Inspection on 17/05/07 for Emerton Close

This inspection was carried out on 17th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Emerton Close 12/12/05

Emerton Close 01/08/05

Emerton Close 23/03/05

Emerton Close 21/12/04

Emerton Close 19/02/04

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 Emerton Close 1 - 3 Emerton Close Bexleyheath Kent DA6 8DW Lead Inspector Maria Kinson Unannounced Inspection 17th May 2007 10:45 Emerton Close DS0000038187.V334925.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 Emerton Close DS0000038187.V334925.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. Emerton Close DS0000038187.V334925.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Emerton Close Address 1 - 3 Emerton Close Bexleyheath Kent DA6 8DW 0208 303 4940 0208 303 4940 emerton@mcch.org.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) MCCH Society Limited Vacant Care Home 12 Category(ies) of Learning disability (12), Physical disability (12), registration, with number Sensory impairment (4) of places Emerton Close DS0000038187.V334925.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th December 2005 Brief Description of the Service: Emerton Close is operated by MCCH Ltd and is registered to provide care for up to twelve adults with profound learning and physical disabilities, sensory impairment and complex needs. The home consists of three bungalows in close proximity to each other. House 1 and 2 has three single bedrooms and house 4 has four single bedrooms. All three bungalows have one bathroom, a separate toilet, kitchen and a lounge. Each bungalow has a small garden and there is limited parking space at the front of the buildings. An office and a sensory room are located in separate buildings. The fees charged by the home range from £1575.00 per week. This does not include additional charges such as hairdressing, toiletries, aromatherapy, hydrotherapy, holidays, transport and activities. This information was provided to the commission on 04.05.07. Emerton Close DS0000038187.V334925.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on 17th May 2007 and was unannounced. The acting manager was on leave at the time of the inspection but feedback was provided by telephone on her return to the home. The inspector spent eight hours in the home observing care practices and examining care, medication, money, health and safety and staff recruitment and training records. During the day the inspector met most of the people living in the home and spoke with some of the staff on duty and a visitor. All of the communal areas and a selection of bedrooms were viewed. It was not possible to establish the views of the people using the service due to communication issues but written feedback was obtained from four relatives and three health care professionals. There were ten people living in the home at the time of this inspection. What the service does well: This home provides a consistently good standard of care and support for people with complex needs. Relatives and health care professionals were satisfied with the overall standard of care and said that staff met people’s health care needs, maintained their privacy and dignity and provided a happy and relaxed home. The arrangements for admitting new people into the home were good with opportunities to visit and stay in the home before making a decision to move in. Staff were undertaking a number of specialist techniques such as emergency treatment for people with epilepsy and caring for people with a (PEG) feeding tube. All of these tasks were well managed. Although most of the people living in the home were not able to communicate their wishes staff had established ways of finding out what they liked or wanted. People were supported to undertake a varied range of activities in the home and community. The building was maintained to a satisfactory standard and appropriate equipment was provided. All areas were clean and tidy and most of the staff had undertaken infection control training. Bedrooms were personalised, well decorated and furnished. Staffing levels were satisfactory and there was a low turnover of staff. This provided good continuity of care for the people living in the home. Staff had Emerton Close DS0000038187.V334925.R01.S.doc Version 5.2 Page 6 access to relevant training sessions and were encouraged to work towards achieving recognised qualifications. The home was well managed. Good systems were in place to ensure that equipment was serviced regularly and health and safety issues were identified and addressed promptly. Complaints and concerns were handled effectively. What has improved since the last inspection? What they could do better: Although contracts provided clear information about the level of support and facilities provided, the people living in the home did not know how much they were paying for the service. Care plans provided detailed information about each person’s strengths and needs and personal goals. Plans were reviewed during staff meetings and supervision but the decisions made at these meetings were not always recorded on the individuals care plan. It was not clear when some of the records seen were developed or if they were still relevant as they were not dated or signed. Adequate records must be maintained about medicines received in the home and some of the storage arrangements must be reviewed. Medication support plans should be kept with the medication records so that staff can refer to the guidelines. Emerton Close DS0000038187.V334925.R01.S.doc Version 5.2 Page 7 Some of the checks that were undertaken when recruiting new staff were not kept in the home. New staff must not be allowed to commence work in the home until the manager has written proof that all of the necessary documents have been obtained. Additional NVQ training should be provided, so that at least half the care staff hold this qualification. The home did not have adequate systems in place for reviewing the quality of care provided in the home. Feedback about the service was not obtained from relatives. The manager was committed to maintaining a safe environment for the people living and working in the home but it was not clear if any action had been taken to address the concerns raised in the mains electricity installation report. The refrigerator temperature in house 2 was unsatisfactory and the bath water was tepid. There were good systems in place to manage and account for people’s personal money but no records were maintained about valuable items such as bank books. 