Inspection on 30/04/07 for Elora House

This inspection was carried out on 30th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Elora House 29/04/08

Elora House 07/11/05

Elora House 15/08/05

Elora House 31/03/05

Elora House 08/07/04

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 Elora House 48 Netherfield Gardens Barking Essex IG11 9TL Lead Inspector Julie Legg Key Unannounced Inspection 30th April- 10th May 2007 03:00 Elora House DS0000027887.V339775.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 Elora House DS0000027887.V339775.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. Elora House DS0000027887.V339775.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elora House Address 48 Netherfield Gardens Barking Essex IG11 9TL 0208 591 2260 0208 591 2260 elora@tiscali.co.uk 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) Mr Dia Tilakasiri Mr Dia Tilakasiri Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Elora House DS0000027887.V339775.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th November 2005 Brief Description of the Service: Elora House is a private owned care home, which is registered for three adults with a learning disability. The home is situated in a residential area of Barking and is undistinguishable from other houses in the road. On the ground floor of the home there is one bedroom, an open plan kitchen, dining/lounge and a small conservatory where smoking is allowed. Upstairs there are another two bedrooms, a combined bathroom and toilet and a staff office/sleep-in room. The home is well situated for all local amenities, including shops, library and leisure centre. It is also close to Barking railway station and the bus terminus. The home is run as a family type home, which aims to promote independence and choice and to assist them with developing daily living skills. One of the service users attends specialist day services and another is in part time employment and the third chooses their own daytime activities. The Statement of Purpose is available to all residents and relatives. All of the service users have been given a Service User Guide. The fees for the home are £704-725 a week, this does not include hairdressing, toiletries, and private chiropody or holiday spending money. This information was given by Dia Tilakasiri (the registered proprietor and manager) on 30th April 2007. Elora House DS0000027887.V339775.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place over two days. The registered manager was not available on the first day and therefore a return visit was undertaken by the inspector to access staff files. Discussion took place with the registered manager and care staff. Care staff were asked about the care that service users receive and were also observed carrying out their duties. The inspector spoke to all the service users who were asked to give their views on the service and their experience of living in the home. Relatives were also contacted and asked for their opinion of the service. A tour of the premises was undertaken and all of the rooms were clean and free from any offensive odours. Service users’ files were case tracked; including care plans and risk assessments, together with the examination of other staff and home records. These included medication records, staff rotas, menus, accident/incident records and staff recruitment procedures and staff files. The inspector also contacted one of the funding authorities, however no response was received. The inspector had a discussion with the people who live at the home and the manager about how they wished to be referred to in the report. They expressed a wish to be referred to as service user. This is reflected accordingly throughout the report. The inspector would like to thank the service users, manager and staff for their input during this inspection. What the service does well: What has improved since the last inspection? Since the last inspection one of the bedrooms has been redecorated and new carpet fitted. One of the service users is now attending a club, one afternoon a week. Elora House DS0000027887.V339775.R01.S.doc Version 5.2 Page 6 There was one Requirement from the previous inspection; that opened food was not appropriately labelled, this has now been rectified. All opened foods had labels, which stated the date when the food was opened and when it needed to be used by. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Elora House DS0000027887.V339775.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elora House DS0000027887.V339775.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,2 and 3 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Prospective service users and their relatives have the information they need to be able to make an informed choice about moving into the home. The assessment of needs and other information received from health and social care professionals means that staff have detailed information to enable them to determine whether or not they can meet the needs of prospective service users. Prospective service users know that the home can meet their needs. EVIDENCE: The Statement of Purpose and the Service User Guide are both available to prospective service users, which enables them to know what the home is like and what services they can offer. The current service users have been living at the home for some considerable time; the most recent service user moved into the home in 2004. It would be the procedure of the home to ensure that any new service users are Elora House DS0000027887.V339775.R01.S.doc Version 5.2 Page 9 appropriately assessed prior to admission. The funding authority and health professionals would provide assessments as well as the home carrying out their own assessment. Further information will also be gathered from the prospective service user and their families if appropriate. The admission process would be designed around the needs of the prospective service user. The prospective service user may make several visits to the home and possibly an overnight stay to ensure that they like the home and to meet the other service users. This transition period would also allow staff to get to know the prospective service user and to know whether they can meet the their needs. One service user told the inspector “I visited the home before I moved in and met everyone”. Elora House DS0000027887.V339775.