Inspection on 16/04/08 for Emmanuel Care Services Ltd

This inspection was carried out on 16th April 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Emmanuel Care Services Ltd 09/04/09

Emmanuel Care Services Ltd 25/05/07

Emmanuel Care Services Ltd 02/05/06

Emmanuel Care Services Ltd 06/12/05

Emmanuel Care Services Ltd 13/06/05

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

CARE HOME ADULTS 18-65 Emmanuel Care Services Ltd 33 Disraeli Close Thamesmead SE28 8AP Lead Inspector Maria Kinson Key Unannounced Inspection 16th April 2008 11:15 Emmanuel Care Services Ltd DS0000042496.V361795.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 Emmanuel Care Services Ltd DS0000042496.V361795.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. Emmanuel Care Services Ltd DS0000042496.V361795.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Emmanuel Care Services Ltd Address 33 Disraeli Close Thamesmead SE28 8AP 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) 0208 310 9340 0208 310 9340 careemmanuel@yahoo.co.uk Mrs Remi Konan Mrs Remi Konan Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Emmanuel Care Services Ltd DS0000042496.V361795.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 3 25th May 2007 Date of last inspection Brief Description of the Service: Emmanuel Care Services was registered in February 2005 to provide care for up to three adults with learning disabilities. The provider of the home is also the manager. The home is a three-storey semi-detached house situated in central Thamesmead. A bus service connects with the town centre and local facilities. There is one single bedroom on the ground floor and two further single bedrooms on the second floor. None of the bedrooms are en-suite but all of the bedrooms have a hand washbasin. There is a lounge and kitchen/diner on the first floor, a bathroom with shower and toilet on the second floor and a toilet on the ground floor. There is a small, enclosed paved garden at the rear of the property. The fees charged by the home range from £1000 to £1500 per week. This does not include additional charges such as hairdressing, toiletries, activities, transport and holidays. This information was supplied to the commission on 30/06/08. Emmanuel Care Services Ltd DS0000042496.V361795.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 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was unannounced and took place over three days. The inspection had to be undertaken in this way to maintain one persons routine and to minimise any stress for this person. The inspector spent eight hours in the home in total. During the inspection we met and spoke with two members of staff, the manager and two people that use the service. Comments cards were sent to five health care professionals that were in contact with the home and two advocates. Two comment cards were given to the manager to send to people’s relatives. None of the comment cards that we sent out were returned to the commission. We assessed all of the key standards during this visit. There were three people living in the home at the time of this inspection. What the service does well: Because this home is small it feels very homely and people receive a personalised service. As the staff team is small people were able to develop close working relationships with staff. People were supported to dress smartly and to take pride in their appearance. Staff considered potential risks and worked out how they could help people to stay safe. People were encouraged to make decisions for themselves and could obtain support from other people such as relatives and advocates if necessary. People were supported to undertake regular activities, to attend college or day centres and to use community services and facilities. The home was pleasantly decorated and furnished and all areas were clean, tidy and comfortable. Emmanuel Care Services Ltd DS0000042496.V361795.R01.S.doc Version 5.2 Page 6 The menu was varied and people said they liked the food that staff prepared. Most of the people that worked in the home had a care qualification. Staff said the manager was supportive and helped them to stay “motivated”. Fire safety arrangements were good and the people that lived in the home were supported to take part in fire drills and were told what they should do if there was a fire. Equipment was inspected regularly to ensure that it was safe to use and working properly. What has improved since the last inspection? What they could do better: The Service User Guide did not provide adequate information about the fees and what the fees include. Staff did not always obtain adequate information before people moved into the home from carers and people’s representatives. This information would help staff to prepare an individualised and detailed care plan for the person. During the assessment period staff should also consider whether the person that wants to move into the home is likely to get on with the other people that are using the service. Care plans provided good information about the support that people required when they moved into the home, but were not always updated when people’s needs changed. Staff had not received challenging behaviour training and did not have access to relevant policies and procedures. Emmanuel Care Services Ltd DS0000042496.V361795.R01.S.doc Version 5.2 Page 7 Staff did not keep adequate and accurate records about medicines that were received and used in the home. This meant that people could be at risk of receiving medicines at the wrong time of day or of receiving too much or too little medicine. There was no guidance for staff about how often or when they could give homely remedy medicines. We could not establish if people were supported to undertake the household tasks that were listed in their care plans, as the daily care records did not make any reference to these activities. The safeguarding procedure was not dated or signed and there was no review date. The kitchen flooring was worn. This should be replaced. It was difficult to assess if there were adequate staff on duty at times, as the duty roster did not specify if the times that staff started their shift was am or pm. The manager must be able to prove that there were adequate staff on duty at all times. The manager obtained all of the necessary documents for new staff but did not always check whether there were any gaps or irregularities in the information provided by applicants. The home did not have adequate systems in place for monitoring the quality of care provided in the home. Records were kept about accidents that occurred in the home and community but some of the forms that we looked at did not include adequate detail. 