Inspection on 13/05/08 for Esther Care Home Ltd

This inspection was carried out on 13th May 2008.

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 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

Esther Care Home Ltd 02/10/07

Esther Care Home Ltd 19/06/06

Esther Care Home Ltd 22/11/05

Esther Care Home Ltd 24/05/05

Esther Care Home Ltd 10/09/04

Esther Care Home Ltd 21/06/04

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

CARE HOME ADULTS 18-65 Esther Care Home Ltd 15 Russell Hill Purley Surrey CR8 2JB Lead Inspector Lee Willis Key Unannounced Inspection 13th May 2008 12:50 Esther Care Home Ltd DS0000035826.V363254.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 Esther Care Home Ltd DS0000035826.V363254.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. Esther Care Home Ltd DS0000035826.V363254.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Esther Care Home Ltd Address 15 Russell Hill Purley Surrey CR8 2JB 020 8668 5667 020 8763 0875 esthercarehomes@hotmail.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Kalyani Kalaiyalagan Sathiavathy Jeyarany Nesarajah Kalyani Kalaiyalagan Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Esther Care Home Ltd DS0000035826.V363254.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 categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 8 2nd October 2007 Date of last inspection Brief Description of the Service: Esther Care is a privately run care home that provides personal support for up to 8 generally older adults (i.e. 40 and over) with moderate to severe learning disabilities. One person currently residing at the home is a permanent wheelchair user. Mrs Kalyani Kalaiyalagan, who co-owns the service with her mother Sathiavathy, remains the registered manager and continues to be in operational day-to-day control of the home. This detached Victorian property is perched on top of a hill in a quiet residential suburb in Purley. The home is within easy walking distance of the centre of Purley, which is well served by a wide variety of local shops, cafes; take aways, pubs, and banks. The home is also relatively close to a number of main line bus routes and a local train station, which has good links to Croydon and the surrounding areas. This detached property comprises of 8 single occupancy bedrooms, of which three have en-suite facilities. Communal areas include an open plan lounge/dining area; a separate activities room; large kitchen; entrance hall, walk-in larder; laundry room; cellar, and top floor office. The rear garden is well maintained and contains a wide variety of well-established trees and shrubs, although the lawn is not particularly accessible as it lies on a steep slope. People who use the service are offered copies of the homes Statement of Purpose and Residents Guide. People who use the service are currently charged £655 to £1,013 a week for facilities and services provided. Esther Care Home Ltd DS0000035826.V363254.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This service has an unchanged quality rating of 1 star. This means the outcomes experienced by the people who use the service remains adequate. From all the available evidence gathered during the inspection process the Commission for Social Care Inspection (CSCI) has judged the service as having some strengths, but also areas of particular weakness that have placed the people who use the service at risk of harm. The home has been required to provide us with an improvement plan setting out how it intends to rectify major breaches with regards its fire safety arrangements, which we will monitor closely. The providers have a good track history of responding well to major shortfalls brought to their attention and we are confident these major health and safety breaches will be addressed in a timely fashion. As part of the key inspection process we also undertook a thematic probe to gather additional information about the homes safeguarding arrangements. In total we spent four hours at the home. During this unannounced afternoon visit we met all five of the people who currently use the service, the registered manager/co-owner, and two relatively new support workers. We also looked at a variety of records and documents, including the care plans for two people we selected to case track their care. The remainder of this site visit was spent touring the premises. We received comment cards from the relative of one person who uses the service and a member of staff who works there. We also spoke at length to two care managers who represented a number of people who lived at the home. Finally, the proprietor completed and returned an Annual Quality Assurance Assessment (AQAA) that tells us about the service, how it makes sure of good outcomes for the people using it, and any future developments that are being planned. What the service does well: Two people who live at the home told us they feel well cared for. Some of the comments made by them included, “I like it here”, and “I’ve lived here a long time - this is my home”. One relative wrote on a comment card, “the home offers a good general standard of living, and there’s nothing it could improve”. We saw that staff relate well with the people who live at Esther care and the atmosphere remained relaxed and pleasant throughout the course of this afternoon inspection. Typical comments made by people who lived there about staff included, “staff are nice”, “they listen to me”, and “my keyworker takes Esther Care Home Ltd DS0000035826.V363254.R01.S.doc Version 5.2 Page 6 me out a lot”. The home was also able to demonstrate it is very responsive to different peoples