Inspection on 19/06/06 for Esther Care Home Ltd

This inspection was carried out on 19th June 2006.

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 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Esther Care Home Ltd 13/05/08

Esther Care Home Ltd 02/10/07

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 08/07/2008.

CARE HOME ADULTS 18-65 Esther Care Home Ltd 15 Russell Hill Purley Surrey CR8 2JB Lead Inspector Lee Willis Key Unannounced Inspection 19th June 2006 09:30 Esther Care Home Ltd DS0000035826.V289532.R01.S.doc Version 5.1 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.V289532.R01.S.doc Version 5.1 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.V289532.R01.S.doc Version 5.1 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 esthercarejhomes@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) Mrs Kalyani Kalaiyalagan Mrs Sathiavathy Jeyarani Nesarajah Mrs Kalyani Kalaiyalagan Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Esther Care Home Ltd DS0000035826.V289532.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd November 2005 Brief Description of the Service: Esthercare is a privately run home that is registered to provide personal care and support for up to 8 younger adults (18-65) with moderate to severe learning disabilities. All 5 service users currently residing at the home are aged forty and over. Mrs Kalyani Kalaiyalagan, who co-owns the service with her mother Sathiavathy, is also the registered manager. This detached Victorian property is perched on top of a hill in a quiet residential suburb in Purley. The home is less than a quarter of a mile from the centre of town, which is well served by a wide variety of local shops, cafes, take-aways, pubs, and banks. The home is also within fifthteen minutes walk of several main line bus routes and a local train station with good links to central Croydon, London, and the surrounding areas. This detached Victorian property comprises of 8 single occupancy bedrooms, of which three have en-suite facilities; a main open plan lounge/dining area; a large separate activities/visitors room; kitchen; walk-in larder; laundry room; cellar, and top floor office. The sloping gardens at the rear of the property are reasonably well maintained, but not particularly accessible. Service users have all been offered copies of the homes Statement Of Purpose, new Residents Guide, and Occupancy Agreements. These documents contain all the information prospective service users need to know about the services and facilities provided and what fees they can expect to pay, which currently stands at between £638 - £991 a week. Esther Care Home Ltd DS0000035826.V289532.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This service has more strengths than weaknesses, although the proprietor acknowledges that there are still areas of significant weakness where important elements of key National Minimum Standards are not being met. The proprietor is required to provide the Commission with an improvement action plan, which we will use to monitor progress. The actual site visit was unannounced and was carried out on Monday 19th June 2006 between 9.30am and 2.15pm. During the course of this four and three quarter hour inspection only one service user was met. The remainder of this site visit was spent talking to the homes Registered co-owner/manager and deputy, examining records, and touring the premises. A relatively new support worker who was on duty at the time, was also met, albeit briefly. Prior to the visit four comment cards were received by the Commission, of which two had been completed by service users relatives, one by a service users Care Manager representing their placing authority, and the last by a local GP. A reviewing officer representing another service users funding authority was also contacted by telephone to ascertain their views about the service following their recent visit to the home. The proprietor completed a preinspection questionnaire prior to the visit taking place and was also given an equalities survey to fill. What the service does well: All the written and verbal feedback received from service users relatives and their professional representatives was very favourable about the home. One relative wrote ‘Staff always give my (Next of Kin) all the support, care and encouragement they need so that they feel safe, comfortable and happy’, and another service users Care manager said ’they were impressed with the professionally manner in which the proprietor conducted their ‘clients’ annual care plan review and the positive attitude of all the staff met during their visit’. The one service user who was a home at the beginning of this site visit appeared to be well cared for and seemed to have a good working relationship with the relatively new member of staff who was providing them with one-toone support at the time. Staff files inspected at random showed that in the main sufficient numbers of staff were suitably trained to carry out their duties effectively. Esther Care Home Ltd DS0000035826.V289532.