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. Emerton Close DS0000038187.V334925.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 Emerton Close DS0000038187.V334925.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): 2, 4 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People that were thinking of moving into the home were supported to view the facilities but did not receive adequate information about how much they would pay for the service. This information would help people to decide if the service offers value for money. EVIDENCE: The people living in the home had not changed since the last inspection. The arrangements for assessing and admitting new people into the home were assessed during the last inspection. It was found that prospective service users and their relatives were able to spend time in the home meeting and getting to know staff and the other people living in the service before they made a decision to move in. The funding authority provided information about people’s needs and preferences. A copy of the joint assessment form was seen in some of the files examined during the inspection. Staff had received an individual contract for each of the people living in the home. The contact provided clear information about the service and pictures to assist some of the people using the service to understand their rights and responsibilities. The contract did not include information about fees and was Emerton Close DS0000038187.V334925.R01.S.doc Version 5.2 Page 10 not agreed or signed by the service user or their representative. See recommendation 1. Emerton Close DS0000038187.V334925.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 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care needs, preferences and personal goals for each individual were recorded in their personal plan. Comprehensive plans were developed to manage potential risks to service users and staff. EVIDENCE: The care records for two of the people living in house 2 and 3 were examined. The files included routine information about the person’s next of kin and GP, detailed guidance about how the person communicated and how staff should interpret specific facial expressions or gestures, information about health issues such as diet, weight and tube feeding regimes and directions about preferred routines such as support with personal care and mouth care and preferred times for getting up and going to bed. The information provided for staff was very person centred and demonstrated that the staff had excellent knowledge of the people they were caring for. The files also included an Emerton Close DS0000038187.V334925.R01.S.doc Version 5.2 Page 12 enhanced health and social care plan which outlined health issues and the action required to maintain the persons health and wellbeing and a individual plan that provided information about personal goals. Care plans were well written and easy to follow. Staff said that care plans were reviewed during staff meetings and supervision, and there was a formal review involving the service user and their relatives once a year. It was not always possible to see if the care plan had been reviewed regularly and if any personal goals were met. One plan stated that staff should offer the service user a second cup of tea during the morning. Discussions with staff indicated that this was no longer taking place. The care plan had not been reviewed and updated to reflect this change. Some documents such as mouth care guidelines were not dated or signed. See recommendation 2. The people living in the home were not able to communicate verbally or use signs and symbols to tell people what they wanted. Despite this staff were committed to giving people choices and ascertaining their views. One health care professional said, “clients are not able to express their wishes but staff are very astute to what they enjoy”. The records maintained in the home provided detailed information about how people indicated that they disliked something and what they liked doing. Staff said they were able to tell if the person did not like something or wanted something but the people living in the home were not able to make more complex decisions or choices. In this instance relatives and people that knew the person well were consulted. Staff said if the person was not able to choose items for themselves, such as personal clothing, they purchased items that they thought the person would like and based on their personality. Risk assessments were seen in both of the files examined. Staff had undertaken assessments to see if the person was at risk of developing pressure sores and had identified other potential hazards such as falls from a chair, injuries due to the use of bedrails or when assisting a person to move. Clear strategies to minimise the risk of injury to the people living in the home or staff were recorded. Emerton Close DS0000038187.V334925.