Inspection on 22/05/07 for Gardiner Close

This inspection was carried out on 22nd May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Gardiner Close 10/10/05

Gardiner Close 10/05/05

Gardiner Close 14/06/04

Gardiner Close 19/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Gardiner Close 2 Gardiners Close Dagenham Essex RM8 2XG Lead Inspector Mr Roger Farrell Key Unannounced Inspection 22 May 2007 12:00P DS0000027900.V349391.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000027900.V349391.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000027900.V349391.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gardiner Close Address 2 Gardiners Close Dagenham Essex RM8 2XG 0208 592 3616 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) Outlook Care Mrs Julie Michelle Wilson Care Home 7 Category(ies) of Learning disability (7) registration, with number of places DS0000027900.V349391.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th October 2005 Brief Description of the Service: Gardiners Close is a care home registered to providing care and support to seven people who have a learning disability. It is operated by Outlook Care, a not-for-profit organisation who run a range of support services for vulnerable adults in North East London and Essex. The home was purpose built in 1996, and is on a generous plot at the end of a cul de sac. All residents have their own bedrooms, and share spacious and well-maintained communal rooms. The building is owned by London and Quadrant housing trust, who are responsible for maintaining the property. Five of the residents moved in together when the home opened in March 1996, having lived together in an older style home that was being closed. The age span of residents is from early fifties to three who are now over sixty-five. One person moved in December 2002 and quickly became established as a member of this settled household group. The seventh person joined the group in February 2004. Dependency levels have increased significantly over the past couple of years due to mental and physical needs to do with aging. Barking and Dagenham pay for all places as part of a block contract. DS0000027900.V349391.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 12noon and 5:40pm on 22 May 2007. Julie Wilson, the registered manager had returned an updated ‘pre-inspection questionnaire’ a couple of weeks earlier. She was on duty on the day of this visit, and was again efficient and competent in responding to the inspector’s enquiries. This included giving a description of current staff levels on shifts, including waking night cover, which had been the only requirement listed in the last report. The inspector returned the following week to collect paperwork he had requested. He had left pictorial questionnaires for service user. This service has a good record of involving advocacy services. The regular advocate had tried to use these questionnaires with residents, but levels of understanding have become a barrier to establishing the views of service users and hearing their opinions. In addition to covering all the core standards, the main focus of discussion was the increasing dependency needs of all residents. The manager gave a detailed overview of each person’s care and support needs, covering mental and physical abilities, including signs of dementia, mobility and continence; dependency on staff for day-to-day living tasks, such as help with personal hygiene; and contact with family and other representatives. In addition to looking at support plan files, the manager provided an up-to-date synopsis report covering each resident’s assessments and contact with health care workers, including the degree of mental frailty. The introduction to her profiles said – “Over the past year all seven service users have shown significant decline in cognitive functioning, some more severe than others. Six of the seven service users are now seen on a regular basis by the community learning disabilities team and have regular reviews with a consultant psychiatrist”. Also, six residents now need help with continence. The headline finding of this service audit is that the manager and team continue to provide an excellent service to residents whose needs have increased significantly as they grow older. However, there is a need for the organisation and sponsoring council to closely monitor the adequacy of staffing levels to ensure they are sufficient to meet the increasing level of dependencies. Questionnaires were sent out to relatives who have active contact with service users. The inspector is grateful to the five people who returned ratings and comments. These views have helped the inspector arrive at the positive conclusions set out in this report, and he has used quotes from this consultation. The inspector took time to explain to the manager and the deputy changes in the way care services are monitored. Using a flow chart, he described each change, including – the frequency and types of inspection; the increased importance of the new annual self-assessment form called an ‘Aqaa’; the DS0000027900.V349391.R01.S.doc Version 5.2 Page 6 introduction of ‘star-ratings’, and how these will be made public early next year; and ways of hearing the views of people who use services and their representatives. He also outlined how the Commission is moving towards having