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? Where weaknesses have emerged in the past the proprietor has always acknowledged them and generally managed them well. The Commission accepts the registered co-owner/managers and her deputy’s comments that the service continues to improve. Since the homes last inspection the proprietor has introduced a new service user ‘friendly’ guide that is written in plain English and illustrated with all manner of coloured photographs and pictures, making it far more accessible to the people for whom the service is intended. Furthermore, written terms and conditions of occupancy now set out in far greater detail what services and facilities people will be expected to be charged ‘extra’ for and care plan contain more detailed information about each service users specific cultural and religious needs. There have been no significant changes made to the physical layout of the home in the past six months, although as recommended in a recent Occupational Therapy report suitable grab rails have now been fitted to stairs and showers cubicles to ensure these areas are much safer for service users to access. In the past six months a new cooker, fridge/freezer, and microwave have all been purchased for the kitchen. The homes recruitment practices have significant improved since the homes last inspection with suitably robust arrangements in place to ensure all new recruits are not permitted to commence working at the home until they have been checked against the Criminal Records Bureau (CRB) and Protection Of Vulnerable Adults (POVA) registers and supplied two satisfactory references. It was positively noted that one new member of staff, despite being appointed, has still not been allowed to start work because they have been unable to provide the home with a second reference from their last employer. Sufficient numbers of staff have recently attended moving and handling training and the proprietor has finally been awarded a National Vocation Qualification Level 4 in both management and care. Finally, after a number of delays and false starts the proprietor has now managed to introduce a professionally recognised self-monitoring system that uses satisfaction questionnaires to ascertain the views of service users relatives and professional representatives to assure the quality of the service provided. The new system has already proved useful with action taken to resolve issues raised about the effectiveness of the homes arrangements for communicating with external agencies. Esther Care Home Ltd DS0000035826.V289532.R01.S.doc Version 5.1 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. Esther Care Home Ltd DS0000035826.V289532.R01.S.doc Version 5.1 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.V289532.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 5 Quality in this outcome area is good. This judgement has been made using all the available evidence. Prospective service users and their representatives have the vast majority of information they need to make an informed choice about the standard of care provided by the home, although the homes Statement of purpose and more formalised Residents guide needs to be updated at more regular intervals and include the views of service users/representatives regarding the standard of care provided. Significant progress has been made to introduce a service user ‘friendly’ guide to the home that is far more suitable for the people for whom the service is intended. Sufficiently robust arrangements are in place to ensure no prospective service users are admitted without their unique aspirations and needs being thoroughly assessed to determine whether or not the placement is capable of meeting their needs. Each service user and their representatives are provided with a written contract that clearly states what services and facilities they can expect to receive and how much they will be charged for them. Esther Care Home Ltd DS0000035826.V289532.R01.S.doc Version 5.1 Page 10 EVIDENCE: The home helps prospective residents and their representatives to understand the service by providing them with a Statement of Purpose and guide. These documents set out what the homes aims and objectives, the philosophy of care that underpins its practice, and the services and facilities it provides. It was positively noted that a far more service user friendly guide is now available in addition to the more formalised version. The new residents guide is written in plain English and illustrated with all manner of coloured photographs, pictures and symbols. The vast majority of information that is not included in the new guide, which prospective service users and their representatives need to know about the service, is available from other sources, including the homes Statement of purpose. The manager conceded that the homes Statement of purpose/guide has not been reviewed for over a year and nor does it make any reference to the availability of CSCI reports. The deputy manager has recently carried out some research into people’s views about the service, which the Commission recommends she publish the results in the resident’s guide. In the past six months one service user has moved leaving the home with three vacancies. In this period three new referrals were received by the home, although none were accepted. It was positively noted that the proprietor undertook a thorough assessment of their needs. In each case the proprietor concluded that her staff team either did not have the necessary skills and experience to meet their individual needs or their admission would most likely have an adverse affect on the health and welfare of the existing group of residents. The proprietor has clearly demonstrated that despite having a number of long-term vacancies she is not prepared to compromise the health and