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): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A varied programme of activities and therapies were provided to stimulate people’s senses and enhance their wellbeing. Food was prepared and served to meet individual needs. EVIDENCE: Although the people living in the home had complex health care needs, limited mobility and difficulty communicating, a wide range of different activities were provided. One relative said he had to telephone the home before he visited because his relative “was always out”. On the day of the inspection some of the people living in the home went to the cinema, theatre and local bowling alley. Because of the dependency of the people living in the home a joint activity programme was developed. This ensured that everyone had an opportunity to take part in activities and staff were able to continue to support the people that remained in the home. The activity programme indicated that Emerton Close DS0000038187.V334925.R01.S.doc Version 5.2 Page 14 people visited the hydrotherapy pool, went on trips to the cinema, pubs, shops, theatre and bowling alley and enjoyed films, music, manicures, aromatherapy, spa baths and foot massage sessions in the home. Staff made a record of the activities that people had taken part in and assessed whether they felt the person had enjoyed the event. Two people had just returned from a holiday in Norfolk and staff were planning holidays and birthday treats for some of the other people living in the home. Feedback about the service was obtained from four relatives. Relatives said their family member always received appropriate care and support and they were usually kept informed about important matters. Relatives said that permanent staff were “well trained and “knowledgeable” but two relatives expressed concerns that some of the agency staff did not have adequate skills and knowledge. One relative said the care provided for his family member was “fantastic”; staff talk to the people living in the home “as if they were their friends”. Relatives said they were able to visit the home at anytime and always received a warm welcome from staff. One relative said “it’s always the same when I visit, spotlessly clean and my relative always looks clean, comfortable and happy”. “The staff here are the “best”. Staff assisted people to maintain contact with their friends and family by assisting with transport if relatives were frail or unwell and by supporting people to visit their relatives if they were not able to come to the home. Records showed that varied meals had been served. Staff were observed preparing the evening meal in house 2. Guidelines about the consistency of the food provided were followed and support was provided to eat. The staff member sat at the same level as the person they were feeding and spent time talking about the meal and encouraging the person to eat. A number of people living in the home were not able to take diet or fluids by mouth and were fed via a tube. Staff that undertook this task received specialist training and were assessed at regular intervals to ensure that they were following the correct procedure. Emerton Close DS0000038187.V334925.R01.S.doc Version 5.2 Page 15 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 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff worked in partnership with other professionals to maintain and improve people’s quality of life, health and wellbeing. Adequate records were not maintained about medicines received in the home. EVIDENCE: Staff had recorded people’s individual preferences and usual routines. Records indicated that long- standing health issues were monitored and staff arranged for the people living in the home to see their GP when they were unwell or when new concerns were identified. Other professionals such as the optician, physiotherapist, speech and language therapist and dentist had assessed some of the people living in the home in recent months. A number of people that were not able to take food by mouth required specialist-feeding regimes. Feeding pumps were clean and regimes set by the Emerton Close DS0000038187.V334925.R01.S.doc Version 5.2 Page 16 dietician to meet peoples nutritional needs were followed. This aspect of care was well managed. Staff assessed if people were at risk of developing pressure sores and specialist equipment such as cushions and mattresses were provided. Three health care professionals that were in regular contact with the people living in the home provided written feedback about the service. Respondents said that the staff on duty usually had appropriate skills to meet people’s health care needs and “requested advice, if required” or “if they were unsure about procedures”. Respondents said that staff were “always keen to improve clients quality of life” and were particularly good at maintaining people’s privacy and dignity. The only area that other professionals felt the home could improve was communication between staff, as some staff accompanying people to appointments were “not fully aware of the reasons why the client was attending and did not have all the relevant information”. See recommendation 3. In the period since the last inspection the home had notified the commission about three medication errors. All of the issues were investigated and appropriate action was taken to reduce the risk of a similar error. Staff attended medication training and completed a practical assessment before administering medication in the home. Three medication charts were examined in House 1 and 3. Records of receipt of medication were poor. For this reason it was not possible to complete a full audit trail. The medication charts seen indicated that people were receiving their medication regularly and all medicines were in stock. To ensure that all medicines can be accounted for staff must record any medication that is left over from the previous months supply on the new medication chart. Storage facilities appeared to be satisfactory but room temperatures were not monitored and one medicine was stored in the domestic refrigerator next to food. The staff member immediately took action to address this issue by placing the medication in a sealed container. The room temperature must be monitored in the area where medicines are stored