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6,7,8 and 9 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Not all of the care plans and risk assessments have been regularly reviewed and updated. Daily records need to be more informative on the welfare of the service users. This could have an impact on service users’ needs not being appropriately met and that service users and others could be at risk. The registered person should consult with the service users on all aspects of the home. This will ensure that the home is being run in their best interests. EVIDENCE: The inspector examined each service user’s file, which contained a care plan and risk assessments, Staff were observed interacting with service users and some elements of the care plans were discussed with the manager. The care plans identify personal care, social care, religious and health care needs of each individual service user and how these needs are to be met. The Elora House DS0000027887.V339775.R01.S.doc Version 5.2 Page 11 care plans could be more person centred, which would identify more person centred activities and perhaps employment opportunities. There was evidence that care plans are being evaluated, reviewed and updated, however two service users’ care plans have not been reviewed in the past six months; therefore they may not be reflecting the service users’ current needs. There was evidence that one of the service users had an annual review in February 2007, which was carried out by the funding authority, there was evidence that the care plan had been updated following the review. A relative confirmed that she had attended the review and that there had been no major issues. The manager must ensure that all service users’ care plans are regularly reviewed, at least every six months and updated to identify and reflect the service users’ changing needs. This is Requirement 1. Care plans were examined alongside the daily records and compared with the support being given. The care staff know the service users very well and give a detailed verbal handover, however the daily records are too brief and only state what activity the service user is attending that day. These records need to reflect the well being of the service users and how residents are involved in the life of the home and demonstrate how daily records evidence care plan goals. This is Requirement 2. All of the service users are able to participate in activities within the home, assisting with tasks such as setting and clearing the table, washing up, making a cup of tea and their own breakfast, preparing the vegetables, putting the washing in the washing machine and gardening. One of the service users attends a horticultural course at the local college and another works one day a week at a local barber’s shop. None of the service users choose to attend a place of worship. All of the service users are able to handle small amounts of money and are encouraged to pay for their own personal items when visiting the shops and car boot sales. One of the service users told the inspector, “I enjoy cutting the grass and looking after the flowers”, another service user said, “I do my own breakfast every morning”. Staff were observed interacting with the service users, their relationship was easy going and friendly but in a professional manner. Some aspects of the service users’ care were discussed with the manager, particularly in relation to their personal care, dietary and social care needs. All of the service users were at home during the inspection and gave their views. Comments from the service users were “I’m happy here”, “the staff are ok” and “M takes me shopping and to the café”. There is a small stable care staff team, who know the service users and their needs very well but this should not stop the manager and the staff engaging with the service users, to look at their aspirations for their future. Risk assessments that were examined showed areas identified such as, tasks and activities within the home, in the community and health risks. They evidenced that service users are being supported to experience ordinary living Elora House DS0000027887.V339775.R01.S.doc Version 5.2 Page 12 within a safe environment. Most of the risk assessments were being evaluated, reviewed and updated, however there had been a change in one service users’ circumstances and this needs to be reflected in his risk assessment. This means that one risk assessment is not reflecting the current risk situation with one of the service users. This is Requirement 3. Service users are sometimes consulted on the day-to-day running of the home; though service users’ meetings are held infrequently, their views are taken on board regarding holidays and some day- to- day activities within the home. However the staff, who know the service users likes and dislikes regarding food, undertake the menu planning, without consulting with the service users. The manager must ensure that the service users are consulted on all aspects of life in the home, such as, menu planning and the redecoration and refurbishment of the home. This is Requirement 3. Risk assessments that were examined showed areas identified such as, tasks and activities within the home, in the community and health risks. They evidenced that service users are being supported to experience ordinary living within a safe environment. Most of the risk assessments were being evaluated, reviewed and updated, however there had been a change in one service users’ circumstances and this needs to be reflected in his risk assessment. This means that one risk assessment is not reflecting the current risk situation with one of the service users. This is Requirement 4. Elora House DS0000027887.V339775.