Inspection on 26/10/06 for Green Lane (626)

This inspection was carried out on 26th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Green Lane (626) 19/01/06

Green Lane (626) 02/03/05

Green Lane (626) 11/01/05

Green Lane (626) 25/03/04

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

CARE HOME ADULTS 18-65 Green Lane (626) 626 Green Lane Goodmayes Ilford Essex IG3 9SD Lead Inspector Stanley Phipps Key Unannounced Inspection 26th October to 17th November 2006 10:45 DS0000025902.V317562.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 DS0000025902.V317562.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. DS0000025902.V317562.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Green Lane (626) Address 626 Green Lane Goodmayes Ilford Essex IG3 9SD 020 8503 8392 020 8503 8392 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) www.rchl.org.uk Redbridge Community Housing Limited [RCHL] Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (6) of places DS0000025902.V317562.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To include one named person over 65 years of age. Date of last inspection 19th January 2006 Brief Description of the Service: 626 Green Lane is a residential home for six adults with a mental health condition and is managed and run by Redbridge Community Housing Limited. The home is situated on a main road on the outskirts of Goodmayes, and has easy access to pubs, shops and other local amenities. There are good transport links both to central London and within the local area. The home was opened in 1991, and is supported by staff on a twenty-four hour basis. Most of the current service users have lived at the home for a considerable period and as such, are growing beyond the original age criteria of the home. However, the registered persons have been employed strategies to enable them to continue to live in the home. They included occupational therapy assessments to determine the suitability of the environment in meeting the needs of individual service users as well as the provision of training for staff in diseases associated with the elderly. A key objective of the service at 626 Green Lane is working with all service users to maintain their independence whilst living in the home. Staff work closely with them in ensuring that their personal, social, spiritual, psychological, mental health and general healthcare needs are met. An on-call system is in place to support staff beyond the normal working hours, including the weekends. There are bedrooms on both floors of the building, with a set of stairs allowing access to them. There is no lift facility in the building and this would have implications for service users as they grow older and become frailer. Toilets and bathrooms are located on both floors and, the building contains separate dining and lounging facilities. There is also a kitchen adequately sized and equipped to allow service users opportunities to maintain their culinary skills. A well-maintained rear garden is easily accessible to all individuals living at 626 Green Lane. A statement of purpose is made available to all service users and/or their relatives and a copy of the service user guide is given to each service user. Fees are charged between £94.45 £98.65 pence per week. DS0000025902.V317562.R01.S.doc Version 5.2 Page 5 Service users pay additional for toiletries, holidays and hairdressing – the prices of which are all variable. DS0000025902.V317562.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and a key inspection of the service for the inspection year 2006/2007. This meant that all key standards were covered as well as any other standard for which a requirement was made at the last inspection. The visit was done over two days beginning on 26/10/06 at 10.45 a.m. and ending on the 17/11/06. The inspection generally found improvements to the service and this is positive as an outcome for service users. Some improvement is still required to fully comply with the national minimum standards for younger adults and they are outlined later in this report. A new manager has been in post from July this year and has been working with the staff, the organisation and the Commission in improving the services at 626 Green Lane. An assessment of menus, policies and procedures, records, service user plans and the environment was undertaken. Detailed discussions were held with staff, most of the service users and the manager during the course of the inspection. Formal interviews were also held with two staff and two service users. Attendance to a staff meeting formed part of the inspection methodology. Questionnaires were sent out to staff, service users, the manager, and external professionals, but none had been returned at the time of writing this report. Any feedback that is received from these surveys would be incorporated in the next inspection report. The inspection concluded that service users continued to receive a good standard of care and support at 626 Green Lane. This outcome was very much echoed by all service users spoken to. What the service does well: Service users continue to live in a safe environment - one that is relaxed and calm. They engage with staff in manner that is not pressured in carrying out their daily routines and objectives. In this respect service users despite their range of needs, enjoy good periods of stability. The management and staff work well with service users in making them feel valued by ensuring that their birthdays and special occasions in their lives, are recognised and celebrated. Service users are very much involved in life at the home, which is usually through regular service user meetings, key work sessions, reviews and quality assurance strategies used by the organisation. Meals provided by the home remain a popular feature of the service provision and service users are quite