welfare of the service users who currently reside there just to fill empty beds. Two service users files being case tracked contained written and costed contracts agreed between the service user/their representatives and the home that set out their terms and conditions of occupancy, including the fees they could be expected to be charged for services and facilities provided, and how much they would be expected to pay for so called ‘extra’ services not covered by the basic price of their placement. It was explicit from these contracts that newspapers, hairdressing, dry cleaning, holidays, private chiropody, dentist and opticians, and ‘personal’ use of the homes vehicle, were all considered additional services which service users and their representatives would be charged ‘extra’ for. Esther Care Home Ltd DS0000035826.V289532.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using all the available evidence. Each service users care plan is kept under review to ensure these documents accurately reflect their unique changing needs and personal goals. Overall, the service users are actively supported to take ‘responsible’ risks as part of structured programme to promote independence and choice, although more detailed guidance regarding one individuals challenging behaviour needs to be established to enable staff to deal more effectively with such incidents. EVIDENCE: The two care plan inspected covered every aspect of the individual’s service users unique personal, social, and health care needs. Both these plans had been formally reviewed in the past six months and up dated accordingly in reflect any changes in need. In attendance at these review meetings had been the service user, their keyworker, the homes manager, a reviewing officer representing the relevant placing authority, and where applicable, the service users next of kin. The deputy manager said service users representatives are always invited to attend their annual care plan review and went onto to say it Esther Care Home Ltd DS0000035826.V289532.R01.S.doc Version 5.1 Page 12 was customary to allow service users significant others two chances to reschedule a proposed review date before going head regardless. A reviewing officer spoken with over the telephone confirmed that they had been invited to attend their client’s last annual review and were impressed with the professional manner it was conducted. In addition to these annual review meetings it was positively noted that less informal in-house reviews are continually held on a monthly basis and care plans up dated accordingly by each service users designated keyworker to reflect any changes in need. The two care plans being case tracked also included up to date assessments that set out in detail any action to be taken by staff to minimise risks associated with service users behaviour or activities they might engage in. It was clear from entries made in one service users daily diary notes and comments made by the managers that this particular individuals needs had significantly altered in recent months. More specific guidance to enable staff to have a better understanding and therefore help them deal more effectively with this type of challenging behaviour needs to be included in the individuals care plan. The manager said that none of the service users currently have advocates, although they are all on a waiting list to join local schemes in the area. Esther Care Home Ltd DS0000035826.V289532.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using all the available evidence. The social, leisure and recreational opportunities the service users have to engage in, both at home and in the wider community, appear to be well managed, ‘age’ appropriate, and provide daily variety and stimulation. Service users dietary preferences and needs are well catered for and the menus nutritionally well-balanced and varied providing daily interest for the people living at the home. Esther Care Home Ltd DS0000035826.V289532.R01.S.doc Version 5.1 Page 14 EVIDENCE: Only one service user was at home during this site visit, all the rest were out attending sessions at various local day and resource centres. The manager said that discussions are on going with senior managers representing the Local Authority regarding future arrangements for day care provision in the area now the Councils proposals to close down a number of day centres is being implemented. The deputy manager said this summer arrangements had already been made for all five service users to go on holiday together to Blackpool for a week. During the visit the one service user who was at home went out with a member of staff to have lunch at a local Hindi Temple. The specific spiritual needs of the two service users being case tracked were included in their care plans. As a large proportion of the service users and staff are all practicing Hindus the proprietor said they were planning to do something special in the house this year to celebrate the Hindi Festival of Diwali. The deputy manager said all the service users have the opportunity to attend special services held at a local church once every three months or so. It was evident from the number of entries made in the homes visitors book, which is conspicuously displayed in the entrance hall, that the service continues to operate an open visitors policy. As previously mentioned, service users relatives are always invited to attend their loved ones review and it was evident from