Inspection on 24/05/05 for Esther Care Home Ltd

This inspection was carried out on 24th May 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 but made no statutory requirements on the home.

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 22/11/05

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 Announced 24 May 2005 09:30 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 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 Stationary 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 G53-G53 S35826 Esther Care Home Ltd V187979 160505 Stage 01.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Esther Care Home Ltd Address 15 Russell Hill, Purley, Surrey, CR8 2JB Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8668 5667 020 8763 0875 kal2001kal@hotmail.com Mrs Kalyani Kalaiyalagan Mrs Kalyani Kalaiyalagan Care Home 8 Category(ies) of Learning Disability (8) registration, with number of places Esther Care Home Ltd G53-G53 S35826 Esther Care Home Ltd V187979 160505 Stage 01.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 13/01/2005 Brief Description of the Service: Esther Care is a privately run residential home which specialises in providing accommodation and personal care 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 continues to be the registered co-owner and day-to-day manager of the home, which she has run since 2002. Since the homes last inspection an acting manager was placed in temporary charge of the home for two months to cover the managers maternity leave. The home itself is a large detached Victorian property situated in a quiet suburban street in Purley with impressive views of the surrounding areas. The home is within ten minutes walk of the centre of Purley and is therefore well placed for accessing a variety of local amenities, including shops, cafes, resturants and pubs. There are also good bus and rail links to Croydon, central London and the surrounding areas. This property comprises of eight single occupancy bedrooms, a main lounge/dinning area, a large games/activities room, entrance hall, kitchen, laundry room, and top floor office. There are sufficent 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. Esther Care Home Ltd G53-G53 S35826 Esther Care Home Ltd V187979 160505 Stage 01.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced and started at 9.30am. It took place over seven and a half hours during the morning and afternoon of 24th May 2005. All six of the service users currently residing at the home were met at various times throughout the course of the day and appeared to be well cared for and relaxed. The majority of the service users are non-verbal and use distinct modes of communication to express themselves. During the course of the inspection a couple of the service users expressed themselves through the use of Makaton sign language and others through various ball games. A total of eight comment cards were returned to the Commission. Four had been completed on behalf of service users by staff and the rest were all from service users relatives. Overall, the written comments received were in the main very positive about the quality of the service being provided. To quote one card, “the staff and management at the home are very helpful, bright and cooperative”. Nevertheless, these comments not withstanding some negative feedback was received, which will be looked at in greater detail under the section entitled ‘What the home could do better’. All three of the service users relatives who had chosen to attend the inspection were spoken with at some length before lunch. Their help with the inspection process is very much appreciated. In addition, the homes co-owner/manager, her mother, who also happens to be the other co-owner, and deputy manager were all met during this inspection. The rest of the inspection was spent examining records and touring the premises. The proprietors were invited to attend a meeting at Commission’s Croydon offices in October 2004 to explain their repeated failure to address a number of on-going issues identified in the homes previous two reports. Furthermore and in additional to the homes statutory visits, a third inspection was carried out in January 2005 to review the homes progress in resolving many of these outstanding issues. What the service does well: As previously mentioned all six of the service users met during this inspection appeared to be well cared for and happy. Staff were observed interacting with service users in a very respectful and kindly manner throughout the day and many seem to have built up a good working relationship with the service users. To reiterate an earlier point the majority of the feedback received from service users relatives was extremely positive, particularly with regard to the attitude shown by the staff team. A couple of relatives described 15 Russell Hill, as “very homely”, and the staff team as being a bit like “an extended family for the residents”. Two relatives said staff always made them feel welcome when they visited and actively encouraged them to continue their involvement in there loved ones lives. Esther Care Home Ltd G53-G53 S35826 Esther Care Home Ltd V187979 160505 Stage 01.