regional contact offices, and how to make sure information reaches the right inspector. What the service does well: What has improved since the last inspection? As well as having files that use pictures and other ways of trying to make sure that residents can be involved in planning their lives – staff keep extra files where they write down the help people need with their physical and mental health. These are being well used, saying what additional help is needed as residents get older. Other people who visit the home, such as nurses, tell inspectors that this is a good home. The last time an inspector told the home there was to be a visit a number of people sent him comments. One relative wrote – “Excellent. I can’t fault the home in any way.” Another said - ”We are satisfied with the care [our daughter] gets. We are informed by the home if any problems arise. We would like to thank the staff for the care and attention they give.” DS0000027900.V349391.R01.S.doc Version 5.2 Page 7 Yet the prominent change is how residents’ day-to-day support needs have continued to increase significantly. Three years ago staff acknowledged that they could not continue to care for one of the original residents as her needs became greater, and she moved to a nursing home. The position now is that a number of current residents have reached similar levels of dependency. The inspector’s last main report said that tests were continuing to establish if one person would be diagnosed as having dementia. Now four residents are showing characteristic signs of such mental frailty. Six service users need intimate assistance due to double incontinence. The inspector’s observations and comments by staff show how the demands of this service have changed. In addition to much higher levels of support around personal care, staff now have to cope with behavioural changes. There are consequences such as needing two staff to carry out some support tasks; the introduction of aids such as pressure relieving equipment; increased input from community nurses and the specialist learning disability team; and a notable reduction in activities away from the home – examples of which are covered in this report. This service is adapting to these changes in a realistic way. For instance, there used to be regular residents’ meetings, including - up to September of last year - a monthly meeting with a familiar advocate from Mencap. However, the advocate and manager agreed that such a forum was no longer appropriate, and there was little point in replacing these with ‘1 to 1’ advocacy sessions. There is still advocacy input, including attending reviews. What they could do better: Following on from enquiries made at the last two visits, the inspector asked to see evidence that the changing profile of this service was being monitored by the registered persons, care managers, and the funding authority. He has seen the minutes of a meeting held last June which raised an alert with the local council’s older person’s services, and looked at staffing levels. There are now two waking night staff, the original cover being one person doing a sleep-in. However, the norm remains just two people on both the early and late shifts. The inspector’s enquiries revealed that this is often supplemented by the manager helping with the practical duties. The inspector believes that this service has been sustained against a backdrop of escalating work demands by the dedication and flexibility of staff. Indeed two staff on this consistent team are close to retirement. When pressed, the manager gave reassurances that the organisation and stakeholder agencies are aware of the main resource issue. There had been an inter-agency meeting the previous week, with the manager saying earnest consideration was being given to the proposal that routine staff cover be increased to three per day/evening shift. One relative gave an example that illustrated the pressure on staff time and priorities, citing an example where staff could not remain with a service user during a one-day hospital admission for an operation as they were needed back at the home. This person said that the organisation must address such shortfalls as “This was his first time in hospital and I was told that someone from the home would be with him all day……My (relative) DS0000027900.V349391.R01.S.doc Version 5.2 Page 8 and other clients are very frightened when they are left alone with people who do not understand them.” The inspector accepts that this challenging change in this home’s workload is to be addressed, and therefore no requirements have been set determining the necessary review of resources. However, the registered persons need to make a formal response to this report, setting out the steps being taken to address this crucial matter. Consideration also needs to be given as to whether a change in registration status is indicated given the increasing needs resulting from aging and dementia rather than as a result of a learning disability. Nevertheless, the concluding remark needs to be that the manager and team are highly commended for their dedication in supporting this group of service users through such difficult life changes. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000027900.V349391.R01.S.doc Version 5.2 Page 9 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 DS0000027900.V349391.