comments made by the manager that one service users in particular continues to spend most of their weekends away at their parents home. There is an expectation that service users who are wiling and capable of undertaking basic household chores are actively encouraged and supported to do so. It was evident from one care plan being case tracked that this particular individual is encouraged to set the dining room table before meals and vacuum their bedroom. During this visit a member of staff was observed sitting next to a service user at the table in the activity room appropriately assisting them with their midmorning cup of tea. The staff member had made sure they were sitting level with the service user to ensure eye contact and their approach was very unhurried and caring. It was clear from the service users excited reaction when the cup of tea and plate of biscuits were appeared that elevenses were part of a daily ritual in the home. Esther Care Home Ltd DS0000035826.V289532.R01.S.doc Version 5.1 Page 15 The homes weekly menus are displayed in the kitchen and are illustrated with al manner of coloured photographs to enable the service users to understand the choice of meals on offer. As all the service users were out the deputy manager there were no plans to prepare any lunch that day, although several had been helped to prepare sandwiches in the morning to take to their respective day centres. It was noted that a bag of frozen lamb was being defrosted in the kitchen preparation for the evening meal, which matched the choice advertised on that days published menu. It was positively noted that staff appropriately maintain a record of all the food consumed by service users. This record demonstrated that the service users receive a varied diet and the diverse ethnic tastes of the service users are well catered for with a combination of British, European, and Indian style cuisine served on a regular basis. The managers said Monday night was traditionally curry night and on Sundays a roast was always prepared. If beef is to be served the deputy manager said an alternative meal is always provided in for the one practising Hindu resident. This specific dietary need was recorded in the individuals care plans and the deputy said they rarely serve beef curries as this particular individual really enjoys Indian style cuisine. Esther Care Home Ltd DS0000035826.V289532.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made using all the available evidence. The home has sufficiently robust arrangements in place to ensure the health care needs of the service users are recognised and met, although the services arrangements for keeping external agencies, such as the Commission, notified about the occurrence of significant incidents involving service users needs to be improved. The homes policies and procedures for dealing with medicines ensure service users are protected from avoidable harm. EVIDENCE: On arrival the one service user who was at home was appropriately dressed for the warm weather and was noted to be wearing a well laundered t-shirt, three quarter length trousers and a pair of house slippers. The two care plans inspected both contained comprehensive overviews of each service users general health care needs. The home appropriately maintains up to date records of all the health care appointments service users attend, which revealed that in the past twelve months one service user, whose health care Esther Care Home Ltd DS0000035826.V289532.R01.S.doc Version 5.1 Page 17 needs had significantly altered in that time, had seen their GP, psychiatrist, dentist, chiropody and specialist nurses. The care manager who attended their last care plan review said they had been satisfied with the arrangements the home had put in place to ensure this particular individual received the appropriate input from all the relevant health care professionals. The homes accident book contained no new entries and the proprietor confirmed that none of the service users had sustained any major injuries in the past six months. The homes incident book revealed that one service user had sustained a scratch during a ‘fight’ with another resident. This incident was well documented, but the proprietor was reminded that the occurrence of such a ‘significant’ event, which clearly affected the welfare of the service users involved, must always be reported to the Commission without delay. The home continues to use a professionally recognised monitored dosage system and all medicines held by the home on service users behalves were found securely stored in a locked metal cabinet in the dinning room. The positioning of the cabinet, which is convenient for staff to administer from, does not look particularly homely fixed to the wall right next to table where service users eat their meals. As the physical size and layout of the property is relatively large the Commission suggests the medication cabinet is relocated to a less conspicuously place e.g. the large kitchen or first floor former staff sleep-in room. Appropriate records continued to be maintained of all medicines received and administered in the home with no recording errors noted on both the Medication Administration sheets sampled at random. These records accurately reflected the current stocks of medicines held by the home on both these service users behalves. The deputy manager said the home does not currently handle any Controlled Drugs or ‘as required’ (PRN) medication. Esther Care Home Ltd DS0000035826.V289532.