Inspection on 22/11/05 for Esther Care Home Ltd

This inspection was carried out on 22nd November 2005.

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 13 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 19/06/06

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 Unannounced Inspection 10:15a 22 & 25 November 2005 nd th Esther Care Home Ltd DS0000035826.V258475.R01.S.doc Version 5.0 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.V258475.R01.S.doc Version 5.0 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.V258475.R01.S.doc Version 5.0 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.V258475.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th May 2005 Brief Description of the Service: Esther Care is a privately run residential care home, which specialises in providing accommodation and personal support for up to eight younger adults with learning disabilities. There are currently six service users residing at the home who are all aged between thirty and sixty. Mrs Kalyani Kalaiyalagan has been the registered co-owner and in opertional day-to-day control of the home since 2002, although she went on maternity leave for a couple of months earlier in the year. There have no been significant changes made to the phyiscal environment of the home since the last inspection. This large detached Victorian property still comprises of eight single occupancy bedrooms, a main lounge/dinning area, a seperate games/activities room, large entrance hall, fully functioning kitchen, laundry room, and top floor office. There are sufficient numbers of toilets and bathrooms located near service users bedrooms and communal areas. The garden is mainly laid to lawn and forms part of a steep incline, which can only be accessed by steps. Situated on top of a small hill in a quiet street in Purley, a residential suburb to the south of Croydon, the home not only has impressive views of the surrounding areas, but is also within easy walking distance of Purley town centre, which has a wide variety of local shops, cafes, resturants and pubs. The home is also within easy walking distance of several bus routes and a local railway station which has good links to central Croydon, London and the surrounding areas. Esther Care Home Ltd DS0000035826.V258475.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection involved two visits the first of which was unannounced and the second announced. The first visit was undertaken on the morning of Tuesday 22nd November and lasted no more fifteen minutes. The second was undertaken on a Friday morning, beginning at 10.15am and lasting three and three quarter hours. Since the homes last inspection the Commission has not received any comment cards in respect of this service. The majority of this inspection was spent talking to both the co-owners, one of whom is also the manager of the service, the homes deputy manager, the one service user who was at home at the time of these visits, a couple of care workers who were on duty at these times, and a visiting aroma-therapist. The rest of the inspection was spent examining the homes records and touring the premises. No additional visits or complaints investigations have been carried out by the CSCI in respect of this service in the past twelve months, although a couple of case conference meetings involving senior managers from Croydon Social Services, the CSCI and the homes proprietors have been convened in the past six months to discuss on going concerns various professional agencies have had about the home. These issues are discussed in greater depth in the main body of this report, although it is worth stating here that significant progress has been made by the proprietors to address many of the shortfalls identified. What the service does well: What has improved since the last inspection? It was pleasing to note that the vast majority of the poor practice issues/concerns identified at various multi-agency meetings convened in the past six months, as well as the homes most recent inspection visits, had been Esther Care Home Ltd DS0000035826.V258475.R01.S.doc Version 5.0 Page 6 addressed, although the proprietors still acknowledge that they have someway to go to resolve them all. Since the homes last inspection in May’ 05 the co-proprietor/manager and her deputy have ensured service users terms and conditions of occupancy have been amended to include ‘extra’ charges payable for services not covered by the basic cost of each service users placement; care plans are far more person centred and focus more on individual service users preferences/wishes and health Care needs; complaints and any action taken in response are recorded in greater detail; money held by the home on service users behalves is kept in a far more secure place; several of the services users bedrooms have been redecorated and fitted with new floor coverings; suitable grab rails were installed in one service users en-suite shower facility and new fence panels erected in the rear garden; all new staff were checked against the Protection Of Vulnerable Adults (POVA) register before they were allowed to commence working at the home; sufficient numbers of staff received suitable training in basic food hygiene, first aid and recognising/preventing abuse; and finally the homes electrical wiring was checked by a suitably qualified electrician. What they could do better: These positive comments made overleaf notwithstanding there are still a dozen or so core areas of practice that the home still needs to improve upon: Firstly, the service users guide still needs to be made more accessible for the people for whom the home is intended by establishing a far more service user friendly guide that is written in plain English and includes pictures, photographs and symbols. Care plans must contain more detailed information about each service users unique spiritual and mobility needs, including what support they require to ensure these needs are met. A time specific roiling programme to replace all the homes ‘stretched’ carpets needs to be established. The temperature of hot water emanating from all the homes water outlets needs to be more closely monitored and a record kept to ensure it remains below 43 degrees Celsius at all times. Action to secure all the homes loose patio slabs and fit suitable grab rails both inside and outside the home needs to be undertaken, and a safety notice warning staff about low beams in the cellar must be put up. The proprietors are reminded that only in ‘exceptional circumstances’ and providing certain conditions are met is it permissible for a new member of staff to commence working at the home without an up to date criminal records check. The Commission considers it to be not only ‘poor’ practice, but also highly risky, to allow any person to commence their employment at the home while their Criminal Records (CRB) check is still being processed. Furthermore, under no circumstances is it permissible to start a new member of staff without Esther Care Home Ltd DS0000035826.V258475.R01.S.doc Version 5.0 Page 7 first obtaining two written references in respect of that individual. Sufficient numbers of staff still also need to receive suitable training in moving and handling techniques and Makaton signing. Finally, as identified in the homes two previous inspection reports the proprietors still need to introduce an effective quality assurance system, which is based on the views of service users and other stakeholders, to measure how successful or not they are at achieving the homes stated aims and objectives. The results of any self-monitoring surveys/questionnaires need to be published on an annual basis. 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.V258475.R01.S.doc Version 5.0 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.V258475.R01.S.doc Version 5.0 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 The homes guide still needs to be made far more service user ‘friendly’ to ensure the people for whom the service is intended have access to information about the services and facilities provided by Esthercare. EVIDENCE: Since the homes last inspection the deputy manager has been using a ‘widget symbols’ software package to compile draft versions of the service users guide in an attempt to make the document far more accessible for the people for whom the service is intended. However, despite this shortfall being identified in the homes two previous inspection reports the process of creating a more service user ‘friendly’ guide remains on going. The deputy manager said she had initially struggled to get to grips with the new technology, although she now feels more confident about applying it. It was therefore agreed at the time of this inspection with the co-proprietor, the manager and her deputy that a far more service user ‘friendly’ version of the homes guide would be supplied to each of the service users and the Commission by 1st March 2006, exactly one year after this issue was first brought to the homes attention. This timescale for action will not be extended again and failure to comply on this occasion will result in the Commission considering taking enforcement action. Esther Care Home Ltd DS0000035826.V258475.R01.S.doc Version 5.0 Page 10 The home has not received any new referrals in the past twelve months and consequently continues to have two vacancies. As required in the homes previous report service users individual written contracts which set out their terms and conditions of occupancy have been amended to include the fees the home charges for services and facilities provided, who pays them, as well as the cost of so called ‘extras or additional’ costs, which are not covered by the basic price of each service users placement. Three contracts sampled at random all clearly stated that food and drink, heating, lighting and laundry costs are all covered in the basic fees, although newspapers, hairdressing, chiropody, clothing, holidays and using the homes vehicle for what the manager refers to as ‘personal’ use is not. It was agreed at the time of this inspection by all those present at the aforementioned four-way meeting that these contracts will need to be amended further to make it more explicit that the cost of meeting services users ‘special’ dietary needs will always be covered by the basic price of their placement, as well as the cost of replacing any items of clothing which are damaged or go missing at the home. Esther Care Home Ltd DS0000035826.V258475.R01.S.doc Version 5.0 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 Significant progress has been made to improve the homes care plan format, which know contains far more detailed information about each service users individual social and healthcare needs, personal goals and likes, thus ensuring staff are far more equipped to plan for and meet service users unique needs, wishes and preferences. EVIDENCE: It was positively noted from three care plans sampled at random that a far more person centred approach to developing them has been adopted by the home, which