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, and 5. Quality in this outcome area is ‘good’. This judgement has been made using available evidence including a visit to this service. The headings covered in this section are all rated as satisfactory. The last person to join this group was three years ago, and inspection reports described it as a successful move-in. The paperwork covering that transition showed a wellplanned approach to assessment, including good coordination with carers and health workers who knew the resident well. This service can show that it used a methodical approach to helping new people become part of this resident group, that is in line with the organisation’s guidelines. EVIDENCE: Outlook Care have a good set of guidelines and assessment forms covering move-ins. At a previous visit the inspector looked at the ‘assessment folder’ of the last person to join this household group in 2004. This contained a good range of information, including – a seven page ‘care plan’ and profile done by the key worker at the person’s previous home; a detailed referral assessment and update completed by a social worker; and the additional assessment and tracking notes done by the manager. There was also a detailed pre-admission review. There had been a series of day visits with the new resident being accompanied by her existing carers, followed by an overnight stay. Details on the ‘assessment folder’ had additional information that showed a methodical approach – including progress reports of each introductory visit, and a meeting with the community learning disabilities nurse who has known the service user for many years. Suitable attention was paid to matching needs and consideration of compatibility with the established household group. This DS0000027900.V349391.R01.S.doc Version 5.2 Page 11 resident’s history and key information had been carried forward onto the current file. An advocate had been involved with the second last resident to move-in who is a person that cannot express himself verbally. Barking and Dagenham Council sponsor all residents, and a signed copy of their standard contract of residency is available. The inspector saw the signed ‘Licencee Agreement’ issued to each person by the landlord housing trust, and the organisation also use a pictorial version. Files contain letters regarding rent accounts and adjustments. There is a detailed and attractively presented ‘statement of purpose’. This is in a format that is seeks to be understandable to service users, including the using pictures. Of an equally high standard is the ‘service users’ guide’, that also makes good use of pictures. They cover all areas asked for under these standards, including a section on service users’ views. Copies of these and other main documents are available in the hall, along with a pictorial version of the complaints’ procedure. Copies are available in the entrance hall, along side a photomontage of the residents with their views on the service. The service users and staff notice boards have an appropriate range of up-to-date information. DS0000027900.V349391.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 and 10. Quality in this outcome area is ‘good’. This judgement has been made using available evidence including a visit to this service. The headings covered in this section are all rated as satisfactory. The way residents’ files are kept up-to-date show how the team continue to take into account individual needs and choices. Staff are fully aware of the way each person communicates their views, and the extent to which they are willing and able to participate in activities like household tasks. Staff have shown great dedication in making sure every-day living needs are met, though this now involves a significant increase in the level of hands-on care. The manager said despite decreasing abilities, they remain alert to helping residents do what they can for themselves. Comments from relatives included - “They are very understanding of my (relative’s) needs. I visit her at various times and she is always very smartly dressed and her hair tidy.” And - “The residents of the home are well looked after and everything is done for their comfort. The staff are very friendly and welcoming.” EVIDENCE: Over successive visits the inspector has looked at a selection of service user files. This included ‘person centred planning (‘pcp’) files’; the ‘health care files’; and the ‘daily diaries’. The main sections of the ‘pcp files’ are designed to involve the residents in their support as far as possible. They show that DS0000027900.V349391.R01.S.doc Version 5.2 Page 13 planned reviews are taking place, including involvement of the community learning disabilities team. They contain a ‘health care checklist’ and a ‘health care year planner’. There is good cross-referencing to the ‘health care files’. There was also a good range of individual risk assessment forms. The manager is planning to introduce more pictorial elements into the personal files in line with changing levels of comprehension. A priority for this team is to remain alert to the changing needs of residents, including how decreased abilities and behaviour patterns are linked to the onset of dementia. Reviews carried out in-house, and by supporting agencies demonstrate good attention to detail, including seeking the views of relatives, and where