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: The positive comments made overleaf notwithstanding, there are still some areas of the service that could and must be improved. There are three areas of major concern that need to be addressed as a matter of urgency. Firstly, the homes arrangements for the laundering and care of service users clothes need to be improved. Service users relatives repeatedly raised concerns about creased and damaged clothing, as well as service users wearing clothes that did not belong to. Secondly, the home has experienced quite high levels of staff turn over in a relatively short period of time with approximately 50 of the homes former staff team leaving in the space of less than twelve months. It is appreciated that the reasons for staff leaving can be as varied as they are complex, but the homes inability to retain staff has inevitably had an adverse affect on the continuity of care the service users have received. The lack of staff retention was another matter of concern repeatedly raised by all the visiting relatives and is an area the management could make more of a concerted effort to try and improve. An immediate requirement was issued at the time of this inspection after is was discovered that a new member of staff had been allowed to commence their employment before they had been checked against the Protection of Vulnerable Adults Register. This matter was promptly resolved within the prescribed timescale for action, although the management are reminded that under no circumstances must any new members of staff be allowed to commence their employment, supervised or otherwise, before they have been checked against the Protection of Vulnerable Adults Register. Esther Care Home Ltd G53-G53 S35826 Esther Care Home Ltd V187979 160505 Stage 01.doc Version 1.30 Page 7 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 G53-G53 S35826 Esther Care Home Ltd V187979 160505 Stage 01.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Esther Care Home Ltd G53-G53 S35826 Esther Care Home Ltd V187979 160505 Stage 01.doc Version 1.30 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 standard(s) 1 & 5 Limited progress has been made on making the homes guide more service users friendly. It is essential that both prospective and existing service users have greater access and understanding about the range of services and facilities they are entitled to receive while residing at the home. Service users contracts do not set out clearly what charges service users are expected to pay for additional services not covered by the basic cost of their placement. Greater clarity is needed to enable service users and their representatives to know exactly what and how much they will be expected to pay for services and facilities the service providers considers ‘extras’. EVIDENCE: The homes Statement of purpose has recently been revised to include all the information a prospective service user and their representatives will need to make an informed choice about the facilities and services provided by the home. The general consensus of opinion expressed by all three of the relatives met during this inspection was that the homes Statement of purpose was very detailed and informative. However, the homes guide is still not particularly accessible, especially for the people for whom the service is intended as it remains in a format that is not particularly service user ‘friendly. This is regrettable as this shortfall was identified in the homes previous inspection report. The Deputy manager stated that she has recently purchased a software package for incorporating widget symbols into word documents and will amend Esther Care Home Ltd G53-G53 S35826 Esther Care Home Ltd V187979 160505 Stage 01.doc Version 1.30 Page 10 all the homes guides as soon as practicable to make them more service user friendly. Each service user now has an individual written and signed contract setting out the terms and conditions of occupancy. Two contracts sampled at random contained the majority of the information required by the National Minimum Standards and associated Care Homes Regulations (2001), although they lack sufficient detail with regards the homes charges for so called ‘additional’ or ‘extra’ services/facilities not covered by the basic cost of each placement (e.g. transport costs, holidays, chiropody ect…). Concerns about the lack of transparency and openness in respect of both the amounts and number of these ‘additional’ services was raised by the relative of one of the service users at the time of this inspection and subsequently by their placing/funding authority. The home will need to keep more detailed records of all its charges to ensure this process is transparent to all interested parties, including the service users, their relatives, the funding authority and the Commission. Esther Care Home Ltd G53-G53 S35826 Esther Care Home Ltd V187979 160505 Stage 01.doc Version 1.30 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 standard(s) 6,7 & 9 Care plans accurately reflect service users assessed needs, but more progress is required