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. Emmanuel Care Services Ltd DS0000042496.V361795.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 Emmanuel Care Services Ltd DS0000042496.V361795.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 and 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager prepared written information about the range of needs the home could meet and the facilities that the service could offer. Some additional information about the fees charged by the home should be added to the Service User Guide. Staff completed a basic needs assessment before people moved into the home and obtained information from other professionals. This information was then used to develop an individual care plan for the person. EVIDENCE: The registration certificate and a valid public liability certificate were displayed in the lounge. The ‘Statement of Purpose’ provides information about the home and the type of support that the service can provide. The manager said the Statement of Purpose was recently revised and some information was updated. As highlighted in the previous report, this document stated that staff received training about mental illness. There was no evidence that this was taking place. Emmanuel Care Services Ltd DS0000042496.V361795.R01.S.doc Version 5.2 Page 10 Some of the items that were listed on personal money records, such as bedding and towels are usually provided as part of the fees. The Service User Guide must state what items are included in the homes fees and what people are responsible for purchasing out of their own funds. See recommendation 1. In the period since the last inspection the home had supported a number of people on short- term placements and a new service user was admitted to the home in December 2007. Before the new service user was admitted to the home the manager obtained information from the funding authority about their needs and received a copy of their Care Programme Approach (CPA) plan. The manager visited the service user in their previous placement to check that the information received was accurate and to assess if the home would be able to meet their needs. The assessment that was completed by the manager was very brief. There was no feedback from staff at the previous placement about what triggered specific behaviours and about how these issues were best managed. The assessment was not signed. See recommendation 2. There was no evidence that the manager had considered whether the prospective service user was likely to get along with the other people that lived in the home and what impact, if any, the new admission would have on their quality of life. Emmanuel Care Services Ltd DS0000042496.V361795.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. Care plans and risk assessments were developed to meet people’s needs on admission to the home, but were not always updated when people’s needs or circumstances changed. People were able to make day-to-day decisions for themselves and were supported by staff, advocates and relatives to consider more complex issues. EVIDENCE: We examined two sets of care record’s, one for a person that had moved into the home since the last inspection and one for a person whose support needs had changed following an accident. Care plans were personalised and well written overall, but were not always updated when people’s needs changed. One person had recently sustained an injury that meant they required additional support with some activities of daily living. There was no information about this in the care plan or about the observations that staff should make in relation to the treatment the person had received. This person Emmanuel Care Services Ltd DS0000042496.V361795.R01.S.doc Version 5.2 Page 12 had started to spend a considerable amount of time alone in recent months. Although the daily care notes showed that staff had identified this issue there was little information in the care plan to show what staff were doing to support the person to become less isolated. One of the care plans and risk assessments that we viewed provided guidance for staff about how they should respond when a person became agitated or aggressive. The plan stated that staff should watch for trigger signs and should be trained in breakaway techniques. The records did not state what the trigger signs were and there was no evidence that staff had received breakaway training. See standard 35. See requirement 1. Although some of the people that lived in the home had challenging behaviour and complex needs staff ensured that everyone was able to undertake activities that they enjoyed and go out. Risk assessments considered potential risks in the community and strategies were developed to support people to live active and fulfilling lives. All of the people that lived in the home were able to make day- to- day decisions about what they wanted to eat, what they wanted to wear and about what activities they wanted to do. Care plans prompted staff to encourage people to make decisions for themselves and staff that we spoke with said they did this routinely. Some of the people that lived in the home may have difficulty considering more complex issues without support from staff and their relatives. In the period since the last inspection two people that did not have regular contact with relatives were supported to apply for an advocate. Records showed that advocates spent time in the home and community with the people they were supporting. Emmanuel Care Services Ltd DS0000042496.V361795.