possible those of service-users. There is little evidence of the need to have restrictions, beyond everyday safety matters that are well covered by risk assessments. All residents have to be accompanied when away from the building, though some residents now go out less. The front door has a discreet alarm to let staff know when a resident opens the door to a caller. There is also a main risk assessment file covering a range of general areas, such as use of parts of the building. No resident is assessed as capable of managing their own money without help. No individual staff member acts as an appointee for residents benefit claims – personal accounts are managed centrally by the organisation. Cash held in the safe for residents is generally limited to £50, and the inspector saw how this is checked at each hand-over. The person who carries out the ‘monthly visits’ also checks cash accounts. No discrepancies have been found over the past year All residents now need supervision or assistance with personal and domestic routines. The organisation hold service user consultations and invitations are made known to service users, but none of this group are now able or willing to attend. Each file has a completed ‘missing-person’ form with a photo attached. There is a procedure to follow if someone is unaccounted for. The inspector has seen the policies covering confidentiality and data protection. This issue is covered in the induction programme, including the shorter version used for bank staff. Personal information is kept in a locked filing cabinet in the office. Each person can have access to their ‘pcp’ file and their day-to-day diaries. DS0000027900.V349391.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17. Quality in this outcome area is ‘good’. This judgement has been made using available evidence including a visit to this service. Previous reports have praised the way staff helped residents enjoy varied and individually appropriate social and leisure activities. The manager reflected the reality of current circumstances in saying – “Activities are somewhat reduced due to the support needed by each service user. Also, some day services can no longer accommodate the needs of some individuals.” For some time two residents have found it too stressful being out in crowds. As residents get older and dependencies increase it is proving harder to find suitable organised activities. The situation is however helped by having an activities organiser one day a week. EVIDENCE: In judging these standards inspectors look at records covering planned weekly activities. In Outlook Care homes this includes each person’s ‘How I like to spend my week’ section, and the ‘What I have done this month’ sheets. The manager gave an overview of how each resident spends their time. It is clear that the range of options previously supported has decreased. The inspector asked the manager for an up-to-date list of main activities for each person. It is clear that staff have been determined to ensure worthwhile activities DS0000027900.V349391.R01.S.doc Version 5.2 Page 15 continue where abilities allow. This includes one resident using The Maples day centre, and five or six attending sessions at the Bethel Hall Centre on Mondays, including the craft classes and music sessions. Unfortunately, the Tuesday sessions at the Dagenham Church Club on have stopped, as has the Monday Evening Club. The manager said “This reflects the reality that opportunities that suit our service users are getting harder to find.’ Previously all residents would go away on a group holiday, with additional weekends away - but only one person was listed as having a holiday in recent months, with a couple of people having a weekend break in March. Other occasional leisure activities were also set out on the manager’s list, such as going out for lunch, bowling, occasional day trips and party celebrations. Some organised events have not gone ahead as residents have declined to attend, such as an Elvis Celebration. The inspector was told that the scope for outside activities has decreased as there is less leeway to allow staff to go out on ‘1 to 1’ trips as all hands are needed on each shift given the increased level of personal care. It was pointed out that some staff help with trips during their off-duty times. One person still attends church. There is a home delivery dvd service. The home has a vehicle, but its use is very limited as the only approved driver is the manager. The inspector heard about each person’s links with their families, and the regularity of contact and whether they attend reviews. In general, all but one person has regular contact, varying from weekly visits, to once every couple of months. Last year one resident met with his sister who was visiting from the USA. All residents are understood to have used their postal votes in the past, but levels of confusion are such that this is unlikely to be the case at future elections. Relationships with the immediate community are described as cordial, with contact limited to exchanging greetings. Residents are asked to make meal choices using picture cards or pointing to options. Staff have a good knowledge of individual’s likes and dislike, one person having told the inspector – “People prefer straight forward meals, meat with two veg, though we do get a take-away occasionally.” Two residents now have ‘soft’ meals, and a daily record of intake is kept. There was a good range of food stocks in the kitchen, including fruit and fresh vegetables. DS0000027900.V349391.