sets out in far greater detail each individual service users unique needs, personal goals, preferences and support they each require. For example, the three care plans sampled at random who referred to the individual service users unique specialist communication needs, their preferred modes/methods of communication, social interests and food preferences. Two out of three of the care plans sampled had also been reviewed in the past two months and updated accordingly to reflect changing needs. Records showed that in attendance at one of these review meetings had been the service user, one of their parents, their care manager representing the placing Esther Care Home Ltd DS0000035826.V258475.R01.S.doc Version 5.0 Page 12 authority, and senior representatives from the home, including the homes coowner/manager. It was also positively noted that more detailed information about the individual’s special dietary needs had been included in their care plan. Esther Care Home Ltd DS0000035826.V258475.R01.S.doc Version 5.0 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, 16 & 17 Service users have opportunities for personal development, but more detailed information about each of their specific spiritual needs must be included in their care plan to enable staff to plan for and meet them. The number and range of social, educational and vocational opportunities the service users have to engage in, both at home and in the wider community, appears to be extremely varied and stimulating. Dietary needs are well catered for, nutritionally balanced, and clearly based on personal preferences and specific cultural needs. EVIDENCE: During the course of this inspection a visiting aroma-therapist was met. The aroma-therapist said they had been coming to the home on a weekly basis for the past two years. The one service user who participated in these sessions on a regular basis clearly looked forward to them and gestured with her arms that she was very keen to get started. The aroma-therapist said she had always been impressed with the attitude of staff working at the home. Esther Care Home Ltd DS0000035826.V258475.R01.S.doc Version 5.0 Page 14 It was evident from information contained in care plans that three of the service users currently residing at Esthercare are Hindus. It was positively noted that staff continue to take the one service user who chooses to practice their faith to a local Hindu temple every week. None of the other service users choose to attend church services or go to temples. Each service users spiritual needs are noted in their care plan, although it was felt that this could be expanded upon to include more specific details about each service users unique wishes. Furthermore, it was agreed that the home should consider celebrating Hindu festivals, as well as the major Christian ones, with half the service users and so many of the staff team affiliated to this particular faith. Having arrived unannounced in the morning of the first day of this inspection the only member of staff on duty at the time said all the service users were out at various day centres. On the second visit, which was announced, five out of six of the service users were out at day centres, while as previously mentioned, one reminded at home awaiting their weekly aromatherapy session. Records sampled at random revealed that service users had been given numerous opportunities during the past four weeks to engage in a wide variety of social, leisure and recreational activities, both in the home and in the wider community. The manager said service users are encouraged to develop their independent living skills by participating in household chores, such as cooking and cleaning their own bedrooms. These tasks are specified in each service users care plan. The manager said that service users who attend day centres either take packed lunches or the home pays for them to have a cooked meal at the centre. The manager went onto to say that service users who go on holiday with staff continue to receive at least three main meals a day, which is covered by the basic price of their terms and conditions of occupancy. It was noted on a tour of the home that ample stocks of fresh and correctly stored food was available in kitchen. An officer from the local Environmental Health department last visited the home in November 2005 and was satisfied with the homes food hygiene arrangements. Consequently, in the subsequent report no requirements or recommendations were made. It was positively noted that the one service user who chooses not to eat beef on religious grounds is well catered for and that this information is clearly stated in their care plan. Esther Care Home Ltd DS0000035826.V258475.R01.S.doc Version 5.0 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Suitable arrangements are in place to ensure that service users physical and emotional health care needs are identified, planned for and met, although more specific details about the exact support one service user receives from staff to ensure their specialist mobility needs are met must be included in their care plans. The homes arrangements for the safe handling of medication received and administered are sufficiently robust to ensure the service users are protected from harm and/or abuse. EVIDENCE: The one service user who was at home at the time of this visit was wearing an outfit that was both clean and ironed. The manager said that she was not aware of any incidents since April’05 where any items of clothing and been lost or damaged at the