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 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were supported to undertake activities that they enjoyed in the home and community. The menu was varied and people said they liked the food that was prepared in the home. EVIDENCE: Two people attend a local college where they can attend various classes and learn new skills. One person said they enjoyed meeting their friends at college and particularly liked the arts and crafts and computer sessions. The manager was trying to find a suitable placement at a day centre or college for the remaining resident. All of the people that lived in the home had an activity care plan that outlined the type of activities that they liked and places that they liked to visit. The plans included activities and hobbies that people liked to do at home such as Emmanuel Care Services Ltd DS0000042496.V361795.R01.S.doc Version 5.2 Page 14 playing play station games, doing jigsaw puzzles, spelling and reading and activities in the community such as basketball, walks and outings. Records showed that people were supported to go out regularly and spent their free time doing the activities that they enjoyed. One person told us they visited a local park, supermarket, bowling alley and cinema during the half term holiday and showed us a jigsaw puzzle that they were completing. Staff told us that one person liked to spend time with their family who lived locally. Records showed that this person had visited the family home on several occasions. The other people that lived in the home had some telephone contact with relatives. There were regular community meetings that people could attend. Different topics were discussed and there was an opportunity for people to make suggestions or to put forward ideas. People were also reminded that they could speak to staff privately, if they wanted. The minutes from a recent meeting indicated that one person wanted to assist staff to vacuum and mop the floor. This offer was welcomed by staff and incorporated into the persons care plan. There was information in care plans about the tasks that people were expected to undertake in the home, such assisting staff to tidy and clean their room, making hot drinks and helping out with shopping and cooking. The monthly key worker review document indicated that people were supported to undertake these tasks but it was not clear when this happened or what progress they were making. We did not observe people undertaking any of these activities on the day of the inspection. Staff should ensure that they make an entry in the daily care records when they support people to carry out these activities and note if the person makes any progress or experiences any difficulties. See recommendation 3. There were good supplies of food in the home including fresh fruit, vegetables and salad. The menu was varied and people said they enjoyed their meals. Emmanuel Care Services Ltd DS0000042496.V361795.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 adequate. This judgement has been made using available evidence including a visit to this service. Support was provided to meet people’s personal care needs but emotional issues such as challenging behaviour was not always dealt with in a consistent manner. The management of medication was poor. This could affect people’s health and compromise their safety. EVIDENCE: Records showed what support people required and stated if they had any specific preferences about how they were supported. All of the people that lived in the home were registered with a local GP and were supported to attend appointments. Records showed that in recent weeks one person had attended a dental appointment, was reviewed by a psychiatrist and received regular visits from a specialist community nurse. It was evident during the inspection that not all of the staff managed challenging behaviour in a consistent manner and some of the guidance Emmanuel Care Services Ltd DS0000042496.V361795.R01.S.doc Version 5.2 Page 16 provided in care plans and risk assessments was not always followed. Some staff did not have an adequate understanding of why people might challenge the service or about the strategies that they could use to manage this type of behaviour. See the comments on page 23 about training. The home did not have a policy and procedure about how staff should respond if people became aggressive or violent. See requirement 2. We examined two medication charts. All of the information recorded on the charts was hand written by staff. None of the entries were checked and countersigned by a second member of staff and two medicines were not signed. It was not clear how often or what time of day staff should give two medicines, as this information was not recorded. Medicines that were received in the home were recorded in a book. The record of receipt for one medicine was incorrectly recorded. We could not assess whether the remaining supply of some medicines were correct, as the records of receipt of medication were difficult to follow. There were too many tablets in cupboard when we deducted the amount of medicine given, from the amount received in the home for one medicine. This medicine was administered on an ‘as required basis’. See requirement 3. Medicines were stored in a small room under the stairs. There was no surface in the room to place medicines pots or medication administration charts on and the medicine cupboard was congested. See recommendation 4. The home kept a small supply of homely remedy medicines. There was no record of when these medicines were received in the home so it was not possible to assess whether the supply remaining in the home was correct. There was no evidence that the use of homely remedies was agreed by the GP and there was no guidance for staff about the use of these medicines. See requirement 4. Some members of staff had completed medication training courses. The manager said that she was the only member of staff that administered medicines in the home. Some of the issues that were identified during the previous inspection about the storage of medicines had been addressed but a number of new concerns were identified. Failure to ensure that medicines are properly managed could result in enforcement action. Emmanuel Care Services Ltd DS0000042496.V361795.