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): Standards 12,13,14,15,16 and 17 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Service users have opportunities for personal development within the home and access to educational placements, employment and limited access to leisure activities within the local community that are appropriate to age and culture. Service users have appropriate personal and family relationships. Their rights are respected and are supported to take responsibility for their actions. More thought and discussion with the service users needs to be given in ensuring that they are provided with a varied and nutritionally balanced diet. EVIDENCE: Elora House DS0000027887.V339775.R01.S.doc Version 5.2 Page 14 Service users’ care plans identify lifestyle choice, such as local leisure activities, activities within the home, day services, college placements, employment and family contact. Daily logs record whether these activities have taken place. All of the residents have opportunities for some personal development within the home and in the community, however their activity programme could be more varied taking into account their preferences and interests, particularly at the weekends. Two of the service users attend day services; one attends a horticultural course at the local college. He told the Inspector “I love it, I have been gardening at the Church”. Another service user works one day a week at a local barber shop and all three attend various clubs. One of the service users does not wish to attend any day services as she thinks she is too old but now attends a club on Friday afternoons. She enjoys going out shopping with her keyworker and having lunch at the local café. She also enjoys attending her hair appointments at a local salon. All three of the service users are going to Blackpool for their holidays in September and have varied interests, such as, swimming, car boot sales and the cinema. Though the service users attend a number of activities most of these are associated with the clubs they attend and not organised by the home. One relative commented, “They are going less places than they use to, they don’t go out enough”. One service user said, “We use to go bowling, I really enjoyed it”. The inspector spoke to the manager and he confirmed that the service users are not participating in many activities outside of the clubs, particularly at the weekends. The manager should talk to the service users and discuss with them what activities or social outings they would like to attend. This is Requirement 5. All of the service users’ have their own televisions and music centres in their bedrooms and there was evidence of their particular interests and hobbies. One had football posters displayed and a large volume of CDs, another had pictures that he had coloured and his swimming medals, the other service user had lots of photographs and ornaments on display. The three service users receive visitors, some more regularly than others. One of the service users goes home every Sunday and returns on Monday, he travels there independently by bus. He has also been to stay with his cousin, he told the inspector “I really had a good time”. There are no set ‘house’ rules and service users were observed to go about the home freely. At the time of the inspection one service user was asleep on her bed and another was listening to music in his bedroom. Staff have the overall responsibility for the cleaning of the home, however the service users are able to participate at varying levels, such as, dusting their bedrooms, putting their clothes away, helping with putting their laundry in the washing machine and putting the rubbish out. Elora House DS0000027887.V339775.R01.S.doc Version 5.2 Page 15 The inspector examined the menu and it stated ‘ham, egg and chips’ for lunch, the two service users confirmed that they both had that for lunch, when asked neither of them knew what they were going to have for dinner. The inspector asked the manager who decided on the menu, he confirmed it was the staff. The menu for the previous week was examined and it was evident that the food being provided could be more nutritionally balanced; on Tuesday 24/4/07, chips were on the menu both at lunch and dinner, Wednesday 25/4/07 (lunchtime) Pizza was served with brussel sprouts with gravy. I asked the manager if this was the choice of the service users and he said “No, the member of staff was not English and she didn’t’ realise that you wouldn’t put Pizza with Brussel sprouts”. Some of the care staff are culturally diverse from the service users, the manager must ensure that all care staff are knowledgeable of the food that is appropriate to the cultural needs and likes and dislikes of the service users. The inspector asked the service users “do you enjoy the food and do you get enough to eat?” One service user said, “It’s alright, there is enough of it”. Another service user said, “I enjoy it”. The manager must discuss the menu with the service users, to ensure that they have a choice of main meals and that the meals are nutritionally balanced. This is Requirement 6. Elora House DS0000027887.V339775.