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21. Quality in this outcome area is ‘good’. This judgement has been made using available evidence including a visit to this service. This included the manager giving a description of each resident’s contact with medical services over the last year, including assessments for mental frailty and medication reviews. They can show how they link in with health services, and adjust their support to meet residents’ current needs. There are also safe arrangements for helping with medication. EVIDENCE: This manager is able to demonstrate that responsible steps have been followed to assess and monitor residents’ mental and physical conditions, and respond when problems occur that need further investigation. This is notably true when the signs of changing needs are due aging, including loss of mental abilities. She can show how they link in with health services, and how the team adjust their support to meet residents’ changing needs The age span of residents is from early fifties to three who are over sixty-five. There is a separate ‘Need To Know’ file that has pen-picture profiles on each person. This includes the level of support and prompting that each person needs to maintain their personal care. This is also covered in the appropriate sections of the ‘pcp’ files. A couple of years ago it was true to say that in general residents had good levels of self-care skills. This has now changed significantly, all requiring much greater help with every-day tasks. DS0000027900.V349391.R01.S.doc Version 5.2 Page 17 The last main inspection report said the underlying cause of the changes were being tentatively attributed to decreasing mental ability due to aging. It has now been established that four residents have dementia. These confirmed diagnosis were assisted by detailed staff observations – the ‘health care files’ introduced three years ago proving to be essential as a monitoring framework for physical and mental signs and symptoms – and detailing the increased contact with psychiatrists and other health care workers. These files have sections on medical consultations and tracking sheets; observation sheets that have good detailed entries; reports from others such as occupational therapists and speech and language therapists; entries by community learning disability nurses; monitoring charts, such as for blood tests and weight; and older medical reports that have been carried forward. Also, to guide staff they contain fact-sheets on conditions relevant to that resident. One file seen had a chronological resume of one resident’s medical contacts extending back over ten years that the manager had researched. This is a good example of how this service comprehensively covers the ‘carryforward’ of information to assist continuity in such a key area. Routine visits by community learning disability nurses had been were phased out, but have needed to be re-established – learning disability nurses now visit at least monthly, and a psychiatrist makes quarterly calls. There are also regular visits by community nurses due to medical conditions, such as diabetes. At previous inspections visiting nurses have made favourable comments about the quality of care and liaison. Medication is provided weekly in ‘Nomad’ boxes supplied by a local pharmacist, with printed mar sheets. A good safety innovation is that these pillboxes have a photo attached. There are two metal medicine cupboards fixed to the office wall, which were neatly arranged. Other satisfactory conditions include - clear administration records; individual medication profiles; guidance on when to give ‘as and when necessary’ medication; double checks on deliveries; a homely medicines list approved by the GP; and all staff have completed the detailed ‘Safer Handling of Medicines’ distance learning course. There have been no known medication errors over the past twelve months. The Commission’s pharmacy inspector carried out a more detailed audit on 20 January 2005 and a separate report was provided. The supplying pharmacist also does occasional checks at the home, the last being on 10 June 2007 and they were still awaiting that report. Outlook Care also do detailed medication audits. The inspector read the report of the last check that was on 17 April 2007. This consistently scored all areas as satisfactory. One recommendation was made, but the matter raised was already being covered in a separate ‘ordering file’. The person carrying out that last detailed audit had asked other managers to visit Gardiner Close as an example of comprehensive and safe medication systems. There is a policy on guiding residents to consider their wishes regarding illness and dying, with a corresponding section in the ‘pcp’ files. DS0000027900.V349391.