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using all the available evidence. The homes arrangements for dealing with complaints and allegations of abuse appear to be sufficiently robust to ensure service users are so far a reasonably practicable protected from avoidable harm and/or abuse and that their representatives concerns will be listened to and acted upon. EVIDENCE: As previously mentioned it was positively noted that a pictorial version of the homes complaints procedure is included in the new Residents Guide. The homes complaints log revealed that no formal complaints or informal concerns had been made about the homes operation in the past six months. The proprietor said there had been no allegations of abuse made within the home in the past six months and both the manager and her deputy were fully aware of their reporting responsibilities regarding the local authorities vulnerable adult protection protocols. The home has a whistle blowing procedure in place. The balances entered on two service users financial record sheets both tallied with the amounts of money being stored in individual cash boxes held by the home on their behalves. These boxes were kept in a locked cabinet in the former staff sleep-in room. Receipts had been obtained where applicable for all the transactions undertaken by staff on service users behalves and the half a dozen or so checked at random matched the entries recorded on their individualised finance sheets. Esther Care Home Ltd DS0000035826.V289532.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using all the available evidence. Overall the physical design and layout, which is currently maintained to a reasonably standard, ensures service users are able to live in a relatively clean, comfortable, and safe environment. However, the proprietor should establish a time specific rolling programme to refurnish the kitchen and first floor communal bathroom to ensure all parts of the home continue to be reasonably decorated. The outside patio area at the rear of the property still needs to be made safe for service users, their guests, and staff to access. EVIDENCE: On arrival the home looked reasonably clean and bright, was free of offensive odours, and felt pleasantly warm. The proprietor continues to have ‘ambitious’ plans to change the physical layout of the home, but due to financial restraints these have all been put on hold. Esther Care Home Ltd DS0000035826.V289532.R01.S.doc Version 5.1 Page 20 The two service users bedrooms inspected at random were decorated to a reasonable standard and contained all the furniture and fittings specified in the National Minimum Standards. A damaged chest of drawers in a ground floor bedroom must be repaired or replaced. The temperature of hot water emanating from an ensuite shower outlet on the ground floor and a communal bath on the first floor were both found to be a safe 40 degrees Celsius at around 11.30am. Having toured the kitchen and the aforementioned bathroom the proprietor agreed that the rather old and worn out kitchen units and bathroom suite in these areas had all seen ‘better days’ and would need to be replaced sooner rather than later. It was positively noted that in the past six months the proprietor had already replaced some of the homes old kitchen equipment with a new cooker, large fridge/freezer, and microwave. Furthermore, suitable grab rails had been fitted along the length of the stairs. However, the outside patio area still needs suitable grab rails fixed and the uneven floor slabs levelled. The proprietor expressed a desire to make the sloping garden at the rear of the property more accessible by creating a level decking area. While the Commission applauds the proprietors intentions it was clear from earlier discussions that insufficient funds are currently available for implement such an ambitious scheme at present. Consequently, it is imperative that the much simpler task of making the existing patio area much safer for service users to access is made a priority. The timescale for appropriate action to be taken to address this outstanding health and safety issue will be extended for a second and final time. The homes washing machine is capable of washing clothes at appropriate temperatures and also has a sluice programme for dealing with foul laundry. The small laundry room is located on the first floor and therefore there is never any need to take dirty washing through any areas where food is stored, prepared, and/or eaten. Hand washing facilities are predominately sited in the laundry room itself. Adequate supplies of latex gloves are conveniently located throughout the home and the proprietor placed an order for more supplies at the time of this site visit. The homes cellar where laundry is often dried has to be accessed by going outside and a safety notice has now been placed above the door warning people about the low ceiling an uneven flooring in this area. Esther Care Home Ltd DS0000035826.V289532.