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): Standards 18,19,20 and21 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Service users receive personal support in the way they prefer and their physical and emotional needs are met. There are policies and procedures that protect service users with the administration of their medication, however to ensure full protection medication must be recorded at the time of administration. EVIDENCE: Care plans and daily records were examined and discussed with the manager. The care plans identify health and personal care needs and how these needs should be met. Two of the service users do not require assistance with their day-to-day personal care, though they sometimes need reminding. One of the service users does require some minimal assistance with bathing. Service users were seen to be dressed in clothes that were appropriate for the time of year and which suited their personalities; one service user was wearing trainers, jogging bottoms and t-shirt another was wearing a shirt and jeans. A Elora House DS0000027887.V339775.R01.S.doc Version 5.2 Page 17 relative stated, “He always looks clean and tidy”. Another relative stated, “They really look after him”. Records inspected showed that service users have personal health records. All of the service users are supported to access dental care, well woman clinic, opticians, chiropody, and any GP or hospital out patient appointments. The three service users confirmed that they had attended dental, chiropody and optician appointments; one service user has recently had a tooth extracted and told the inspector “I was frightened about going but I’m glad I did because it doesn’t hurt anymore”. Another service user told the inspector “I am going to the doctors on Wednesday”. All of the service users require support to attend their appointments. One of the service users has glasses and dentures, but refuses to wear them. Another service user is diabetic, regular blood tests ensure that his blood sugars are under control. Two of the service users are weighed fortnightly, as one is prone to loosing weight; he also has supplement drinks and the other service user is prone to putting on weight, the other service user is weighed monthly. There are policies and procedures for the handling and recording of medication within the home. Staff have received medication training and there is a list of staff (with their signatures) that are competent in the administration of medication. Medication Administration Records (MAR) charts and the medication cupboard were checked, one of the service users has been deemed competent to be given her lunchtime and evening medication in the morning. She will then self-administer the medication at the appropriate times. The manager must ensure that staff check that the medication has been taken and sign the MAR sheet appropriately and not sign retrospectively. This is Requirement 7. The manager has spoken to the service users about their wishes in the event of their death and there was evidence that these wishes have been recorded. It would be a recommendation that staff now discuss with service users and relatives (if appropriate) Preferred Place of Care Plan (PPC). PPC would detail the resident’s thoughts about their care and the choices they would like to make, including saying where they would want to be when they die. Information about the family can also be recorded so that care staff can read about who’s who and what matters to them. This is Recommendation 1. Elora House DS0000027887.V339775.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The service users’ views are listened to and acted upon. Service users are protected by the policies and procedures and the monitoring systems within the home. EVIDENCE: The home has a clear complaints procedure, which is available in pictorial format. A copy of the procedure has been made available to all of the service users and to their relatives. Since the last inspection there has not been any complaints. The inspector advised the manager that any complaints however minor should always be recorded. The manager stated that he welcomes complaints and suggestions about the service. In discussions with relatives and the service users, it was obvious that they were aware of the complaints procedure and would have no hesitation in making a complaint if necessary. All of the relatives that were spoken to stated that they were aware of the complaints procedure and would have no hesitation in making a compliant, if required. All of the service users were asked, “If there was anything you were not happy about, who would you tell?” Two of the service users said, “I would tell Dia or my mum”, another service user said, “I would tell M (staff)”. All of the service users told the inspector that they were happy at the home and did not want to live anywhere else. Elora House DS0000027887.V339775.R01.S.doc Version 5.2 Page 19 The home has a Safeguarding Adults policies and procedures; these include the local authority (London Borough of Barking and Dagenham) policy and procedure, DOH document ‘No Secrets’ and the home’s policy and procedure. There was signed evidence that these had been read by the staff. The manager was clear in what incidents needed to be referred to the Local Authority as part of the local safeguarding procedures. The member of staff that was spoken to was very clear on what constituted abuse and their responsibilities to report any potential abuse. Staff files indicated that not all members of staff have attended formal Safeguarding Adults training but had covered this topic during their induction. This is Requirement 8. The home has policies and procedures for the safekeeping and expenditure of service users’ money. The three service users’ monies were checked; all were found to be correct. There was a clear audit trail and receipts were available for all expenditures. Elora House DS0000027887.V339775.