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is ‘good’. This judgement has been made using available evidence including a visit to this service that involved looking at the information available regarding this important section. The manager is aware of the action to take if there is a complaint or a suspicion of abuse, explaining the one matter that has been considered in the past year. Residents and relatives are made aware of how they can raise concerns, and can be confident that these will be followed through. This includes having access to an advocacy service. Comments from relatives included: • “I have never had cause to make a complaint. I am very very satisfied with all the care my (relative) gets.” • “I do not have any complaints.” • “I cannot find any need for improvement at the present time. I am more than happy at the way the home is run. My (relative) is very happy there, and the staff are wonderful.” EVIDENCE: Outlook Care have a clear and effective complaints procedure pack, and a copy is available at this home. Information on making complaints is included in the pictorial ‘service users’ guide’, and displayed on the notice board. This includes details of how to contact the advocacy service and the Commission. The policies covering adult protection include ‘Infringement of Service Users’ Rights Procedures’; ‘Whistleblowing’; and ‘Abuse Management’. In addition there were copies of ‘No Secrets’, and the local Adult Protection Guidelines. The leaflet ‘No More Abuse’ produced by ‘Voice UK’ and ‘Change’ is also available. The complaints log had no entries since December 2002. Staff do a one-day course on adult protection, and sign to confirm they have read the local guidelines. Each staff member has been given a copy of the General Social Care Council’s ‘code of practice’, and have given informed answers when asked about safeguards at earlier visits. DS0000027900.V349391.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 and 30. Quality in this outcome area is ‘good’. This judgement has been made using available evidence including a visit to this service. This is a well-maintained and homely house. The inspector viewed all communal parts of the building and saw a sample of bedrooms. The consistently high standard of cleanliness is being maintained despite the increased demands of providing personal care and help with toileting. In recognition of these exemplary conditions the household heading is scored at the highest ‘commendable’ level. This building continues to provide all its residents with a comfortable and safe living environment, including being alert to the needs of those residents who are growing more dependant and lees mobile. EVIDENCE: This well maintained property was purpose-built eleven years ago and is on a good-sized plot at the end of a residential close. The house is well screened from the busy road to the rear, with a large garden and double-glazing helping to reduce the noise. The building is in keeping with neighbouring houses that were built at the same time. There is a handy parade of shops nearby. The inspector again found the home safely arranged, comfortable, bright and clean. There is plenty of space for service users, including a generous entrance DS0000027900.V349391.R01.S.doc Version 5.2 Page 20 hall and wide corridors. All areas are suitably decorated, with good quality furnishings and fittings. All service users have their own bedrooms that are above the minimum space requirements. During the past year five bedrooms and have been redecorated, all have new bedding and curtains, as well as new floor coverings being laid, and two service users have new beds. There are two bathrooms and a shower room on the first floor. The ground floor has a large disability shower room, with an additional door making it accessible from the adjacent bedroom. There is also a separate toilet at this level. All these facilities were found to be hygienic, adequately maintained, and have suitable locks. The staircase has an additional sturdy handrail. There is an assistance call system. The lounge is well furnished, attractively decorated, and has a good range of home entertainment equipment. The seating in the lounge has been recovered within the last year. It is spacious enough to allow a section to be used for a snooker table. The dining room has also been redecorated, part of which is arranged as a lounge area, and can be used for visits. There is a large garden, with patio area and garden furniture. A large sturdy decked area has been fitted. The standard of maintenance of the garden has been improved, and trees and shrubs have been cut back. The manager listed improvements that are being followed up with the landlord housing association, including, adjusting some internal doors and the need for some new fencing panels. DS0000027900.V349391.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 and 36. Quality in this outcome area is ‘good’, though the adequacy of staffing levels needs to be kept under review. This judgement has been made using available evidence including a visit to this service, One comment was – “Having dedicated staff means that what could have been unmanageable has been made manageable…they really have been giving one hundred and ten percent.” This view of a staff team struggling to meet the increased pressures was echoed in the comments made by relatives, including: “Everything they do they do to the best of their ability. Lack of enough staff sometimes can be a bit of a problem, but I feel they cope marvellously really.” And - “They do seem rather stretched at times. As the age of residents isn’t getting any younger, their needs are becoming more demanding. I think there are worries about their safety, especially at night. An increase in staff would