home. It was evident from care plans sampled at random that service user continue to receive input from all the relevant health care professionals on an as required basis, including occupational therapists and physio’s. The care plan for the one service user whose main source of mobility in the wider community is a wheelchair must contain more specific details about this need in their care plan. It must be made more explicit that this particular individual does not require any staff support transferring. Esther Care Home Ltd DS0000035826.V258475.R01.S.doc Version 5.0 Page 16 The homes accident book revealed that no significant incidents involving service users had occurred in the home since its last inspection in April’05. It was positively noted that as required in the home previous report that a plan relating to one service users foot care needs had been established to minimise the risk of swelling. The home continues to use a recognised monitored dosage system and records kept of all medicines received and administered in the home had been appropriately maintained by staff. Esther Care Home Ltd DS0000035826.V258475.R01.S.doc Version 5.0 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Suitable arrangements are in place to ensure complaints and/or concerns made about the home’s operation are taken seriously and acted upon. Service users are protected from abuse, harm and neglect by the robustness of the homes vulnerable adult protection and financial recording arrangements. EVIDENCE: The home has not received any formal complaints about its operation since its last inspection, although service users relatives raised a couple of more informal concerns. It was positively noted that both these concerns brought to the homes attention had been recorded, including the action taken in response, as required in the homes last inspection report. The manager said that both these concerns had now been successfully resolved to the complainant’s satisfaction. Since the homes last inspection no strategy meetings have been convened by the Local Authority to investigate allegations/suspicion of abuse, although a couple of case conference meetings have been held at the CSCI’s Croydon offices to discuss some on going concerns various agencies have had about the home. It was therefore positively noted that the vast majority of the poor practice issues identified at these meetings have either been addressed or significant progress made to resolve them. None of the service users are capable of managing their own finances and therefore all require staff support to help them look after their money. The deputy manager continues to maintain up to date financial records of all the transactions taken by staff on behalf of the service users. Two financial record sheets sampled at random indicated that staff continue to sign for all outgoing Esther Care Home Ltd DS0000035826.V258475.R01.S.doc Version 5.0 Page 18 payments and keep folio numbered receipts for all goods and service users purchased on service users behalves. The balances recorded on these finance sheets matched the amounts held by the home in respect of both these service users. As required in the homes previous inspection report it was positively noted that service users money is now kept secure in a locked cabinet in the first floor staff room. Since the homes previous report its transport policy has been amended to make it clear that service users are expected to contribute a proportionate amount to the running cost of the vehicle, which the home currently charges at £1 a mile. The manager said service users are only charged for what she referred to as ‘personal’ usage of the homes minibus, which does not include communal outings, such as food shopping trips and picking up or dropping off other service users, for instance. The home currently has three members of staff who are ‘authorised’ to drive the homes vehicle. These drivers appropriately maintain a logbook to record the date, mileage covered, purpose of journey, and who actually went on the trip. Having cross-referenced invoices charged one service user for using the homes vehicle it was positively noted that they had not been charged for the two shopping trips they had been on with staff to buy groceries on 19th September and 6th October 2005. Esther Care Home Ltd DS0000035826.V258475.R01.S.doc Version 5.0 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, 29 & 30 The overall layout of the home, which is furnished and decorated to a ‘reasonable’ standard, ensures the service users live in a relatively homely, comfortable and clean environment. The proprietors have also implemented a number of the environmental changes recommended by a qualified occupational therapist, following their recent visit. However, further improvements are still required to ensure service users live in a far safer environment where their independence is maximised. EVIDENCE: Esther Care Home Ltd DS0000035826.V258475.R01.S.doc Version 5.0 Page 20 The proprietors still propose to make significant changes to the interior layout of the home in the forth-coming year. The manager said she has recently submitted building plans to the Local Authority and is aware that the Commission will need to be notified in writing about these changes when the next timescales for action have been agreed. As previously mentioned in the homes previous report the proprietors are proposing to improve the layout of the building for the service users benefit by converting the existing utility room into a new