to improve the current format to ensure they contain more specific details about each service users personal goals and the type of support they will need to fulfil their aspirations. This lack of detailed guidance for staff means there is no assurance that service users needs’ will be fully met. EVIDENCE: Individual plans of care are available for each of the service users and although they remain basic progress has been made since the homes last inspection to ensure that all six of the service users currently residing at the home have the new care plan format in place. Overall, the plans identify each service users basic personal, social and health care needs. However, the three care plans sampled at random will still need to be amended further to include more specific details about service users individual goals and aspirations, the specialist support and guidance they require to meet these goals, (e.g. through planned interventions, therapeutic programmes, structured environments, development of language and communication, adaptations and equipment), and each service users likes and dislikes, (e.g. food preferences and social/leisure interests ect…). Since the last inspection the home has introduced a system whereby designated keyworkers will sit down with their Esther Care Home Ltd G53-G53 S35826 Esther Care Home Ltd V187979 160505 Stage 01.doc Version 1.30 Page 12 key service user and review their care plan with them on a monthly basis. This is in addition to the more formal reviews held on an annual basis when all a service users representatives will be invited to attend. All three of the service users relatives met during this inspection said they are always invited to attend there loved ones annual care plan review. The manager stated that none of the service users have independent advocates who can speak on their behalves, although as previously mentioned, many of the service users have relatives who are actively involved in their care. In addition, one service users Care manager is looking into the possibility of arranging an advocate for their client. Two of the relatives met during this inspection all said they visited the home on a regular basis and that staff always made them feel extremely welcome. Records indicate that the home is taking a more proactive stance to minimise potential risks and hazards associated with service users daily living. For example each service user now has an assessment, which sets out in detail what action needs to be taken by staff to minimise risks associated with service users receiving personal care and travelling in the wider community. Esther Care Home Ltd G53-G53 S35826 Esther Care Home Ltd V187979 160505 Stage 01.doc Version 1.30 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 standard(s) 12,13,14,15 &17 Opportunities for service users to pursue and engage in social and leisure activities of their choice, both at home and in wider community are generally well managed and provide the service users with daily variety and stimulation. Dietary needs are well catered for and nutritional meals are being prepared for the service users to eat. EVIDENCE: Two out of three of relatives met said they were generally satisfied with the number and variety of opportunities their loved ones had to engage in community based recreational activities, which includes regular swimming trips and outings to the local park and pubs. Individual daily diary notes kept for each service user revealed that they all attend a number of different day centres and colleges during the week. Unfortunately, these notes often lacked detailed about specific activities and day trips the service users had participated in other than going to college and the day centre. Having discussed this matter with the management it was agreed that staff should be reminded to record all the activities the service users engage in, both at home and in the wider community. Anecdotal evidence was provided by the manager Esther Care Home Ltd G53-G53 S35826 Esther Care Home Ltd V187979 160505 Stage 01.doc Version 1.30 Page 14 and visiting relatives who all said that service users regularly go out at the weekends, which is made easier as two of the service users often stay with family during this period. The manager stated that she is in the process of arranging holidays for all those service users who wish to go. Two relatives spoken with said staff are very supportive and actively encourage them to remain involved with there loved ones lives at the home. One relative met said staff always made her feel extremely welcome and that she was not aware of any restrictions on visiting times. Pictorial menus displayed in the kitchen appeared to be varied and nutritionally well balanced. Meals appear to be a good mixture of European and Asian cuisine, which accurately reflects the ethnic mix of the service users. The deputy manager stated that the service users who are non-verbal are able to point to the meals they wish to have, although as mentioned previously, more detailed information about individual service users food and drink preferences still needs to be recorded in their care plans. A large