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 Quality in this outcome area is poor. This judgement has been made using all the available evidence. In the main sufficient numbers of suitably competent and qualified staff are employed on a daily basis to ensure the service users needs are met, although the homes arrangements for ensuring staff have sufficient time of between shifts are woefully inadequate and will need to be improved to minimise the likelihood of service users being placed at risk of harm by tired staff. Furthermore, arrangements for ensuring all staff, including new recruits, receive at least one formal supervision every two months and copies of induction records are kept in the home at all times also need to be improved. All new staff must be suitably inducted and appropriately supervised to ensure service users receive continuity of care from individuals who are able to meets their needs. The homes arrangements for recruiting new staff are sufficiently robust to protect the service users from avoidable harm. Esther Care Home Ltd DS0000035826.V289532.R01.S.doc Version 5.1 Page 22 EVIDENCE: The one support worker who was on duty during midmorning was observed interacting with one service user in a very respectful and relaxed manner. During the course of this visit both the managers demonstrated a good understanding of each service users disabilities and their specific cultural and religious heritage. The proprietor said only the homes deputy manager had achieved a National Vocational Qualification in care (Level 2 or above), although one other member of staff was now enrolled on a suitable NVQ course and arrangements were being made for two others to commence their NVQ by the end of the year. The proprietor is aware that the deadline for at least 50 of her staff team to have achieved this award expired at the end of 2005. The Commission acknowledges that the percentage of care staff who had been awarded an NVQ in care was previously much higher, but had recently decreased due to circumstances beyond the proprietors control i.e. A suitably qualified member of staff recently resigned on personal grounds. At the time of arrival four staff were on duty, which included the proprietor/manager, her deputy, and two support workers. This corresponded with the information displayed on that morning’s staff duty roster. The proprietor said that during the day and at weekends there is always at least two staff on duty, which she felt was sufficient to meet the service users needs. The home continues to have a flexible approach to planning the rosters and will often employ a third member of staff to cover peak periods of activity, i.e. In the mornings and at weekends when all the service users are at home. At night one waking staff is employed while a second staff member is designated as on call to cover emergences. The duty rosters revealed this responsibility is shared amongst the staff team and the proprietor was aware that anyone assigned the task of being on call must be capable of reaching the home within twenty minutes. The staff duty rosters for the previous two months revealed that two members of staff had worked for at least ten consecutive days without a day off in between. The home is in breach of the European Time Directive and placing the service users at risk of harm from tired members of staff. The proprietor said the home is currently understaffed and is still two members shy of its full compliment, although interviews have already been carried out to appoint another new member. The proprietor must ensure suitable arrangements are in place for all staff have at least one full day off a week and is reminded that in future if the service continues to experience staffing problems then agency staff will need to be employed to cover any shortfalls. Information about the number of hours each member of staff is expected to work each week must also be recorded in each person’s terms and conditions of employment. Esther Care Home Ltd DS0000035826.V289532.R01.S.doc Version 5.1 Page 23 Since the homes last inspection two new members of staff have been recruited and as previously mentioned it was positively noted that a third member is due to commence work there as soon as they have supplied the proprietor with a second reference. Furthermore, it was also positively noted that two references had been obtained in respect of the other new recruits and where a written reference had not been provided the deputy manager had contacted there former employers by telephone and obtained a verbal reference, which she duty recorded. The files for both the homes most recent recruits contained up to date Criminal Records Bureau and Protection Of Vulnerable Adult Protection checks; job application forms; proof of their identities; and Home Office approved student visas/work permits. This information had been obtained before these individuals had been allowed to commence working at the home and the managers were both fully aware that these foreign students were only permitted to work a maximum of 20 hours a week during term time. Duty rosters sampled at random confirmed that a staff member on a student visa had worked less than 20 hours a week during the month of May 2006. The deputy manager said both the homes most recent recruits were being given structured inductions, which the one member of staff on duty confirmed. The new recruit met said their induction, which was currently on going, had so far covered safe working practices, principles of care, their role, and service users needs. Unfortunately no record of this induction was available on request because the deputy said the member of staff had taken them home. The home is reminded that all records in relation to a staff member’s employment, which includes induction training, must be available for inspection on request. The service continues