laundry, installing en-suite facilities in a first floor bedroom, and dividing the ground floor games room into two smaller units to be used for dinning and activities. As required in the home’s previous report it was positively noted that the home had made referral to a qualified occupational therapist who undertook an assessment of the premises on 4th June 2005. Twelve recommendations were made in the subsequent report for the home to consider. During a tour of the premises each of these recommendations made by the OT, along with all the environment requirements made by the CSCI in the homes last report, were discussed with the proprietors and the homes deputy manager: It was agreed that the vacant bedroom on the top floor did not need a sink installed because a wash hand basin was available in a separate toilet, adjacent this room. A lockable space has been provided in one service users bedroom and as required in the homes previous CSCI report the damaged chest of drawers in bedroom No#4 has now been replaced. Furthermore, all the uneven off cuts of carpet, which represented tripping hazards in several of the first floor bedrooms, have now been removed. One service users bedroom has been fitted with new non-slip floor covering. Other bedroom carpets, which the OT considered to be unsafe because they had been ‘stretched’ as a result of general wear, the manager has agreed to establish a two-year rolling programme to replace them all. It was positively noted that bedroom No# 4 had been completely redecorated since the homes previous inspection. Having discussed other recommendations made by the OT with the proprietors it was agreed that it was not necessary for the home to install a call bell alarm system throughout the home, purchasing two portable hoists for both the ground and first floors, or fit swivel chairs to baths to help service users transfer in and out, at this time as the service users current mobility needs did not warrant these adaptations. However, the requirement was made in an earlier section of this report that the proprietors need to make it clearer in care plans exactly what type of support and specialist equipment each service user requires for the home to effectively meet their mobility needs. It was positively noted that the loose right hand side grab rail in one service users en-suite shower facility had been replaced and a new rail fitted on the left hand side. It was also noted that the missing fence panels in the rear garden had been erected as recommended by the OT. Esther Care Home Ltd DS0000035826.V258475.R01.S.doc Version 5.0 Page 21 However, these positive comments notwithstanding work to extent the inadequate grab rails after the first and fifth steps on both sides of the stair well remains outstanding. Furthermore, loose patio slabs and inadequate grab rails continue to be a problem in the rear garden. Finally, the low beams and uneven concrete flooring in the cellar represent a serious hazard and appropriate safety notices warning staff of the danger need to be conspicuously displayed in this area. The temperature of hot water emanating from a shower outlet in one service users en-suite facilities on the ground floor was noted to be safe 43 degrees Celsius at 12.30. The deputy manager said that a weekly record of hot water temperature checks was not being undertaken by staff to ensure compliance with this health and safety requirement. This practice needs to be reintroduced as a matter of urgency. Esther Care Home Ltd DS0000035826.V258475.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 The home continues to ensure that sufficient numbers of competent staff are on duty at all times to meet the health and welfare needs of the service users. Significant progress has also been made to ensure sufficient numbers of staff are ‘suitably’ trained to meet most of the service users needs, although further numbers still need to attend moving and handling and Makaton training courses. The homes procedures for recruiting new members are in the main robust, although the poor practice of employing people without first obtaining an up to date criminal records check or two written references places the service users at risk of being harmed or abused by people who are unsuitable to work with vulnerable adults. EVIDENCE: The co-owner manager stated that only her deputy manager had successfully completed a National Vocational Qualification in care (Level 3) to date, although two other members of staff were on course to finish theirs by the end of the year. Furthermore, two out of the remaining three members of staff were enrolled on NVQ courses, which commenced in January and April 2006. The home is well on course to ensure it complies with this National Minimum Standards and have at least 50 of its staff team qualified to NVQ level by the end of 2005, in line with Government training targets for care workers. Esther Care Home Ltd DS0000035826.V258475.R01.S.doc Version 5.0 Page 23 There have been no changes to staffing levels since the homes last inspection, which appear adequate to meet the assessed needs of the service users. On the first unannounced visit only one member of staff, who had just finished a night shift, was on duty. This was adequate as all the service users were out attending various day services at the time. On the second visit three members of staff were working the early shift, excluding the manager and homes other co-owner, which was sufficient to meet the assessed needs of the service users. Since the homes last