bowl of fruit was available in the lounge for service users to help themselves and the kitchen door remained unlocked throughout the course of this inspection. One service user who had just returned from their day centre indicated to staff on duty that he would like a bread and butter snack before tea. The staff member was clearly familiar with Makaton sign language, which is the individual’s preferred mode of communication, and his request was duly granted. The manager stated that one of the service users has recently been referred to a speech therapist following a choking incident. A list of foods this particular must avoid has now been compiled to minimise this identified risk, which staff seem to be familiar with. Ample stocks of fresh fruit, vegetables, salad, bread, snacks and soft drinks were being stored in the kitchen at the time of this inspection. Esther Care Home Ltd G53-G53 S35826 Esther Care Home Ltd V187979 160505 Stage 01.doc Version 1.30 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 standard(s) 18,19, 20 & 21 Arrangements for the laundering of clothes is inadequate and continues to compromise the service users dignity. Suitable arrangements are in place to ensure that service users physical and emotional health care needs are identified, planned for and met. The homes policies and procedures for administering medicines in the home are generally robust, although some recording errors were identified and more diligence in this area is required to ensure the service users are protected from harm. EVIDENCE: The service users have some specific mobility needs and as required in the homes previous report a qualified occupational therapist has been contacted who has agreed to visit the home and carry out appropriate assessments. Serious concerns about clothes care at the home were raised by all three of the service users relatives. The general consensus of opinion was that service users clothes and in particular their jumpers were to often being washed at the wrong temperatures, were not being ironed, and in some instances, service users were wearing clothes that did not belong to them. The homes coowner/manager and deputy both acknowledged that problems with the standard of care shown by staff with regards service users clothes was an on going issue, which they were fully aware of. It was agreed that all damaged items of clothing must be replaced immediately and staff reminded about their clothes care responsibilities. Esther Care Home Ltd G53-G53 S35826 Esther Care Home Ltd V187979 160505 Stage 01.doc Version 1.30 Page 16 The homes accident book showed that there had been two significant incidents involving service users in the past six months, which both pertained to falls and resulted in their admission to Accident and Emergency. Both incidents had been reported to the Commission without delay, in accordance with the Care Homes Regulations (2001), and appropriate action taken to minimise the likelihood of similar incidents reoccurring in the future. Entries in one daily diary revealed that one service users leg and foot had swollen at the end of May 2005. The Deputy manager stated that the individuals GP had diagnosed this particular condition and that staff were all aware how to treat it. However, no recorded details of any plan relating to this particular individual’s health care needs were included in their care plan. An unacceptable number of recording errors where staff had failed to sign for medication administered in the home were found on one individual’s medication administration sheets. The manager stated that none of the service users are currently prescribed any ‘as required’ (PRN) medication, although detailed protocols for its use, which includes clear instructions for staff about when and how to give this type of medication was available on request. All six of the service users care plans now contain detailed information about each individual service users and/or representatives wishes regarding arrangements to be made in the event of their death. Esther Care Home Ltd G53-G53 S35826 Esther Care Home Ltd V187979 160505 Stage 01.doc Version 1.30 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 standard(s) 22 & 23 Service users relatives are on the whole confident that their concerns will be listened to, taken seriously and acted upon in accordance with the homes written procedures. The homes policy on dealing with aggression must be amended and the word ‘restraint’ removed from the text to minimise the risk of service users being harmed or abused by staff who have not been suitably trained to use physical intervention techniques. EVIDENCE: All three of the service users relatives met during this inspection said they had felt compelled to complain about certain aspects of the care provided by the home in the past twelve months. The relatives stated that the coowner/manager was approachable and had listened to their concerns, although many issues remained unresolved, particularly those relating to the homes arrangements for laundering their loved ones clothes. It was noted that none of the complaints/concerns raised by these relatives had been recorded