as some medicines were kept in the kitchen or laundry room, which is usually considered unsuitable for the storage of medicines because it can get too hot or become humid. Unwanted medicines were recorded and disposed of safely. See requirement 1. People had an individual medication support plan that stated how they preferred to take their medication. Medication support plans were kept in the office. See recommendation 4. Emerton Close DS0000038187.V334925.R01.S.doc Version 5.2 Page 17 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 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had procedures in place to respond to complaints and concerns and to protect people’s safety and wellbeing. EVIDENCE: The home had a comprehensive complaints procedure, which included a timescale for responding to concerns and contact details for the commission. Most relatives said they knew how to make a complaint and would speak to staff if they had any concerns about the service. The home had received two complaints about room sharing arrangements and the dove coup in the garden. Both complaints were investigated and responded to promptly. Staff were aware of the procedure to follow if they witnessed or were advised that a person had been mistreated. One concern was investigated under the local authority adult protection procedure in May 2006 and the inspector was advised that the member of bank staff would not be returning to work at the home. Staff had access to relevant policies and procedures and most staff had attended protection of vulnerable adults training in 2006. Staff had a good understanding of abuse and said they would report concerns or allegations to senior staff. The home had not made any referrals to the local adult protection team in the period since the last inspection. Emerton Close DS0000038187.V334925.R01.S.doc Version 5.2 Page 18 Good systems were in place to ensure that personal money was stored securely but valuable items such as bank books were not recorded. The money records for two people were checked. Receipts were kept for all purchases and all of the person’s money could be accounted for. See requirement 2. Emerton Close DS0000038187.V334925.R01.S.doc Version 5.2 Page 19 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, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was maintained to a satisfactory standard and all areas were clean, tidy and comfortable. EVIDENCE: The home was maintained to a satisfactory standard. No significant health and safety issues were identified. Since the last inspection work had been undertaken to improve uneven paving between some of the houses and provide additional ramps. Major work was carried out in house 3 to provide an additional bedroom. All of the work identified in the previous report had been addressed. All of the bedrooms were nicely decorated and furnished and the standard of decoration in the bedrooms in house 3 was particularly good. Staff had Emerton Close DS0000038187.V334925.R01.S.doc Version 5.2 Page 20 purchased colour coordinated bedding and small items such as lamps and photographs to make the rooms look and feel very homely. Specialist equipment to assist staff to move and bathe people was provided and quotes had been obtained to fit an additional ceiling hoist in the new bedroom in house 3. The home was clean, tidy and free of unpleasant odours. A health protection nurse visited the home in August 2006. The home had implemented the advice that was provided during this visit about single use syringes and fitting paper hand towel dispensers. Staff had access to protective clothing and hand-washing facilities were provided in toilets and bathrooms. The refrigerator in house 2 was not maintained at a suitable temperature and the hot water in the bathroom in house 2 was warm. See recommendation 5. Emerton Close DS0000038187.V334925.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff team were committed to maintaining and improving people’s quality of life. Some additional records must be maintained in respect of new staff. EVIDENCE: 39 of staff had attained a vocational qualification in care at level two or above. See recommendation 6. This home has a low turnover of staff but was using agency staff regularly to provide additional support for one person with complex health care needs. As this additional staffing was a temporary arrangement the acting manager was not able to recruit a permanent member of staff to undertake these shifts. Two relatives expressed concern about the use of agency staff. Two new support staff started work in the home in March 2007 leaving one remaining vacant post. Relatives and health care professionals confirmed that the staff team was stable and said “staff know their clients very well”. Emerton Close DS0000038187.V334925.R01.S.doc Version 5.2 Page 22 At the time of this inspection there were two staff working in each house, the senior support worker on duty was responsible for coordinating the shift. During the night there was usually one support worker in each house but an extra member of staff was currently provided in house 3 to provide additional support for one person. The commission had agreed with the Registered Person that staff records could be held centrally if a form outlining all of the information and checks that were undertaken in respect of staff was kept in the home for inspection. Two forms were examined. The agreed form was in use but information about criminal record bureau disclosures were not recorded. See requirement 3. A provider relationship manager from the commission was undertaking additional checks at the company’s head office twice a year. The most recent audit was undertaken in January 2007 when all of the files examined were found to comply with regulations. Training needs were discussed during supervision and staff had access to a comprehensive training programme. During the past year some members of staff