involved in determining what is provided. Apart DS0000025902.V317562.R01.S.doc Version 5.2 Page 7 from the nutritional aspect, they enjoy the flexibility shown by the staff, particularly if they fancied something different. The organisation has maintained a good program in monitoring the service through regular, monthly provider visits. The reports are compiled with good detail as well as, follow up action/s, where improvements are identified. What has improved since the last inspection? Service users now have updated information in their service user’s guide and statement of purpose. Needs assessments for service users were signed off and dated, but more importantly service user reviews made a clear reference to the special needs of individuals with regard to their mental health. On entering the home, the corridor now looks extremely homely, having been redecorated, with pictures hung on the walls as you mount the staircase. There was evidence that the staffing levels were kept under review and this had a positive impact as service users were supported to do much more externally when compared to the last inspection. One example is where service users went on a five-day holiday this year and this is positive. From monitoring the recruitment practices and processes adopted by the organisation, there was an improvement in their robustness, when recruiting new staff. Effective systems are now in place to ensure that staff are thoroughly screened prior to their employment. There was some improvement noted in the policies available to staff in the home, as there was evidence that some were reviewed. Staffing records required for the protection of service users were now maintained in line with the Care Homes Regulations 2001. A risk assessment has been carried out with regards to the service users that are growing older to ensure that they remained safe and well cared for. The organisation has also put in place some guidelines for staff on ageing and this is positive. Service users are now safer, as fire drills were regularly carried out in the home. The registered persons made available to the Commission – a business plan for the home and this bore an indication that the service is fairly stable. The management and staff worked well in supporting a service user to declutter his private space. This course of action is positive in increasing the service user’s awareness in maintaining a safe environment. DS0000025902.V317562.R01.S.doc Version 5.2 Page 8 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000025902.V317562.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 DS0000025902.V317562.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) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users now benefit from having updated information about the services provided at 626 Green Lane, They also benefit from having their needs thoroughly assessed in the home. EVIDENCE: There was evidence that both the statement of purpose and service user guide have been reviewed and updated. The documents now set out clearly what the service is about and what service users could expect from the providers. Both the documents make clear that the age criteria, is between 18-65 yrs. The statement of purpose in addition, states: ‘that the home would continue to provide for their needs for as long the home is able to do so’ (SOP). Both the current and prospective service users are made aware that despite the age range-they would continue to receive a service – once their needs could be met. In speaking with the service users, all of whom were over the age criteria, they were confident that the management and staff at the home were able to meet their needs. There were no new admissions to the home and from the evidence gathered at previous inspections, once service users are referred to Green Lane – a thorough assessment of their needs are carried out. This remains a key part of the home’s admissions process and is complimented by supporting potential DS0000025902.V317562.R01.S.doc Version 5.2 Page 11 service users, to visit the service. It is in line with good practice and for those individuals that had the experience and they were quite pleased with it. DS0000025902.V317562.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): (6,7,9) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All service users now benefit from having their changing needs (including their mental health), reflected and reviewed in their individual plan. Service users are involved in making decisions in their lives and are supported to take risks as part of promoting their independence – within a risk management framework. EVIDENCE: Three out of four service users’ files were assessed and a significant improvement was noted in all cases, in relation to the recording and review of their needs. Support plans were reflective of the individuals’ needs, were reviewed regularly and in line with the home’s policy. There were in-house reviews and reviews involving the multi-disciplinary team – held less frequently (six-monthly). In most cases service users were involved and sign up to the outcomes and this is positive. Another positive feature was the fact that the mental health support needs were outlined in the service user plan. The manager was in the process of developing a relapse plan for one individual and was doing so in conjunction with the key-worker. It was clearer that support for individuals took into consideration the mental health needs of the service users. However, it should be noted that the health DS0000025902.V317562.R01.S.doc Version 5.2 Page 13 and social care needs of service users were also reflected in their individual plans. In one of the cases assessed, the individual had an operation and this enabled him to in maintain his independence. The input of staff in facilitating this outcome for the service