in the homes complaints book. The manager explained that as the concerns were received verbally and not put in writing it was decided not to enter them in the complaints book. The manager was reminded that all complaints made about the homes operation must be recorded, including all verbal complaints, and any action taken in response. A procedure for responding to allegations or suspicion of abuse was available for inspection on request. The home also has a policy for dealing with aggressive behaviour, which refers to using physical intervention techniques as a ‘last resort’. The manager stated that none of the staff team have been formally trained to use physical restraint. Techniques for dealing with verbal and physical aggression were discussed with the manager and it was agreed that based on individual assessments of risk it would inappropriate for staff to Esther Care Home Ltd G53-G53 S35826 Esther Care Home Ltd V187979 160505 Stage 01.doc Version 1.30 Page 18 restrain service users. The homes policy for dealing with aggression will need to be amended to reflect this philosophy. The manager stated that there have been no allegations of abuse or incidents were staff have used physical restraint in the past twelve months. None of the service users are capable of managing their own financial affairs and all are supported to look after their money by the home and the service users relatives. The deputy manager is maintaining up to date financial records of all the transactions taken by staff on behalf of the service users. Records sampled at random indicated that staff are signing for all outgoing payments and are keeping receipts for goods and service users bought on service users behalves. The balances recorded on these finance sheets matched the amounts held by the home in respect of each service user. As required in the homes previous report service users money is now individually stored in lockable cash tins. However, the tins themselves are not locked away and will need to be stored in a more secure place (e.g. lockable filing cabinet, safe ect..). The home has established a policy that clearly states that service users are expected to contribute a proportionate amount (i.e. £1 a mile) related to the use of the homes transport. As previously mentioned in this report to ensure transparency this additional cost not covered by the basic price of the placements needs to be included in each of the service users terms and conditions of occupancy. Esther Care Home Ltd G53-G53 S35826 Esther Care Home Ltd V187979 160505 Stage 01.doc Version 1.30 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 standard(s) 24, 26 & 27 Overall, the size and layout of the home, which is furnished and decorated to a reasonable standard, ensures the service users have a homely, safe and clean environment in which to live. The likelihood of service users scalding themselves while using their bedroom sinks must be risk assessed to ensure their health and safety is protected. EVIDENCE: Esther Care Home Ltd G53-G53 S35826 Esther Care Home Ltd V187979 160505 Stage 01.doc Version 1.30 Page 20 In the next twelve months the proprietors are planning to convert the existing utility room into a new laundry, provide en-suite facilities for a first floor bedroom, and divide the games room into two smaller units for dinning and activities. These proposals will suit the service users needs and the Commission agrees to them in principle. The manager is aware that when the plans are finally drafted a copy will need to be forwarded to the Commission for are perusal. Several bedrooms were viewed at random and were found to be very personalised and decorated to a ‘reasonable’ standard. Television sets in two bedrooms were tested for picture quality and the reception was found to be good. The manager stated that new curtains were on order for Bedroom No#5 and the rolling programme to redecorate all the homes bedrooms by the end of 2005 was well underway. The damaged chest of drawers in bedroom No#4 need to be repaired or replaced. Having discussed the large uneven cuts of carpet laid out in a couple of the bedrooms the management agree that these make shift rugs are not only unsightly, but more importantly, they represent a tripping hazard. These off cuts must be removed and the service users consulted about whether or not they would like to have a new rug in their bedrooms. Having tested the temperature of water running from the hot tap attached to the first floor bath it was found to be a safe 40 degrees Celsius at 2.30pm. The manager stated that none of the wash hand basins in service users bedrooms had been fitted with thermostatic mixer valves that could be preset to a safe temperature. Having tested the hot water in bedroom No#5 it was found to be exceedingly hot. The risks associated with service users scalding themselves while using their bedroom sinks needs to be assessed and appropriate action taken as necessary to minimise the risk (i.e. Install preset, fail safe and tamper proof thermostatic mixer valves). Esther Care Home Ltd G53-G53 S35826 Esther Care Home Ltd V187979 160505 Stage 01.