be accurate. Eleni House DS0000017810.V365269.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 X 3 3 X Eleni House DS0000017810.V365269.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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 YA5 Good Practice Recommendations Where people living in the home have been provided with a copy of terms and conditions of residence (contract) these need to be explained to the individual signed and dated. Where the person is unable to sign, a relative, guardian or advocate should be involved in the process and sign on their behalf. Care plans should be written with the individual, in a person centred way and in a format the individual can understand. Peoples activity plans needed to be revised to accurately show their chosen leisure and social activities, which reflect their hobbies and interests. It is recommended that the kitchen facilities are updated ensuring that all surfaces are ‘wipe clean’. 2. YA6 3. YA14 4. YA17 Eleni House DS0000017810.V365269.R01.S.doc Version 5.2 Page 29 5. YA23 Staff need to be informed of which organisations, including Social Services and CSCI, they should report allegations of abuse to outside of the line management structure within the home and Care Aspirations organisation. Eleni House DS0000017810.V365269.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Eleni House DS0000017810.V365269.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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