race, culture, religion, age, and gender needs and wishes. For example, comments made by people who use the service and records revealed the diverse faiths and cultural backgrounds of the people who use the service are always respected by staff who provide them with a number of different opportunities to attend various places of worship, to eat culturally specific food, and to buy clothes and jewellery that reflect their cultural heritage. Furthermore, the home is commended for ensuring the ethnic, gender and age mix of the current staff team is well matched to that of the people living at the home. The home is also very good at ensuring the families of people who use the service are able to keep in touch with their loved ones and can remain involved in lives. What has improved since the last inspection? We can confirm that as stated in the homes AQAA the management have responded well to the majority of the requirements identified in its last inspection report. All the requirements addressed in the past six months are listed below: All the people who use the service have now been supplied with an update written and costed contracts that set out their terms and conditions of occupancy, which includes details about the fees charged for services and facilities provided. People who use the service now have more of an informed choice about what they can eat at meal times. New wooden flooring has replaced the old threadbare carpet that was fitted in the large entrance hall and dinning room areas, and a more suitable locking device has been fitted to the ground floor toilet door. At least one member of staff on each shift is now suitably trained to carry out first aid in an emergency. The home’s fire alarms system is now being tested on a weekly basis and appropriate records kept. The home has also implemented a number of good practice recommendations made at its last inspection including, introducing more easy to read care plans and assessing the training needs and strengths of the staff team. Esther Care Home Ltd DS0000035826.V363254.R01.S.doc Version 5.2 Page 7 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. Esther Care Home Ltd DS0000035826.V363254.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 Esther Care Home Ltd DS0000035826.V363254.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 5 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service have good information about the home in order to make an informed decision about whether the service is right for them. Arrangements for charging the people who live at the home for facilities and services provided have been improved to make them more open and transparent. This enables people who use the service and their representatives to determine whether or not the home is providing value for money. EVIDENCE: The home’s Statement of Purpose and Service User Guide were made available on request. These documents contained all the information people who use the service and their representatives needed to know about the home including what services and facilities it provides. The information is available in easy to read and understand formats that are suitable for the people who use the service e.g. The Guide is written in plain English and is illustrated with all manner of coloured photographs, pictures, and symbols. Esther Care Home Ltd DS0000035826.V363254.R01.S.doc Version 5.2 Page 10 The proprietor told us that despite having a number of vacant bedrooms the service had not received any new referrals in the six months. All the people currently residing at Esther care have lived there for sometime and the proprietor told us she would only accept new referrals on the grounds they would be compatible with the long standing service user group. Typical comments made by people who use the service included, “I like all the people who live here” and “they are my friends”. As required in the home last inspection report the manager told us all the people who use the service have now been provided with written, signed and costed contracts that set out in detail their terms and conditions of occupancy, including what they and their representatives can expect to pay for facilities and services provided. Esther Care Home Ltd DS0000035826.V363254.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans reflect what is important to the individual, their capabilities, and what support they need to achieve their personal aspirations. The people who use the service are encouraged to participate in the day-today running of the home and consulted about important decisions that affect their lives. In the main people who use the service are protected by the home’s arrangements for assessing and management risk which promotes their independence and choice. EVIDENCE: Esther Care Home Ltd DS0000035826.V363254.R01.S.doc Version 5.2 Page 12 It was evident from the two care plans selected for case tracking that they are person centred and are agreed with the individual. The plans are written in plain language, are easy to understand, and look at all areas of an individual’s life. One support worker spoken with at length clearly had the skills and ability to support the individual they keyworked to be involved in the ongoing development of their plan. Throughout this afternoon visit the two support workers on duty were observed interacting with the people who used the service in a very kind and professional manner. On more than one occasion staff were seen listening to what someone who used the service had to say and then taking appropriate action to facilitate their wishes e.g. offering a choice of hot drinks and destination for that afternoons community based activity. As required in the home’s last inspection a far more comprehensive set of risk assessments that covered every aspect of service users lives were now available. It was evident from the information contained in these assessments that the manager has a positive approach to managing identified risks ensuring people who use the service are able to take ‘responsible’ risks as part of a structured programme to enable people to continue developing their independent living skills safely. Esther Care Home Ltd DS0000035826.V363254.