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34, 35 & 36 The home ensures staff are employed in sufficient numbers at all times to meet the health and welfare needs of the service users. Progress has been made to ensure the staff team are ‘suitably’ trained, although as a result of high levels of staff turnover in the past year, a significant number of the current staff team lack the necessary experience and competence to effectively meet the service users needs. The homes procedures for the recruitment of staff are on the whole robust, although the employers responsibility to undertake appropriate Checks on police records for new staff is still inconsistent and this lack of diligence may put residents at risk from employees who are unsuitable to work with vulnerable adults. EVIDENCE: The manager stated that two members of the current staff team have achieved a National Vocational qualification in care Level 2 or above and that one other hopes to complete this training by August 2005. In addition, arrangements are being made for another four members of staff to begin this training by the end of the year. With eight members of staff currently employed by the home the service is well on course to achieving the aim of having at least 50 of all care Esther Care Home Ltd G53-G53 S35826 Esther Care Home Ltd V187979 160505 Stage 01.doc Version 1.30 Page 22 staff qualified to NVQ level 2 by the end of 2005 in inline with the Governments target. The home has experienced a high turnover of staff in the past twelve months with five staff members leaving for a variety of reasons. This lack of continuity in terms of staff personal was a concern to relatives met during the inspection. The manager acknowledged that high staff turnover inevitably has an adverse effect on the standard of care being provided because new recruits will initially be unfamiliar with service users needs and preferences. Nevertheless, with four new members of staff employed since the turn of the year the home almost has a full complement of staff who are continually familiarising themselves with the service users needs and the homes daily routines. There have been no changes made to staffing levels since the last inspection. The home continues to have at least two staff on duty throughout the day and an additional third member employed to cover mornings and some weekends. The manager is ‘normally’ deemed supernumerary to these calculations. The home continues to operate an ‘on call’ system at night, ensuring a designated member of staff is able to reach the home within twenty minutes to cover emergencies and provide back up for the sleep in member of staff. As previously mentioned since the last inspection the home has employed four new members of staff. All four new member of staffs files were examined and found to contain the majority of information required by the Care Homes Regulations (2001), including a completed job application, the terms and conditions of their employment, two written references, an Enhanced criminal records, Home Office approved working visas and proof of their identity. However, only three out of four of the new recruits had been checked against the Protection of Vulnerable Adults Register before being allowed to commence their employment. The manager was reminded that under no circumstances must any member of staff be allowed to start working in the home, supervised or otherwise, before this check has been completed. An immediate requirement was issued at the time of this inspection and the member of staff in question was suspended from duty while a POVA first check was carried undertaken. The POVA first check was completed within three days and documentary evidence forwarded to the Commission. Esther Care Home Ltd G53-G53 S35826 Esther Care Home Ltd V187979 160505 Stage 01.doc Version 1.30 Page 23 Staff training records revealed that all four new members of staff had started their induction training, which was currently on going. The manager had introduced a new induction programme, which had been compiled by an accredited training company which covered safe working practices, worker roles and responsibilities, needs of the service users and principles of care. One new member of staff met during this inspection was well informed about the homes fire safety arrangements and was able to point out the homes fire exits, alarms and extinguishers. As required in the homes previous report the managers have now carried out an assessment of the training needs of the current staff team. This record revealed that progress has been made with respect of staff training with all staff now suitably trained in fire safety and continence promotion. In addition, only new recruits now need to receive training in moving and handling, first aid, food hygiene, vulnerable adult protection and recognising, preventing and reporting abuse training. As indicated in care plans many of the service users have specialist communication needs and as a direct result of high staff turnover the manager concedes that not all the staff have the individuals knowledge and skills to effectively communicate with all the service users using their preferred mode of