had attended NVQ, protection of vulnerable adults, COSHH, person centred planning, infection control, health and safety, fire safety, food hygiene, first aid, tube feeding, appraisal, personal safety and information technology training. New staff worked alongside an experienced member of staff for the first two weeks. During this period the employee had an opportunity to observe staff, read policies and procedures and get to know the people living in the home. The company provides a comprehensive induction programme that includes first aid, medication, moving and handling, fire safety, food hygiene, health and safety, infection control and adult protection training. During the first twelve weeks staff were expected to complete a workbook that covered all of the common induction standards. Emerton Close DS0000038187.V334925.R01.S.doc Version 5.2 Page 23 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 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There was no evidence that the recent management changes had affected the standard of care provided in the home. Some quality assurance work was taking place but this did not include consultation with service users relatives. Action was taken to provide a safe living and working environment for service users and staff. EVIDENCE: Since the last inspection the manager had resigned and the deputy manager had agreed to manage the service until a permanent manager was appointed. The acting manager has the registered managers award and a Emerton Close DS0000038187.V334925.R01.S.doc Version 5.2 Page 24 certificate in social care and will be undertaking a NVQ in management at level 4 in 2007. The acting manager received regular support and supervision from her line manager and was able to obtain advice about clinical issues from the company’s specialist nurse. Positive feedback about the management of the service was received from staff and relatives. One relative said that the acting manager was “very approachable and knowledgeable” and staff said they still received information about changes and good support. Some quality monitoring was taking place but this did not include feedback from service users relatives. See recommendation 7. The frequency of regulation 26 visits had improved and a medication, health and safety audit and staff survey was undertaken in 2006. There was an up to date fire risk assessment and the fire alarm system and equipment was serviced at regular intervals. Fire safety training was provided and regular fire drills were taking place. The plan that outlined the position of fire safety equipment and exits had been revised following the reconfiguration of rooms in house 3. A random check of health and safety reports and inspections was undertaken. All of the records except the mains electricity installation report were found to be satisfactory. It was not clear what action, if any was taken to address the mains electricity installation, which was reported to be “unsatisfactory”. See requirement 4. Action was being taken to find a company that could service the specialist weighing scales. Accident forms were examined. Staff had recorded relevant information about accidents and incidents on a form and a senior member of staff checked the forms to see if any further action could be taken to prevent a reoccurrence. Advice about reporting under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) was provided. Emerton Close DS0000038187.V334925.R01.S.doc Version 5.2 Page 25 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 X 2 3 3 3 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 2 X 2 3 2 X X 2 X Emerton Close DS0000038187.V334925.R01.S.doc Version 5.2 Page 26 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. 1. Standard YA20 Regulation 13 Requirement The Registered Person must make adequate arrangements for the recording and safe storage of medicines. The Registered Person must ensure that a record is maintained about all valuable items held for safekeeping. The Registered Person must ensure that the agreed form for recording recruitment checks is completed in full for all members of staff. The Registered Person must advise the commission in writing about the action that was taken to address the concerns identified in the mains electricity installation report. Timescale for action 09/07/07 2. YA23 17 09/07/07 3. YA34 17 09/07/07 4. YA42 23 30/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Emerton Close DS0000038187.V334925.R01.S.doc Version 5.2 Page 27 1. YA5 2. 3. YA6 YA19 4. 5. 6. 7. YA20 YA24 YA32 YA39 The Registered Person should ensure that contracts include information about the fees charged by the service and are agreed and signed by the service user or their representative. The Registered Person should ensure that care plans are reviewed and updated regularly to reflect people’s current needs and are signed and dated. The Registered Person should ensure that staff that accompany people to appointments have adequate information or a written report about the reason for the consultation. The Registered Person should consider placing the medication support plan alongside the medication chart so that staff administering medication can refer to it. The Registered Person should ensure that there is an adequate supply of hot water in all parts of the home and refrigerators are maintained at a suitable temperature. The Registered Person should provide additional NVQ training, so that at least 50 of the staff working in the home hold this qualification. The Registered Person should ensure that feedback obtained from family, friends and other professionals about the home is used to improve the service. Emerton Close DS0000038187.V334925.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 Emerton Close DS0000038187.V334925.R01.S.doc Version 5.2 Page 29 - 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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