to recognise the importance of training and in the main delivers a programme that meets the service users needs. As required in the homes previous report the proprietor said that sufficient numbers of her current staff team had now received training in moving and handling. Furthermore, two staff files sampled at random both contained documentary evidence to show these individuals had both recently receiving training in fire safety, basic food hygiene and health and safety. The proprietor acknowledged that a suitably qualified first aider was not always on duty, especially at night, because only three members of staff had been suitably trained to administer basic first aid. More staff also needs to attend vulnerable adult protection training and it is recommended the proprietor remind her staff team about the homes equal opportunities and racial harassment policies and procedures. Esther Care Home Ltd DS0000035826.V289532.R01.S.doc Version 5.1 Page 24 Having inspected the staff files for both the homes most recent recruits is was noted that they had only received one formal supervision session each with a suitably qualified senior member of staff despite commencing their employment at the home over four months earlier. The proprietor is reminded that it is imperative that all staff, especially new ones, have at least one formal recorded supervising session with a senior member of staff once every two months. As previously mentioned with over a third of service users and staff having the same cultural and religious heritage the ethnic mix of the home is reasonably well balanced, although the proprietor acknowledges that the largely non-white staff team is not particular representative of the white British service users, who make up over 50 of the current resident group. Esther Care Home Ltd DS0000035826.V289532.R01.S.doc Version 5.1 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42 Quality in this outcome area is adequate. This judgement has been made using all the available evidence including a site visit to this service. The service users benefits from living in a reasonably well run home which is run by two suitably qualified and competent individual managers. The home has effective quality assurance and monitoring systems in place, which enables service users, and their representatives to voice their opinions about the quality of the service provided, although the findings of any satisfaction surveys undertaken by the home still need to be published. Without access to these results service users, their representatives, and other interested parties, including the CSCI, will be unable to determine how successfully or not the service has been at achieving its stated aims and objectives. In the main the homes arrangements for testing equipment at regular intervals are sufficiently robust to ensure that so far as reasonably practicable service users are protected from avoidable harm, although its annual gas installations check was a few weeks overdue. Esther Care Home Ltd DS0000035826.V289532.R01.S.doc Version 5.1 Page 26 EVIDENCE: The registered co-owner/manager has now been awarded both the management and care components of her National Vocational Qualification Level 4 to meet this standard. It was also positively noted that both the proprietor and her deputy have arranged to attend a British Institute of Learning Disability approved dementia course in order to have a better understanding and knowledge of this topic. Minutes taken of staff meetings revealed that three had been held since the beginning of the year. These meetings had been well attended and covered a wide variety of topics including staffs laundry and keyworking responsibilities and the changing need of one service user in particular. The proprietor and her deputy have established an effective quality assurance system and have sought the views of service users and their representatives about the standard of care provided by the home by distributing anonymous satisfaction surveys. The deputy manager said she had received approximately two thirds of the surveys back from service users relatives; day centres workers and GP’s, and was currently in the process analysing the results. The deputy is fully aware that her findings must be published at least once a year for any interested parties, which includes the CSCI, to view. As previously recommended the deputy should consider incorporating her finding into the homes Statement of purpose/guide, when it is next reviewed. The home has an Equal Opportunities policy, which refers to all the relevant Anti-discrimination legislation, (e.g. Race Relations, Sex, and Disability Discriminations Acts), and its Racial harassment procedures clearly states how such incidents either between service users; by services users on staff; or by staff will be dealt with by the home. The homes fire records indicated that its fire alarm system continues to be tested on a weekly basis and fire drills involving all the service users and staff are carried at least once every six months. The last drill was carried out in May 2006 and not problems were identified. During the site visit the deputy manager tested the fire alarm system, which was clearly audible in the top floor office. Having arrived at 9.30 is was noted that three fire resistant doors on the ground floor were being inappropriately wedged open preventing there automatic closure in the event of the fire alarm being activated. If