communication and/or language (e.g. Makaton, Hindi). It was positively noted that a referral has recently been made to a speech and language therapist who has introduced prompt cards to enable one service user communicate more effectively. Some of the service users use Makaton sign language and the requirement is made that all staff, and in particular new members, attend ‘suitable’ training in this area of practice. Records sampled at random revealed that staff had all received one supervision with a senior member of staff in the past two months in accordance with good practice, although no one had received an annual appraisal in the past twelve months. This shortfall was identified in the homes previous report and the manager has agreed to address the matter. The manager and staff members on duty at the time of this visit were observed interacting with the service users in a very caring and respectful manner throughout the course of the day. Esther Care Home Ltd G53-G53 S35826 Esther Care Home Ltd V187979 160505 Stage 01.doc Version 1.30 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39 & 42 Although progress has been made with regards to the home obtaining a quality assurance system, this still needs to be implemented. Without this, the involvement of the residents and relatives could be limited. Overall the homes health and safety arrangement are adequate to protect the service users and staff from avoidable harm. The damaged ‘dorguard’ attached to the fire door in the kitchen must be repaired and the homes electrical wiring must be checked as a precautionary measure against the risk of fire. EVIDENCE: Esther Care Home Ltd G53-G53 S35826 Esther Care Home Ltd V187979 160505 Stage 01.doc Version 1.30 Page 25 Since the homes last inspection the registered co-owner/manager has spent three months on maternity leave. As agreed at a meeting held between the Commission and the proprietors last October (2004) the registered manager arranged for a ‘suitably’ competent and qualified person to be in operational day-to-day control of the home in her absence. The individual appointed was in post for less than two months and Mrs Kalaiyalagan returned to work after being on maternity leave for less than three months. The manager still needs to complete her NVQ level 4 in both management and care by the end of the year (2005) to comply with the National Minimum Standards. The manager acknowledges that balancing the competing demands of managing the home, studying for her NVQ level 4 in management and care, and having a baby is difficult, but is nevertheless determined to continue in her current role. As required in the homes last inspection the manager has purchased an accredited quality assurance system, although the management conceded that the system has not been introduced yet. The manager stated that the views of the service users, their relatives and other stakeholders will underpin all there self monitoring and the results of these quality assurance surveys will be published and made available to all interested parties on request. The home needs to make more of a concerted effort to establish suitable arrangements for self-monitoring and ‘openness’, a view echoed by all the relatives met during the course of this inspection. 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. Inspection of the homes fire records indicated that the fire alarm system continues to be tested on a weekly. The homes last fire drill was carried out in January 2005. Up to date Certificates of worthiness were in place for the homes fire extinguishes and alarm system as evidence that they had been checked by a suitable qualified professional in then past twelve months. The homes most recent electrical wiring certificate revealed that it had not been checked for the past five years contrary to health and safety regulations. This health and safety issue must be resolved as a matter of urgency. Similarly, at 11.15am on the morning of the inspection a fire door leading from the kitchen to the hallway was wedged open. Staff explained that the sound activated release mechanism (i.e. Dorguard) that usually kept the door open was damaged. The manager is reminded that under no circumstances must fire doors be wedged open. If a sound activated release mechanism is damaged it must be repaired as soon as practicable and in the interim the door kept shut when it is not in use. Esther Care Home Ltd G53-G53 S35826 Esther Care Home Ltd V187979 160505 Stage 01.doc Version 1.30 Page 26 Esther Care Home Ltd G53-G53 S35826 Esther Care Home Ltd V187979 160505 Stage 01.doc Version 1.30 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 x x x 2 Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x 2 2 x x x Standard No 11 12 13 14 15 16 17 x 3 3 3 3 x 2 Standard No 31 32 33 34 35 36 Score x 3 3 1 2 1 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Esther Care Home Ltd Score 2 2 2 3 Standard No 37 38 39 40 41 42 43 Score 3 x 1 x x 1 x G53-G53 S35826 Esther Care Home Ltd V187979 160505 Stage 01.doc Version 1.30 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 1 Regulation 5(1) (2) & 12(4)(b) Requirement The service users