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24,25,26 and 30 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home is homely, clean, and free from any offensive odours. However most of the home, needs to be redecorated and some refurbishment need to be undertaken to ensure that the service users’ home is safe and comfortable. EVIDENCE: The home is in keeping with other properties in the road. A tour of the home was undertaken including the service users’ bedrooms. The home is furnished in a homely fashion and the entire home was clean, tidy and free from any offensive odour. On the ground floor there is an open plan kitchen, dining/ lounge area, one of the bedrooms and a small conservatory which houses the washing machine and tumble dryer. Upstairs there are two bedrooms and a combined bathroom and toilet as well as the staff office/sleeping- in room. The three bedrooms are of a good size; one of the bedrooms has been redecorated and new carpet laid, however the other two bedrooms also need to be redecorated and new carpets fitted. All of the bedrooms were personalised with Elora House DS0000027887.V339775.R01.S.doc Version 5.2 Page 21 posters, swimming medals, CDs, Videos and family photographs. Some of the bedroom furniture is looking worn; an armchair and a chest of drawers need replacing. This is Requirement 9. The open plan kitchen, dining/lounge area is in need of some redecoration and the carpet is showing signs of wear and needs replacing. The stair carpet is also showing sign of wear and needs to be replaced as this could put the safety of residents at risk. This is Requirement 10. The garden is well kept, one of the service users enjoys cutting the grass and tending to the flowerbeds. Elora House DS0000027887.V339775.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34,35 and 36 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Service users are mostly supported by qualified and competent staff. Staffing levels are satisfactory and there are sufficient staff on duty. The majority of the staff have the skills and training to ensure that staff are able to meet the individual needs of the service users. The procedures and practices for the recruitment of staff needs to be more robust to ensure service users living in the home are protected. There was evidence that staff receive supervision but this is not on a regular basis and annual appraisals also need to take place. EVIDENCE: Duty rotas were inspected and they correlated with the staff member on duty, there is sufficient staff on duty to meet the needs of the service users. There are three service users living at the home and there is always one member of staff on duty, at night there is a sleeping member of staff. There is good staff Elora House DS0000027887.V339775.R01.S.doc Version 5.2 Page 23 retention within the home and permanent staff covers any absences, this ensures continuity of care for the service users. There is a recruitment policy and procedures. Five staff files were inspected and these showed that appropriate recruitment procedures were not always being followed; all of the files had a completed application form, an up to date Criminal Records Bureau (CRB) check, copies of appropriate documentation, such as, permission to work and proof of identity. Three of the files had one written reference and a telephone reference (every new member of staff should have two written references, one which should be their present or most recent employer). It is difficult in obtaining references from staff coming to work from overseas, however the manager must make every effort to ensure that he obtains two written references. This is Requirement 11. Staff files showed that there was a lack of mandatory training; not all of the staff have undertaken Food & Hygiene or Safeguarding Adults training, though there was evidence that staff have been booked on to forthcoming training for Safeguarding Adults. The member of staff on duty at the time of the inspection confirmed that she had not attended Safeguarding Adults training but was very aware of what constituted abuse and what action she should take if she had any concerns. This is Requirement 12. Staff training that has been undertaken includes; Health & Safety, Moving and Handling, risk assessment, emergency first aid and challenging behaviour. Some of the staff have attained their NVQ 2/3 qualification and there is a member of staff who is currently undertaking her NVQ 2. It would be beneficial for the staff if the manager completed a training profile for each member of staff, which identified what training they had undertaken and what training they required. This is Recommendation 2. Staff files indicated that supervision ha taken place, however this needs to be on a more regular basis. One member of staff stated, “The manager is always available, when he is not here we can always contact him by phone”. Annual appraisals also need to take place. This is Requirement 13. Service users spoke positively about the staff, one service user said, “I love going out with M, she always listens to me”, another service user stated, “they are all nice, we can have a laugh with them”. A relative stated, “They look after him really well”. Elora House DS0000027887.V339775.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39, 41 & 42 People using the service experience adequate quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. The manager of the home is a qualified and experienced person, recently however the management of the home has not been run in the best interests of the service users. Systems need to be reintroduced to ensure that service users can be confident that their views underpin the review and development of the home. The home’s record keeping, policies and procedures safeguard the rights and best interests of the service users. Elora House DS0000027887.V339775.R01.S.doc Version 5.2 Page 25 EVIDENCE: The manager is very experienced and qualified (NVQ 4) to manage the home and has a sound understanding of the service users’ needs.However it was evident during the inspection that the home has been lacking clear leadership in recent months. The staff spoken to during the inspection spoke about how supported they felt by the manager and that he was very approachable. The manager has had a period of poor health and some personal issues; this has had an impact on the quality of some aspects within the home. The manager is fully aware of this and advised