user was quite positive. Service users are therefore enjoying a higher quality of input from the staff in not only identifying but, in meeting a full range of their changing needs. In discussions and interviews held with service users, they expressed the view that staff were supportive in enabling them to make decisions in their lives. In at least two cases, service users had the benefit of accessing advocates and this worked in their best interests in terms of both, making informed decisions and ensuring that they are heard. Records of service user meetings also bore an indication that individuals would raise issues that affected them, which would be dealt with in this forum. It is important to note that there was individuality in decisions that were taken, e.g. whether an individual wanted to go to: church, day trips, the day centre or to express their sexuality in a particular way. Whatever the outcome, there was documentation as to what decisions were reached and how this was done. This is a strong area of the home’s operations. It was noted that risk assessments were in place for each service user. They not only identified the elements of risks but, detailed the actions required to keep them to a minimum. More importantly, risk assessments were reviewed and kept updated. This ensured that individuals were able to maintain their independence as far as possible, taking risks in so doing. Service users spoken to were aware of their limitations, but were equally able to say what they are able to do and why. There is a policy in place in the event of a person is missing at the home and staff spoken to were aware of it. Service users are generally safe living at 626 Green Lane. DS0000025902.V317562.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): (12,13,15,16,17) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are encouraged to participate in appropriate activities and are able to maintain and develop social and personal networks of their choosing. They are supported to exercise their rights, which are respected and promoted by staff in the home. Meals provided at Green Lane are reflective of service users’ choice and nutritional requirements. EVIDENCE: Service users are individually and collectively involved in determining the type and level of activities they participate in. Regular service user meetings are held and from the records seen, activities are discussed in this forum. A good example could be drawn from the decision to introduce an interactive TV bingo game to the home. Staff worked well in acquiring the apparatus, and organising an evening, which reportedly had some hiccups, but did come off. It turned out that all the participants enjoyed the evening. As a result, plans to invite external friends to make a bigger entertainment activity out it, has been suggested for the future. In discussion with three service users they stated that, ‘it was good fun – and we had a good time’. DS0000025902.V317562.R01.S.doc Version 5.2 Page 15 During the inspection a number of service users were observed playing a board game, reliving a bit of their past and they were well engaged with this activity. Service users also have opportunities to: watch digital TV (offering a wider range of channels), listen to music, read magazines, attend social functions e.g. barbecues and birthday parties, where they meet with their peers and have a good time. Some service users love shopping and they are encouraged to so do. One individual was also in the process of taking up knitting again and this is positive. One individual showed off some of the items she acquired at a bargain shop, which she was extremely pleased with. It must be said that the items represented ‘good value for money’. Another was interested in getting in the Ilford Recorder and staff were supporting him to achieve this. Service users also had the experience of going on a five–day holiday and from the feedback received, it was quite a positive experience. One individual gave his feedback at his CPA meeting about his experience. There was a strong sense of community presence amongst the service user group as they were visited the banks, local shops, restaurants and pubs. One of the most recent experiences involved getting out for an evening meal and from the group feedback, this was positive. One service user was considering rejoining the Vine birthday club, while another attends up to twice per week. This individual also attends a day hospital on a Friday and attended the world mental health day. There was evidence that one individual attends church on Sundays and each individual had their personal preferences with regard to how they engaged with their community. It was noted that most service users did not have a great deal of family involvement. Where possible the relatives and friends of service users are encouraged to visit and maintain contact with their loved ones. The ethos of the home gives a sense of family living, whilst recognising individual preferences. This is crucially important as it reinforces that sense of belonging. One service user continues to maintain contact with his sister through post cards and for the service user concerned - this is meaningful. Another spoke of contacting her brother. What is positive about this is that, the staff recognises the value of such contact and as such, take steps to support service users to achieve their individual outcomes. It is a credit to them, listening to how they were discussing the Christmas arrangements for service users, being aware of their individual preferences. It must be said that from talking to service users they had something to look forward to. During the course of the inspection it was clear that the rights of service users were respected throughout most aspects of their lives. Service users’ responsibilities for their part in the home are detailed