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, & 17 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the main the people who use the service have a relatively good range of age appropriate and stimulating recreational activities to engage in within the home, although there remains scope to improve the quality of the community based outings, especially in the evenings and at weekends. This will ensure the people who use the service have far greater opportunities to live more fulfilling and interesting lives within the local community. Excellent arrangements are in place to enable the families of people who use the service to continue their involvement in the lives of their loved ones. Dietary needs and preferences are well catered ensuring the people who use the service are provided with daily variation, choice, and nutritionally wellbalanced meals. EVIDENCE: Esther Care Home Ltd DS0000035826.V363254.R01.S.doc Version 5.2 Page 14 On arrival all five of the people who reside at Esther Care were out attending various day centres. Two daily diary notes sampled at random showed that in the past three months these individuals had participated in a wide variety of stimulating activities including, horses riding, swimming, walks in the park, drives, in-house music and art sessions, puzzles, and watching television. The two people spoken with at length who reside at Esther Care told us ‘they went out a lot’ and that ‘they never got bored’. Daily diary notes examined in depth revealed that staff continue to support one individual to practice their religious beliefs by actively encouraging them to attend a local Temple each month. These positive comments not withstanding typical comments made by care managers and staff who worked at the home about the type of social and leisure activities on offer included, “there are lots of opportunities for people to do things in the home, but we could go out more”, “we need to improve the variety of outings we go on, especially in the evening and at weekends”, and “activities provided aren’t bad, but I think my client would benefit from having more opportunities to engage in more stimulating activities in the local community”. The proprietor also conceded this point in the home’s (AQAA), which states in the section entitled, ‘what we could do better’ - ‘Social activities to be improved. Social and recreational activities could be expanded to include staff getting more involved.’ One person who uses the service told us they had spent the weekend visiting relatives, which they do on a regular basis. It was evident from comments made by staff that the home continues to operate an open visitors policy without restrictions and that families are actively encouraged to remain involved in supporting their loved ones. One relative told us “staff at the home always makes me feel welcome when I visit”. The proprietor told us relatives are also actively encouraged to join them on group outings, for which the service is commended. As a good security and fire safety measure the proprietor insisted on my arrival and departure I sign the visitors book to enable staff to closely monitor who is in the home at any given time. Both the care plans examined in depth contained structured programmes that set out in detail what sort of routine chores they were expected to be responsible for around the house. One person spoken with told us staff help them to tidy their bedroom, do their laundry and set the dinning table for meals. It was evident from the typical comments made by staff on duty at the time of this visit that they are committed to ensuring the people who use the service are actively encouraged to do more things for themselves. One member of staff spoken with at length demonstrated a good awareness of the specific dietary requirements of a number of different services users who practiced a variety of faiths. The home continues to maintain a record of all the food served each day, which showed Monday nights, was still curry night. Esther Care Home Ltd DS0000035826.V363254.R01.S.doc Version 5.2 Page 15 Records showed the curries served changed from week to week and matched the food preferences and cultural heritage identified in a number of peoples care plans. Two people spoken with about food at the home both told us ‘they looked forward to having curry on Monday nights’ and ‘can always ask to have something else if they don’t fancy what’s on the published menu that day’. During the visit a member of staff was observed preparing a lamb casserole and assorted vegetables for supper. The meal appeared to be nutritionally well balanced and smelt very appetising. The member of staff told us main meals are always served with a dessert and we noted a bowl of fresh fruit was available in the dinning room, which people could help themselves too. During a tour of the kitchen we found the fridge and freezer were well stocked with a wide variety of fresh and healthy foodstuffs. Esther Care Home Ltd DS0000035826.V363254.