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. There were procedures in place to manage complaints and to safeguard the people that use the service. EVIDENCE: The home had not received any complaints or concerns in the period since the last inspection. People that lived in the home were reminded at meetings that they could speak with staff privately if they had any concerns. The home had an adult protection procedure. The manager said the procedure had not changed in the period since the last inspection but told us after the inspection that some minor amendments were made to the procedure. The amended procedure stated what action the home would take to protect people using the service, whilst an investigation was in progress. The procedure was not signed or dated and did not have a review date. See recommendation 5. One issue was referred to the local authority for investigation under their safeguarding procedure. The manager was not aware if the referral had been accepted, as she had not received any recent communication about the issue. Staff said they would report concerns or allegations to the manager and were confident that the manager would pass their concerns on to other agencies, such as social services. Emmanuel Care Services Ltd DS0000042496.V361795.R01.S.doc Version 5.2 Page 18 The manager said that staff had recently watched a DVD about abuse and had completed a test to assess their understanding and knowledge about the subject. The manager said the assessments that were completed by staff would be sent to a training company for marking and staff that passed the test would receive a certificate. Money records were difficult to assess as none of the three people living in the home had access to any personal money. The manager said she had raised this issue with care managers during review meetings and telephone conversations. One person had a personal bank account but had not received any money into this account. The manager maintained records about the money that she loaned to service users until December 2007 but said she stopped doing this in early December because it was “a waste of time”. As the home is not currently responsible for safeguarding any money for people we cannot make any requirements about this issue. The manager said receipts were kept but they were not in any order and could not be checked due to time constraints. See recommendation 6. Emmanuel Care Services Ltd DS0000042496.V361795.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, 25, 28 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 clean, comfortable and welcoming. EVIDENCE: The home is located in a modern town house, on a housing estate in Thamesmead. There is a local bus service and various shops within walking distance of the home. We viewed all of the communal areas and two bedrooms with the assistance of staff and some of the people that use the service. All areas were clean, tidy and free from unpleasant odours. Hand-washing facilities were good. All of the people that lived in the home had their own bedroom. Two people showed us their bedrooms and pointed out some of their favourite photographs and work that they had undertaken at college. People said they liked their rooms. Emmanuel Care Services Ltd DS0000042496.V361795.R01.S.doc Version 5.2 Page 20 A few maintenance issues were identified. We know that some of these issues had only occurred in recent days because they were not apparent on day one of our visit. One of the radiator covers was damaged, a fire extinguisher had been removed from the wall and damaged and the kitchen flooring was worn in parts. See recommendation 7. The lounge and dining area were clean, comfortable and welcoming. Emmanuel Care Services Ltd DS0000042496.V361795.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, 33, 34, 35 and 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. We could not establish from the records if there were adequate staff on duty at all times. Staff did not receive adequate training about some aspects of their work. Staff recruitment procedures had improved but further work was required to ensure that information provided by applicants was checked. EVIDENCE: The information that we received from the home indicated that three out of the four care staff that were employed by the home had a vocational qualification in care at level two or above. We examined the duty roster for the week of the inspection. As the duty roster did not specify if the start time for some shifts was am or pm it was difficult to assess if there were adequate staff on duty at all times. The manager said that shifts were covered. See requirement 5. We examined the recruitment files for two staff that had recently started working in the home. Pre- employment checks such as Criminal Record Emmanuel Care Services Ltd DS0000042496.V361795.R01.S.doc Version 5.2 Page 22 Bureau (CRB) disclosures and two written references were obtained and documents that provided proof of the person’s identity and fitness to work were obtained. One applicant did not include the relationship of one of their referees on the application form. One referee was recorded as a past employer, but there was no evidence on the person’s employment history that they had worked with this person. The second applicant completed an employment history but the dates that they were employed from and to were not clear, for instance the applicant said they were employed in one job for a “two year period”. The manager must take greater care when assessing applications to ensure that all parts of the form are fully completed and all information is checked. See requirement 6. A record was maintained about staff interviews and all applicants were asked the same questions. The manager had purchased various distance learning training packages for staff to complete. In recent months some of the staff had completed medication, food hygiene, infection control, fire safety and adult protection courses. The training involves watching a DVD and completing an assessment, which tests the persons understanding and knowledge of the topic. The assessment paper was sent away for marking and staff receive a certificate, if they achieve an adequate score. The manager was advised that this type of training does not meet everyone’s needs and other training methods should be considered. Although the service was supporting one person with complex needs and challenging behaviour none of the staff had received training about challenging behaviour. The manager said this training was planned. See standard 9 re breakaway training. See requirement 7. Supervision contracts were agreed and signed and staff confirmed that they had regular opportunities to discuss their work, concerns and training needs with the manager. Emmanuel Care Services Ltd DS0000042496.V361795.