be the only improvement I would suggest. EVIDENCE: The manager’s description of the intensified demands due to increased disability regularly referred to the remarkable fortitude and dedication of the staff. This dedication is reflected in the fact that the team is remarkably stable, with no staff having left over the past year. A number of staff have experience of working in other care homes. One comment was – “You know when you have done a shift (at this home) as it is very hard physical work…you can be quite worn out by the end, but you know that everyone mucks in, including Julie.” Another quote in a similar vein was – “Some days it’s like working in a nursing home, it can all be about ‘mopping-up’. It can be very demanding day DS0000027900.V349391.R01.S.doc Version 5.2 Page 22 to day – but we know we are keeping the (service users) healthy, happy, wellfed and clean.” The need to re-evaluate the adequacy of staffing levels is referred to in the Summary Section of this report as the main consideration for the registered providers, and the sponsoring authority. At previous visits inspectors have looked at a sample range staff files to check that the right vetting is being carried out. The staff folders have completed application forms; two written references; a photo; copies of passports and other paperwork that prove identity; medical forms; and statements of terms and conditions. The organisation is a registered body with the CRB and have received enhanced level checks on all staff at this home. The manager confirmed that there had been a recent re-audit of the ‘pink staff folders’. The organisation has a very good record on training and induction. The inspector was an up-to-date resume of staff training in all the required core areas – this mostly being ‘refresher’ training for this group - including safeguarding procedures; first aid; food hygiene; risk assessments and manual handling; and infection control. Additional training has included ‘Working with Dementia’, ‘personal safety’/lone working’; autism awareness; diabetes control; and the company’s quality control systems. Copies of confirming certificates are kept on each person’s file. A significant achievement is that all staff have NVQ qualifications, most at the higher Level 3. This, and the strong staff team profile is recognised by awarding the highest scores five of the six categories under this section. DS0000027900.V349391.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41, 42, and 43. Quality in this outcome area is ‘good.’ This judgement has been made using available evidence including a visit to this service. Outlook Care are very good and running their services in an open and accountable way. There are a number of in-house and external service audit systems; ways for residents to make their views known; and clear policies and procedures. This works well in providing monitoring and safeguards for those who use their services. EVIDENCE: The manager has worked at this home since April 2000, moving from deputy to acting May 2005. Her experience, qualifications, and strong leadership qualities have ensured that this service has been able to meet the extraordinary demands of recent years as service users needs have changed significantly. The deputy has held that post since October 2005, having worked at the home for a number of years and having taken a career break. At the last visit the inspector asked to see a range of documentation and certificates covering health and safety. This included fire safety arrangements; DS0000027900.V349391.R01.S.doc Version 5.2 Page 24 electrical, gas and water safety checks; periodic building safety checks; and insurance cover. The inspector saw the manager’s last audit of safety certificates and other paperwork done the previous month. The company arrange independent fire risk assessments in line with the revised fire safety regulations. The last inspection by and environmental health inspector was in July 2006 with satisfactory conditions reported. The manager consistently presents all records in an ordered and efficient way, reflecting the good office arrangements. There are a range of quality assurance systems. This includes regular ‘monthly visit reports’; specialist audits such as the medication arrangements; and external accreditation schemes like ‘ISO9002’, ‘Investors in People’, and ‘Positive About Disabled People’. The company operate a quality assurance scheme – called the ’Continuous Improvement Programme’ (CIP). This includes steps to ensure that staff are familiar with all current policies, guidelines, and practice forms. This has also included doing some policies and procedures in an ‘easy read’ format. Recently, managers have been doing a ‘self-assessment’ of their service, and the inspector saw this manager’s report carried out in May 2007. This positive approach to quality monitoring leaves them well placed to tackle the ‘AQAA’ assessments being introduced by the Commission this year. DS0000027900.V349391.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 4 32 4 33 3 34 4 35 4 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 4 4 3 3 3 3 3 3 DS0000027900.V349391.R01.S.doc Version 5.2 Page 26 No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000027900.V349391.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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