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person is treated as an individual and the care home is very responsive to people’s cultural heritage and preferences. Suitably robust arrangements are in place to ensure the people who use the service receive personal support in the way they prefer and require, and that their unique physical and emotional health care needs are continually recognised and met. Policies and procedures for handling medication are sufficiently robust to ensure people who are unable to manage their medication themselves receive the support they need to keep them safe. EVIDENCE: Esther Care Home Ltd DS0000035826.V363254.R01.S.doc Version 5.2 Page 17 All five service users met during this visit were suitably dressed in wellmaintained clothes that were appropriate for the time of year. One individual was wearing an outfit that reflected their cultural heritage. A member of staff told us this individual prefers to wear this style of clothing and also loves to wear matching jewellery and accessories. A care manager spoken with over the telephone told us they thought the home was particularly good at meeting the specific cultural preferences of the people who use the service. The proprietor is commended for arranging for specially tailored clothes to be sent from Asia to meet this particular individuals style and size requirements. Information contained in the two care plans being case tracked showed people’s personal healthcare needs are clearly identified and action plans are in place to meet them. Staff maintain records of all the appointments people who use the service attend with health care professionals, who included GP’s, community based nurses, dentists, opticians, and chiropodists. Records kept of all the accidents and incidents that had occurred in the home since it was last inspected showed staff on duty had appropriately dealt these with at the time. Staff administer medication to people living at the home safely and keep accurate records of all medicines received, administered and returned to the dispensing pharmacist. No recording errors were noted on medication administration (MAR) sheets sampled at random. These records reflected current medication stocks held by the home on service users behalves, which were securely stored in a locked metal cabinet in the dinning room. The proprietor stated in its (AQAA) that the service does not currently hold any ‘as required’ (PRN) or Controlled Drugs. Esther Care Home Ltd DS0000035826.V363254.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): 22 & 23 People who use the 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’s arrangements for dealing with concerns and complaints are sufficiently robust and understood by staff to ensure people who use the service feel listened too and safe. In the main the homes safeguarding arrangements are sufficiently robust to protect the people who use the service, although they are still being placed at unnecessary risk of harm and/or abuse because less that half the people working at the care home have received safeguarding vulnerable adults training. EVIDENCE: Two people who use the service were spoken with at length about if they felt staff listened and acted upon their views. Both individuals told us they felt able to speak to all the staff that worked at the home, but would prefer to speak to the proprietor or their keyworkers first. One person told us they could always talk to their relative if they were not happy about something at the home. Both agreed that the proprietor and staff always take their views seriously and would act on what they had told them. Finally, both individuals told us they had been given a leaflet that told them what to do if they were unhappy and that staff had also spoken to them about what they could do if they didn’t feel safe. Esther Care Home Ltd DS0000035826.V363254.R01.S.doc Version 5.2 Page 19 A record of the one formal complaint made about the home’s operation in the past six months was made available on request and included, the nature of the complaint and what action the proprietor had taken in response. The complaints log showed this had been taken seriously, dealt with in a timely fashion and appropriate action taken to remind staff about maintaining of clothes responsibilities. The proprietor demonstrated a good understanding of what the term safeguarding meant and was able to produce the local authorities safeguarding procedures and a copy of the Department of Health’s ‘no secrets’ on request. The proprietor was also able to produce copies of the homes own safeguarding and whistle blowing policy documents. These policies referred to the role played by external organisations such as the police, the local authority, and the CSCI in safeguarding matters and the proprietor was able to demonstrate a good understanding of their responsibilities with regards safeguarding matters. One allegation of abuse has been made within the home in the past six months, which the proprietor reported to the appropriate external organisation in a timely fashion in accordance with local safeguarding protocols. The local authority investigated the matter, which was not upheld due to the evidence being inconclusive. The proprietor was aware what a Protection Of Vulnerable Adults (POVA) referral was, but despite knowing this she was not aware she would be the one who was ultimately responsible for making it. The home does not have a POVA policy and the proprietor was unclear about how to go about making such a referral. The home recently up dated staff skills and training needs assessment showed that less than 50 of the current staff team had received any safeguarding training. The proprietor told