guide and other information about the home must be avialable in formats suitable for the people for whom the service is intended (e.g. appropriate languages, pictures, symbols ect..). Copies of the up dated version must be given to each of the service users and the Commission. Previous timescale for action of 1st March 2005 not met. A record of all the homes charges, including any extra amounts payable for services not covered by the basic cost of each placement, must be appropriately maintained. These charges must be included in each service users terms and conditions of occupancy. Care plans must set out in greater detail each service users likes and dislikes, their goals and aspirations, and what support they will require to enable them to ascertain these goals. The homes arrangements for laundering and care of service users clothes must be improved to minimise the risk of damage. Timescale for action 1st August 2005 2. 5 5(1)(b c) & 17(2), Sch 4.8 1st September 2005 3. 6 15(1) 1st September 2005 4. 18 12(4)(a), 16(2)(e) & 18(1) 15th July 2005 Esther Care Home Ltd G53-G53 S35826 Esther Care Home Ltd V187979 160505 Stage 01.doc Version 1.30 Page 29 5. 19 12(1) & 17(1)(a), Sch 3.3(m) 13(2) 6. 20 7. 22 17(2), Sch 4.11 12(1) & 13(6) 8. 23 9. 23 16(2)(l) 10. 11. 26 26 16(2)(c) 13(4) & 16(2)(c) 12. 27 13(4) 13. 34 13(6) & 19, Sch 2.7 The home must appropriately maintian details of any plan relating to a service user in respect of any specialist health care needs they may have and treatment they are recieving. Staff must appropriately maintain medication records and sign for all medicines administered in the home. A record of all complaints made about the homes operation and the action taken, if any, must be approprately maintianed. All the references in the homes policies and procedures regarding staff being allowed to use physical intervention techniques, even as a last resort must be removed. The home must provide a secure (i.e. lockable) place where service users money may be deposited for safe keeping. The damaged chest of drawers in bedroom No#4 needs to either be repaired or replaced. Off cuts of old carpet used as rugs in a couple of the first floor bedrooms must be either removed and/or replaced with more suitable flooring in accordance with the service users wishes. The likelihood of service users scalding themselves while using their bedroom sinks needs to be assessed and prompt action taken to minimise any identified risks. Immediate requirement issued at time of this inspection: New member of staff who had not been checked against the protection of vulnerable adults register was suspended from duty while a POVA first check was undertaken. 15th July 2005 15th July 2005 15th July 2005 1st August 2005 15th July 2005 1st August 2005 1st August 2005 15th July 2005 24th May 2005 Esther Care Home Ltd G53-G53 S35826 Esther Care Home Ltd V187979 160505 Stage 01.doc Version 1.30 Page 30 14. 35 18(1) 15. 36 18(2) 16. 39 24(1) (3) 17. 18. 42 42 13(4) & 23(2)(c) 23(4)(c)(i ) All staff who have yet to do so must receive suitable training in moving and handling, first aid, food hygiene, Makaton signing and vulnerable adult protection. Documentary evidence of this training must be forwarded to the Commission on completion. Ensure that all care staff have an annual appraisal. Previous timescale for action of 1st April 2005 not met Ensure that for quality assurance purposes an internal audit takes place annually, which involves service users. The results of any survey must be published possibly as part of a wider consultation with stakeholders. Explore the possibility of using an objective, professionally recognised quality assurance system (39.3 4).Previous timescale for acton of 1st April 2005 not met. The homes electrical wiring needs to be checked by a suitably qualified professional. The damaged sound activated release mechanism attached to the fire door in the kitchen must be repaired as a matter of urgency. Under no circumstances must any fire door be wedged open. 1st October 2005 1st October 2005 1st October 2005 15th July 2005 1st July 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 13 Good Practice Recommendations More detailed records regarding service user participation in social, leisure and recreational activities, both inside and outside the home, should be kept in their daily diary notes. G53-G53 S35826 Esther Care Home Ltd V187979 160505 Stage 01.doc Version 1.30 Page 31 Esther Care Home Ltd 2. 3. 32 37 50 of care staff (including agency staff) to have achieved an NVQ level 2 or above in Care by the end 2005 (32.6). The registered manager should have achieved or at least begun studying for the Care component of her registered managers award (NVQ Level 4) by the end of 2005. Esther Care Home Ltd G53-G53 S35826 Esther Care Home Ltd V187979 160505 Stage 01.doc Version 1.30 Page 32 Commission for Social Care Inspection Croydon, Kingston & Sutton 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 G53-G53 S35826 Esther Care Home Ltd V187979 160505 Stage 01.doc Version 1.30 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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