inspection this service continues to experience staff retention problems and consequently has had to recruit two new members of staff to replace the two staff who have left in the past six months. The two new member of staffs’ files was examined in some depth and it was noted they both contained proof of their identifies and protection of vulnerable adults register (POVA first) checks. This information had been obtained by the home before these members of staff had been allowed to commence working their, although the proprietors conceded that these new recruits had been permitted to start before their Enhanced Criminal Records Bureau (CRB) checks had been successfully completed. Furthermore, the proprietor conceded that these members of staff had also been allowed to work unsupervised with the service users during their probationary periods of employment. The proprietors are reminded that it is only acceptable for new members of staff to commence working in a care home before their criminal record checks has been processed in ‘exceptional’ circumstances and even then the practice is considered extremely risky. If a situation arises where the home believes the service users are being placed at risk and their care comprised then and only then will the Commission consider allowing this practice on a case-by-case basis providing certain conditions are met. These conditions are as follows: any new remember of staff must have at least applied for their CRB; have an up to date POVA First check, along with all the other documents specified in Schedule 2 of the Care Homes regulations (2001); never work alone with service users, and have a suitably qualified mentor to supervise them at all times who is named on the duty rosters. Finally, approval must always be sought from the CSCI before allowing anyone to start without a CRB. It was also noted that only one new member of staff had provided the home with two written references in accordance with the Care Homes Regulations (2001). The deputy manager explained that they had been unable to obtain a second written reference for one new recruit despite making several requests to the individual’s former employer. The deputy said she was eventually able to make verbal contact with the individual’s former employee and obtained a reference over the telephone. Unfortunately no record of this conversation was made, an area of practice the proprietors acknowledge they need to improve upon. Esther Care Home Ltd DS0000035826.V258475.R01.S.doc Version 5.0 Page 24 It was positively noted that documentary evidence was available on request to show that sufficient numbers of the current staff team had attended fire safety training on 15th November 2005, basic food hygiene and first aid. Furthermore, almost half the staff team have now attended a vulnerable adult protection course and the manager is actively looking for new dates for the rest of he staff team to attend in the New Year. Progress on this matter will be assessed at the homes next inspection. As required in the homes previous report far more of the homes staff team still need to attend moving and handling, and makaton signing courses. Two staff files sampled at random both contained minutes of the three supervision sessions they had each received from their manager in the past six months, as well as an annual appraisal of their overall performance in the past twelve months. Esther Care Home Ltd DS0000035826.V258475.R01.S.doc Version 5.0 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, 39 & 42 No progress has been by the home with regards implementing an effective quality assurance system based on service users and other stakeholders views about the service, which means the home is still unable to measure how successful or not it has been in achieving its stated aims and objectives. Overall the homes health and safety arrangement are suitably robust to protect the service users and staff from avoidable harm. Esther Care Home Ltd DS0000035826.V258475.R01.S.doc Version 5.0 Page 26 EVIDENCE: Kalyani as the homes registered co-owner and manager remains in operational day-to-day control of Esthercare and said she is well on course to have achieved her NVQ level 4 in both management and care by 1st April 2006. Kalyani reiterated a statement she made in the homes previous report that although she sometimes found it difficult to continue balancing the competing demands of managing the home, studying for her NVQ level 4 in management and care, and caring for a newborn baby, she was nevertheless confident she was capable of successfully juggling all three commitments. It was disappointing to note that as required in the homes two previous inspection reports and despite acquiring an accredited quality assurance system, no progress had been made by the home to implement it. As mentioned in the homes two previous reports it is essential that the home introduces an effective quality assurance system, which uses an objective, consistently obtained and verifiable method, that is based on service users and other stakeholder’s views about the service. Without this the proprietors will be unable to measure how successful or not they have been in achieving the homes stated aims and objectives. This process of self-monitoring must be continuous and the results of service users/stakeholder surveys/questionnaires must be published and made available to all interested parties, including service users, their representatives and the CSCI. The timescale for the home to take action and meet this outstanding