us she was fully aware of this training need and was in the process of arranging dates with the local authority to rectify this shortfall. Staff met demonstrated a good understanding of what to do if they witnessed or suspected abuse within the home and confirmed they had read and understood the homes whistle blowing procedures. The procedure is rather hidden away in a folder in the top floor office. We therefore recommend the proprietor consider making this policy more accessible by displaying in a more conspicuous place Two people who use the service told us they feel safe living at Esther Care and one person met clearly knew about their rights and what to do if they felt abused or neglected having recently made such a disclosure to staff at the home. As previously mentioned in this report the matter was appropriately dealt with by the proprietor in line with local safeguarding protocols. Esther Care Home Ltd DS0000035826.V363254.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): 24, 27, 28 & 30 People who use the 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 home’s décor, fixtures, and fittings are kept in good condition, which ensures the people who use the service live in a relatively homely and comfortable environment. The home’s arrangements for controlling infection are sufficiently robust to ensure the people who use the service also live in a very clean and safe environment. EVIDENCE: Esther Care Home Ltd DS0000035826.V363254.R01.S.doc Version 5.2 Page 21 People spoken to were happy with their environment. Typical comments included, “I like my bedroom” and “I often sit in the games room”. We saw the home generally provides the people who use the service with a relatively pleasant and comfortable place to live. Furnishings and fittings remain domestic in appearance and are relatively well maintained. The main lounge/games room remains the most popular venue for people who use the service to congregate when they are not in their bedrooms. Since the home’s last inspection the threadbare carpet that was fitted in the dinning room and large entrance hall has been replaced with some new wooden flooring. During a tour of the premises it was noted that all the communal areas were spotlessly clean. A care manager spoken with told us the home is always kept clean and tidy. A number of the bedrooms were viewed on this site visit. The proprietor told us she was still developing a time specific programme to redecorate the one bedroom that was in urgent need of upgrading. The loose lock that was fitted to a toilet door on the ground floor has also been replaced with a more secure locking device that can be overridden by staff in case of an emergency. Both the proprietor and a member of staff told us based on an occupational therapist assessment an individuals en-suite bathroom was being adapted to enable them to access their bedroom with greater ease. No work has been carried out to replace the rather worn out bathroom on the first floor. A number of tiles are now missing from the walls in this bathroom and the proprietor conceded this room was in urgent need of up grading. Progress made to address both these matters will be assessed at the homes next inspection. Records are appropriately maintained of regular checks carried out by staff on hot water emanating from the homes baths. Results showed that en-suite facilities remain at a constant 40-41 degrees Celsius, while the water emanating from the bath on the first floor routinely fluctuates between 36 and 38 degrees Celsius. The temperature of hot water emanating from this bath at 13.25 on the day of this inspection was found to be a very low 29 degrees Celsius. The temperature of hot water used in baths should be close to 43 degrees Celsius at all times and the home will need to review its water temperature control arrangements. Documentary evidence was made available on request to show that sufficient numbers of the current staff team had either received infection control training or were scheduled to attend a suitable course by the end of the year. Esther Care Home Ltd DS0000035826.V363254.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): 32, 33, 34, 35 & 36 People who use the 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 persons working at the home have been suitably trained or supervised. The home’s variable approach to training and supervision needs to be improved to ensure all persons working there have all the relevant knowledge and skills to meet the supports needs and wishes of the people who use the service. The home’s recruitment procedures are sufficiently robust to minimise the risk of service users being harmed and/or abused by people who are ‘unfit’ to work with vulnerable adults. EVIDENCE: Both support workers on duty at the time of this site visit were observed interacting with all five people who currently use the service in a very caring and respectful manner. Typical comments made by two people who use the service included, “I like all the staff who work here”, “In know who my keyworker is and I can speak to them if I’m unhappy”, and “all the staff are nice”. Esther Care Home Ltd DS0000035826.V363254.R01.S.doc Version 5.2 Page 23 Staff duty rosters sampled at random and the numbers found to be working on the afternoon of this unannounced inspection were adequate to meet the needs of the people using the service. It was also noted that the ethnic, age, and gender mix of the current staff team matched that of the service user group. E.g. the home now employs a number of middle aged British Asian as support workers. The proprietor told us she believed the recruitment of