the inspector of areas where he knows improvement is required. The inspector had a discussion with the manager around the introduction of the Mental Capacity Act 2005, which becomes effective from April 2007. The manager was aware of this new legislation and he advised the inspector that he would be discussing this with staff and service users. Standards particularly in relation to staff training and supervision and the décor within the home need to improve. The manager needs to be more service user focused, and work to improve the high quality of service that service users previously received. There is a small staff team that have worked together for some time and with their support and in partnership with other agencies this can be achieved. Information needs to be gained from service user meetings; complaints, concerns and compliments; and quality assurance questionnaires, to make improvements and influence service delivery. Audits, spot checks and quality monitoring systems need to be reintroduced to provide evidence that practice reflects the homes policies and procedures. The home has in the past benefited from quality assurance procedures. An Annual Quality audit is normally undertaken by the registered proprietor/manager. As part of the quality audit, questionnaires have been sent to service users, relatives and other stakeholders. All this information was collated and a report has been available to the service users and any other interested parties, including the Commission. However, there has not been an annual quality audit undertaken this year, the manager is aware of this and he advised the inspector that this would take place by September 2007. This is Requirement 14. The home has responsibility for the personal allowances of some of the service users and secure facilities are provided for their safekeeping, with records being maintained and accurate. All of the service users are able to handle varying amounts of money, and one service is able to withdraw his money from his Building Society account. Elora House DS0000027887.V339775.R01.S.doc Version 5.2 Page 26 A wide range of records were looked at including fire safety, emergency lighting, health and safety checks and accident/ incident reports. These records were found to be up to date and accurate. The annual Gas safety certificate was dated 04/12/06 and the 5 year Electrical safety certificate is date 22/10/02. All accidents and injuries are recorded appropriately. There have only been minor injuries and no hospital admissions. The home has a fire risk assessment and a fire inspection was is due to take place the week following the inspection. The water temperatures of the water outlets is also tested monthly and fried and freezer temperatures are also regularly recorded. Elora House DS0000027887.V339775.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 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 2 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 2 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 2 2 X X 3 3 X Elora House DS0000027887.V339775.R01.S.doc Version 5.2 Page 28 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15 (2)(b) Requirement The registered person must ensure that each service users care plan must be kept under review, at least every six months. All daily records must be informative, up to date. The registered person must ensure that the service users are consulted on all aspects of life in the home, such as, menu planning and the redecoration and refurbishment of the home. The registered person must ensure that all risk assessments clearly identify the risks and that they are kept under regular review. The registered person to consult with the service users regarding a programme of leisure activities The registered person must provide the service users with a choice of meals that are nutritionally balanced The registered person must ensure that all medication is signed for at the time of administration. Timescale for action 30/06/07 2 3 YA7 YA8 17(1)(a) 16(20(n) 31/05/07 30/06/07 4 YA9 13(4)(a) 30/06/07 5 6 YA14 YA17 16(2)(n) 16(2)(i) 31/07/07 31/05/07 7 YA20 Schedule 3 (3)(i) 31/05/07 Elora House DS0000027887.V339775.R01.S.doc Version 5.2 Page 29 8 9 YA23 YA24 13(4)(c) 16(2)(c) 10 11 YA26 YA34 23 (2)(d) Schedule 2(3) 18(1)(i) 18(2) 12 13 YA35 YA36 14 YA39 24 The registered person must ensure that all staff attend Safeguarding Adults training The registered person must ensure that the service users’ bedroom furniture is fit for the purpose and all worn carpets replaced The registered person must ensure that the home is reasonably decorated The registered person must obtain two written references, one being the present or most recent employer The registered person must ensure that all staff receive appropriate training The registered person must ensure that all staff receive regular supervision as well as yearly appraisals. The registered person shall establish a system for reviewing the quality of the care provided at the home, that takes into account the views of the service users and significent others. 30/06/07 30/11/07 30/11/07 31/05/07 31/08/07 31/08/07 30/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA21 Good Practice Recommendations It is recommended that staff now discuss with service users and relatives (if appropriate) Preferred Place of Care Plan (PPC). PPC would detail the resident’s thoughts about their care and the choices they would like to make. It is recommended that the manager completed a training profile for each member of staff, which identified what training they had undertaken and what training they required, in line with the Sector Skills Council training targets. DS0000027887.V339775.R01.S.doc Version 5.2 Page 30 2 YA35 Elora House Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Elora House DS0000027887.V339775.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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