requirement will be extended for the third and final time and must be addressed by 1st April 2006, one year on from when it was first identified as an issue. Overall, the home is well maintained and suitable arrangements are in place to promote and protect the health and safety of the service users and staff. As required in the homes previous report up to date Certificates of worthiness were in place in respect of the homes electrical wiring to show that a suitably qualified electrician had recently checked it in August 2005. The damaged sound activated release mechanism, which was attached to the fire resistant kitchen door, has now been removed, as the proprietors have taken the decision not to wedge this door open during the day. It was noted that this door remained closed in its frame when it was not in use throughout the course of both visits to the home. During a tour of the premises it was also noted that no fire resistant doors were being inappropriately wedged open, in line with fire safety regulations. Esther Care Home Ltd DS0000035826.V258475.R01.S.doc Version 5.0 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 1 3 X X 2 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X X X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X 2 2 2 2 2 LIFESTYLES Standard No Score 11 2 12 3 13 X 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 3 1 1 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Esther Care Home Ltd Score 2 3 3 X Standard No 37 38 39 40 41 42 43 Score 3 X 1 X X 3 X DS0000035826.V258475.R01.S.doc Version 5.0 Page 28 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 Timescale for action 12(4) & The service users guide must be 01/03/06 5(1) (2) avialable in a more accessible format that is suitable for the people for whom the service is intended (e.g. Be written in plain English language, and illistrated with pictures, photographs, symbols ect..). Copies of the up dated version must be supplied to each of the service users and the Commission. Previous timescales for action of 1st March and 1st August 2005 not met. 5(1)(b) (c) Service users written contacts 01/03/06 setting out the terms and conditions of their occupany include a statement that makes it clear that the cost of meeting all the service users ‘special’ dietary needs and any items of clothing which may be damaged by staff will be met by the home (i.e. not considered ‘extra’ costs to be paid for in addition to the basic cost of each placement). DS0000035826.V258475.R01.S.doc Version 5.0 Page 29 Regulation Requirement 2 YA5 Esther Care Home Ltd 3 YA11 4 YA18 5 YA26 6 YA27 7 YA28 8 9 YA29 YA29 10 YA34 11 YA34 Care plans must contain more specific details about service users unique spiritual needs and what arrangements the home has in place to meet them. 17(1)(a), More detailed information must Sch 3.3(m) be included in service users care plans, which relates to their specialist mobility needs and more specifically about the exact support they require to meet them. 16(2)(c) A time specific rolling programme to replace all the homes old ‘stretched’ carpets in service users bedrooms must be established. 13(4) The temperature of hot water emanating from all the homes water outlets, especially baths and showers, must be continually monitored and appropriate record of these checks kept. The tests must be at least weekly. 13(4) & Loose patio slabs in the rear 23(2)(b) garden need to be made secure and suitable grab rails fitted to most of the exterior steps in the garden. 13(4) & The stairwell grab rails need to 23(2)(b) be extended beyond the first and fifth steps on both sides. 13(4) A safety notice warning all staff about the low beams and uneven concrete flooring in the cellar must be conspicuously displayed in this area. 13(6)19(1), No new members of staff must 2.5 2.7 be permitted to commence their employment at the home before satisfactory an Enhanced Criminal Records Bureau (CRB) check has been obtained in respect of that individual. 19(1), Sch Two written references must be 2.5 obtained in respect of all person who works at the home. DS0000035826.V258475.R01.S.doc 12(4)(b) 01/02/06 01/02/06 01/04/06 15/12/05 01/04/06 01/04/06 01/01/06 01/01/06 01/01/06 Esther Care Home Ltd Version 5.0 Page 30 12 YA35 18(1), Sch 2.4 13 YA39 12(3) & 24(1,2 & 3) Sufficient numbers of staff must 01/02/06 receive ‘suitable’ training in moving and handling techniques and Makaton signing, or a timespecific programme established for this training shortfall to be addressed. Previous timescale for action of 1st October 2005 not met. The home must introduce an 01/04/06 effective quality assurance system, which is based on service users and other stakeholder’s views about Esthercare. The results of service users/stakeholders holder surveys/questionnaires must be published at least annually. Previous timescales for action of 1st April and 1st October 2005 not met. 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 3 Refer to Standard YA11 YA32 YA37 Good Practice Recommendations The home should give serious consideration to celebrating Hindu religious festivals. 50 of care staff to have achieved an NVQ level 2 or above in Care by the end of 2005. The registered manager should have been awarded the Care component of her registered managers award (NVQ Level 4) by the 1st April 2006. Esther Care Home Ltd DS0000035826.V258475.R01.S.doc Version 5.0 Page 31 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.V258475.R01.S.doc Version 5.0 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!