good quality carers was the cornerstone of delivering good outcomes for the people who use the service and was very keen to ensure the right people for the job are employed. Information held by the home in respect of its most recently recruited member of staff indicated that the proprietor had carried out all the relevant checks before allowing this individual to commence working at the home. This included; a completed application form, two written references, up to date Criminal Records Bureau and Protection of vulnerable adults checks, proof of their identity, Home Office approved visas where applicable, and induction records. The home’s most recently recruited member of staff was spoken with at length during this visit. They told us they had received a thorough induction before being allowed to commence working at the home. Documentary evidence was produced on request to show the induction process is linked to Skills for care and covered safe working practices, worker role, and the needs of the people using the service. The proprietor has carried out a thorough assessment of the training needs and strengths of her current staff team as recommended at the last inspection. The assessment revealed a large number of gaps in the staff teams knowledge and skills with approximately 50 of the people working there needing to receive suitable training in fire safety, moving and handling, and food hygiene. The manager told us she was in the process of arranging dates for these training shortfalls to be rectified. We also recommended all the homes staff team who provide personal care attend a person centred care planning course. We will monitor closely progress made by the service to address this issue. Following a requirement at the home’s last inspection sufficient numbers of staff (i.e. at least one per shift) are now suitably trained to carry out first aid in an emergency. The personal files held in respect of the two staff on duty at the time of this visit and one other selected at random revealed that only the home’s most recently recruited member of staff had received any formal supervision sessions with the manager in the past six months. One member of staff spoken with told us they could not remember the last time they had supervision. Furthermore, the proprietor told us that none of the people who worked at the home have had their job performance appraised recently. We recommend a system be introduced for this to be carried at least once a year. Esther Care Home Ltd DS0000035826.V363254.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): 37, 38, 39 & 42 People who use the 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 relatively well run, although people who live their would benefit from having a manager who up dates her existing knowledge and skills at more regular intervals. Adequate quality assurance and monitoring systems are in place that allow the views of the people who use the service to influence homes operation and development. The people who use the service are being placed at unnecessary risk of harm because not all the home’s fire safety measures are sufficiently robust to promote and protect their health and welfare. Esther Care Home Ltd DS0000035826.V363254.R01.S.doc Version 5.2 Page 25 EVIDENCE: Staff met told us they liked the management style of the proprietor and found her to be very approachable. The manager holds a National Vocational Qualification Level 4 in management and care, but has not undertaken any additional training to up date her existing knowledge and skills for neatly two years. We repeat the recommendation that the proprietor should be making more of a concerted effort to continually up date her knowledge and skills base. Records revealed the proprietor arranges for staff meetings to be held once every two months to ensure they have the opportunity to influence how the home is run. Topics covered at the last meeting included, the changing needs of several people who used the service and health and safety matters. The quality assurance system the proprietor introduced recently is based on seeking the views of a number of the homes major stakeholders including, people who use the service, their relatives, and other professional representatives. The system is relatively comprehensive, although it does not include any learning achieved as a result of the homes most recent safeguarding referral. The home’s fire risk assessment for the building has not been up dated to include all the information a representative from the London Fire and Emergency Planning Authority (LFEPA) notified the proprietor was missing from the document following their recent visit. Furthermore, none of the homes staff or service users have participated in a fire drill for over six months, despite an identical fire safety breach being identified at the homes last inspection. The original breach was resolved within 24 hours after we issued the home with an immediate requirement notice. As a consequence of the proprietors persistent failure to rectify this matter the home was issued with a warning letter on 21/05/08 making it clear that one more breach of this fire safety regulation would result in the Commission taking enforcement action to ensure future compliance. Suitable arrangements are now in place for the fire alarm system to be tested on a weekly basis. Certificates of worthiness produced on request show the homes fire alarm system; extinguishers and portable electrical appliances have all been tested by a suitably qualified engineer in the past year. All the fire doors tested at random on the ground closed flush into their frames when released. During tour of the kitchen it was noted that some prepared food that had been placed in a covered bowl had not been labelled or dated contrary to environmental health guidelines. A member of staff on duty addressed this matter at the time of this inspection. Esther Care Home Ltd DS0000035826.V363254.