the proprietor insists on having these doors open during the day to ensure the service users have unrestricted access to all parts of the home, which includes the kitchen and games room, then automatic release mechanisms must be fitted to enable these doors to close into their frames when the fire alarm is sounded. The proprietor said they have several ‘Dorguards’ in stock and an Immediate Requirement Notice was issued for these devices to be refitted within the next 14 days. Esther Care Home Ltd DS0000035826.V289532.R01.S.doc Version 5.1 Page 27 Up to date Certificates of worthiness were in place to show that ‘suitably’ qualified engineers had checked the homes fire extinguishers, alarm system and portable electrical appliances in the past 12 months. The homes gas installations check is a few weeks overdue and will need to be resolved as a matter of urgency. All items of food kept in the new fridge were noted to be correctly stored in line with basic food hygiene standards. Esther Care Home Ltd DS0000035826.V289532.R01.S.doc Version 5.1 Page 28 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 4 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 2 27 3 28 1 29 3 30 3 STAFFING Standard No Score 31 X 32 2 33 1 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 3 1 X X 2 X Esther Care Home Ltd DS0000035826.V289532.R01.S.doc Version 5.1 Page 29 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 YA1 Regulation 5(1)(d) & 6 Requirement The homes Statement of purpose and more formalised Residents Guide must make reference to the availability of CSCI reports and be kept under constant review to reflect any changes in provision. An assessment detailing all the action to be taken by staff to minimise the likelihood of a service user self-harming, as well as the most effective method of dealing with such behaviour, must be included in the individuals care plan. The CSCI must be notified in writing and without delay about the occurrence of any significant incidents that adversely affect the health and welfare of the service users. DS0000035826.V289532.R01.S.doc Timescale for action 01/08/06 2. YA9 13(4) & 15 01/08/06 3. YA19 37(1) 20/06/06 Esther Care Home Ltd Version 5.1 Page 30 4. YA26 16(2)(c) 5. YA28 13(4) & 23(2)(b) 6. YA32 18(1) 7. YA33 13(4), 17(2), Sch 4.6(e) & 18(1) 8. YA35 17(2), Sch 4.6(f) & 18(1)(c)(i) 9. YA35 13(4)(c) (6), 18(1) & 19, Sch 2.4 The damaged chest of drawers in a service users ground floor bedroom must either be repaired or replaced. The loose patio slabs in the rear garden must be made secure and suitable grab rails fitted to the steep steps in the same area. Previous timescale for action of 1st April 2006 not met. At least 50 of care staff in the home must have achieved an NVQ level 2 or above in Care or at least be working to obtain one by an agreed date. Recommendation made in past three reports not met. Staff must have at least one full day off a week and the number of hours for which they are employed each week must be recorded in their terms and conditions of employment. A record of the induction undertaken by all new staff must be kept in the home at all times and made available for inspection on request. Sufficient numbers of staff must receive training in first aid and vulnerable adult protection or at least have dates arranged for this to take place. Documentary evidence of this training must be made available for inspection on request. 01/09/06 01/08/06 01/01/07 01/07/06 01/07/06 01/10/06 Esther Care Home Ltd DS0000035826.V289532.R01.S.doc Version 5.1 Page 31 10. YA36 18(1) (2) 11. YA39 24(2) 12. YA42 13(4) & 23(2)(c) All staff must receive at least one formal supervision session with a suitably qualified senior every 2 months. The results of any satisfaction surveys undertaken by the providers to ascertain major stakeholders views about the quality of the service provided must be published on an annual basis and a copy forward to the CSCI. Previous timescale for action of 1st April 2006 partially met. A suitably qualified engineer must check the homes gas installations (Landlords test) at least once a year. 01/09/06 01/09/06 15/07/06 Esther Care Home Ltd DS0000035826.V289532.R01.S.doc Version 5.1 Page 32 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. 2. Refer to Standard YA1 YA20 Good Practice Recommendations The Residents guide should contain the service users and other major stakeholders views about the standard of care provided at the home. The homes medication cabinet, presently attached to a wall in the dinning room, should be relocated to a less conspicuously place, e.g. the large kitchen or first floor former staff sleep-in room. Plans for the first floor communal bathroom to be redecorated should be established and the rather worn out bathroom suite replaced by 2008. The rather worn out units in the kitchen should be replaced by 2008. The proprietor should be mindful of the cultural and ethnic imbalance that currently exists between the homes staff team and the service when she next recruits new staff. Staff should receive in-house equal opportunities and racial harassment training. 3. 4. 5. 6. YA27 YA28 YA33 YA35 Esther Care Home Ltd DS0000035826.V289532.R01.S.doc Version 5.1 Page 33 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 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.V289532.R01.S.doc Version 5.1 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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