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. Health and safety issues were well managed but there were no formal systems in place to identify concerns or to monitor the quality of care provided in the home. EVIDENCE: The manager was registered with the Commission for Social Care Inspection (CSCI) in 2005. The manager holds a National Higher Certificate in Care and Batchelor of Arts in Social Care. The manager had completed some distance learning training courses in the period since the last inspection. Staff said the manager was always available for advice and kept in regular telephone contact when she was off duty. Emmanuel Care Services Ltd DS0000042496.V361795.R01.S.doc Version 5.2 Page 24 There was no evidence of any quality assurance work, apart from community meetings. The manager had not completed any audits or sent out any satisfaction surveys in the period since the last inspection. See requirement 8. Fire safety equipment was serviced at regular intervals and ‘in house checks’ and drills were recorded. Some of the staff had completed fire safety awareness training. The management of health and safety issues was good. Records showed that equipment such as portable electrical appliances, the mains electrical installation and gas appliances were serviced regularly. Radiators were fitted with covers and refrigerator and freezer temperatures were monitored. We looked at nine accident forms. Some of the information that was recorded on the forms was very brief. For instance one form stated that a person was found to have a scratch, it was not clear on the form where the scratch was on the person’s body or how big it was. Some of the other forms stated what had happened, but did not say if a staff member witnessed the accident or if this was the person’s account of what happened. See recommendation 8. The home notified us about a recent accident that occurred in the home. Emmanuel Care Services Ltd DS0000042496.V361795.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 2 2 2 3 X 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 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 2 35 2 36 3 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 3 12 3 13 3 14 3 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 3 3 2 X X 3 X Emmanuel Care Services Ltd DS0000042496.V361795.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 Requirement Care plans must set out in detail the action that staff should take to meet people’s health, personal and emotional care needs. Plans must be reviewed and updated when people’s needs change. A policy and procedure must be developed to show how staff should respond to people that are violent or aggressive. Suitable arrangements must be made for the recording, handling, safekeeping, safe administration and disposal of medication. Repeated requirement. The previous timescale of 20/07/07 was not met. Adequate records must be maintained about the receipt, use and disposal of homely remedy medicines. A policy and procedure must be developed about the use of these medicines. Records must show that the home is providing adequate staff to meet people’s needs. Repeated requirement. The previous timescale of DS0000042496.V361795.R01.S.doc Timescale for action 11/07/08 2. YA19 13 11/07/08 3. YA20 13 11/07/08 4. YA20 13 11/07/08 5. YA33 18 11/07/08 Emmanuel Care Services Ltd Version 5.2 Page 27 20/07/07 was not met. 6. 7. YA34 YA35 19 18 Full and satisfactory information must be obtained about prospective employees. Training should be linked to peoples needs. Staff must receive mental health, challenging behaviour and breakaway techniques training if they support people with these needs and are required to use these skills. A system for reviewing and improving the quality of care provided at the care home must be established. 11/07/08 08/08/08 8. YA39 24 05/09/08 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 YA1 Good Practice Recommendations The Statement of Purpose and Service User Guide should be reviewed to ensure that information about the service is accurate and up to date. The Service User Guide should specify what services are included in the fees and what services/items people are responsible for purchasing out of their own funds. During the assessment, staff should obtain detailed information about how people want to live their life and the support that they require. Staff should record information about housekeeping tasks that people are supported to undertake. Facilities to enable staff to view medication charts and check medication supplies should be provided in the medicine room. The home should consider purchasing a larger medication cupboard. The homes safeguarding procedure should be reviewed and updated. All references to “the agency” should be removed and the procedure should state what action, if any would be taken to protect the people using the service during an investigation. The procedure should be signed, dated and have a review date. DS0000042496.V361795.R01.S.doc Version 5.2 Page 28 2. 3. 4. YA2 YA16 YA20 5. YA23 Emmanuel Care Services Ltd 6. YA23 7. 8. YA42 YA42 Money records should provide a complete audit trail. This includes an up to date and detailed account of what money was received in the home, what money was returned to the service user and the purpose for which money was used. A system should be established for the safe storage and easy retrieval of receipts. The damaged flooring in the kitchen should be replaced. Accident records should provide a full account of the incident and any injury that the person sustains. Emmanuel Care Services Ltd DS0000042496.V361795.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 Emmanuel Care Services Ltd DS0000042496.V361795.R01.S.doc Version 5.2 Page 30 - 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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