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 2 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 3 X 2 3 3 X X 1 X Esther Care Home Ltd DS0000035826.V363254.R01.S.doc Version 5.2 Page 27 Yes 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 YA13 Regulation Requirement Timescale for action 01/09/08 16(2)(m) (n) People who use the service must be supported (as far as reasonably practicable) to attend a wide variety of community-based social, leisure, and recreational activities, especially in the evenings and at weekends. 13(6) Safeguarding vulnerable adults training must be provided for all staff that work at the home. This will ensure the people who use the service are protected (so far as reasonably practical) from harm and/or abuse. The way in which the service ensures the temperature of hot water used in baths remains close to 43 Degrees Celsius at all times must be reviewed as a matter of urgency. This will ensure the people who use the service can take a bath in suitably warm water at any time. 2. YA23 01/09/08 3. YA27 12(1)(a) 15/05/08 Esther Care Home Ltd DS0000035826.V363254.R01.S.doc Version 5.2 Page 28 4. YA35 23(4)(d) Fire safety and prevention training must be provided for all staff that work at the home. This will ensure the people who use the service are (so far as reasonably practical) kept safe. A warning letter was issued on 21st May 2008 reminding the proprietor about her fire safety responsibilities. Suitable lifting training must be provided for all staff that work with people that have been assessed as having difficulty moving themselves. This will ensure the safety of the people who use the service and staff. Basic food hygiene training must be provided to all staff who handle food in the home. This will ensure the safety of the people using the service. All staff that work in the home must be involved in at least one fire drill every six months (we recommended once a quarter). This will ensure the safety of the people using the service. Previous timescale for action of 3rd October 2007 set out in immediate requirement notice issued at the time of last inspection met. However, provider has subsequently failed to meet this requirement in the intervening six months. Warning letter issued on 21st May 2008. 01/07/08 5. YA35 13(5) & 18(1) 01/09/08 6. YA35 18(1) 01/09/08 7. YA42 23(4)(e) & 17(2), Sch 4.14 15/05/08 Esther Care Home Ltd DS0000035826.V363254.R01.S.doc Version 5.2 Page 29 8. YA42 23(4A) The fire safety risk assessment for the home must be reviewed as a matter of urgency and up dated to reflect all the requirements made by the local fire authority. This will ensure the people who use the service are (so far as practical) kept safe. A warning letter was issued on 21st May 2008 reminding the proprietor about her fire safety obligations. 01/06/08 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 YA23 Good Practice Recommendations The service should have a protection of vulnerable adults (POVA) policy and procedure in place to ensure the proprietor knows what to do if she needs to make a POVA referral. The whistle blowing policy should be more prominently displayed in the home. This will ensure this information is more accessible to people who work at the home. The one bedroom that has not been redecorated for some considerable time should be up graded to ensure all the people who live at the home occupy atheistically pleasing rooms. This recommendation was made at the homes last key inspection and is repeated in this report because it was not implemented. A rolling programme to up grade the first floor bathroom suite and retile the walls in a timely fashion should be established. This recommendation was made at the homes last key inspection and is repeated in this report because it was not implemented. 2. YA23 3. YA26 4. YA27 Esther Care Home Ltd DS0000035826.V363254.R01.S.doc Version 5.2 Page 30 5. YA35 Person centred care planning training must be provided for all staff that directly support the people who use the service. This will ensure they receive the person centred support that meets their identified needs and wishes. All staff working at the home should be supervised at more frequent intervals and appropriate records kept of the outcomes of these meetings. This recommendation was made at the homes last key inspection and is repeated in this report because it was not implemented. The way in which the service appraises the performance and training needs of the staff team should be reviewed to ensure this is undertaken on an annual basis. This will help the manager plan staff development programmes and ensure her staff team are suitably qualified and competent to meet the needs of the people who use the service. The proprietor should up date her knowledge and skills at more regular intervals to ensure she remains suitably trained to run a residential care home for adults with learning disabilities. This recommendation was made at the homes last key inspection and is repeated in this report because it was not implemented. 6. YA36 7. YA36 8. YA37 Esther Care Home Ltd DS0000035826.V363254.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Esther Care Home Ltd DS0000035826.V363254.R01.S.doc Version 5.2 Page 32 - 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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