in their service user plans. Most individuals were actively and positively engaged in various aspects DS0000025902.V317562.R01.S.doc Version 5.2 Page 16 of the home, as they enjoyed retaining key elements of their independence. One individual had input from an advocate in agreeing what and how he manages his personal situation. Service users were addressed by their preferred names, asked whether it was okay to access their rooms and most importantly had their wishes carried out. Staff worked well in ensuring that where possible, service users had access to support, for example with finance e.g. involving the housing officer in one particular case. Three service users spoken to expressed the view that their rights were respected in the home. Although a system has been fitted to the front door to promote service users’ safety – this had been risk-assessed. Apart from this, service users have unrestricted access throughout the home and their visitors have access with consent. Menus were in place and in discussion with service users, they confirmed that they are involved in choosing them. One service user enjoys picking up bits of food shopping and staff supports this as an outcome for the individual. Meals recorded were varied and service users confirmed that they are supplied in adequate amounts. As part of the birthday celebrations for one individual, a Chinese take-away was ordered to the choice and delight of the service users. Service users were observed helping themselves to tea and coffee with authority, indicating, that they were in their own home. Food was adequately stored in the home. There was a fresh supply of fruit and vegetables and a good supply of dry goods and meat. Service users again spoke of the flexibility shown by the staff team and this remains a strong aspect of the home’s operations. DS0000025902.V317562.R01.S.doc Version 5.2 Page 17 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) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users enjoy personal support in a manner that is best suited to them. Sound arrangements are in place to provide for their physical and emotional needs. This is complimented by the staffing input with medication, enabling service users to maintain good health. Improvements in the handling medication would enhance this. EVIDENCE: Three of the service users spoken to confirmed that they were happy with the way in which staff provided personal support to them. This is coordinated through the key-worker system used in the home. All service users have their individual style of dress, which was consistent with their choice and personality. Service users have a choice in relation to ‘same gender’ care and are involved in developing their service user plans. These plans individually set out how their personal support is provided. In assessing the record of one individual, it was noted that the staffing involvement was more intense, but even so it was with the agreement of the individual. The management and staff were well aware of the need to balance service users’ rights and choice with their health and safety and this is positive. It was noted that up to two service users had the involvement of advocates and this also positive. One service user described the work of their key-worker, stating ‘she makes sure that I get what I want and, is a joy to work with’. DS0000025902.V317562.R01.S.doc Version 5.2 Page 18 Service users are given good support to ensure that their health needs are provided for. They were all registered with a GP and records assessed indicated that they had input from other health professionals such as the dentist, chiropodist and the opticians. One service user was supported to have in – patient treatment recently and the staffing input to and after this ensured that the individual’s welfare was prioritised. Staff interviewed showed a good awareness of individual service user’s conditions and from the records seen, were also capable of making interventions that were in their best interests. It was clear also from the records that the input sought from the consultant psychiatrist and in cases where a community psychiatric nurse is involved that, the specialist health needs of service users were provided for. This was backed up by the documentation from reviews held on service users. Service users are still able to see visiting health professionals in private either, in their rooms or in the staff office on the first floor and this gives them confidence that their privacy is maintained. Service users continued to receive satisfactory support with their medication, which for most is important aspect of maintaining their wellbeing. At the time of the inspection none of the service users were managing their medication independently. All staff handling medication did have training in; the handling of medication and this was in line with the national minimum standards. Medication storage was satisfactory as was the recording of drugs administered by staff. However, in one case a drug was stopped for an individual and it could not be determined when this happened. There was a need to ensure that a tighter grip is held on changes with service users’ medication and to ensure that staff refer to medication charts when administering medication to service users. This is important to ensure that service users are receiving without a doubt, the medication that is due to them and more importantly that no one else has access to drugs that are discontinued. The manager informed that a new medication system i.e. the monitored dosage system was due to be introduced on the 30/10/06, which should reduce the risk of changes not being identified. The most recent Regulation 26 report confirmed that this system has been implemented. As part of improving staff awareness on drugs, the manager had the most recent edition of the British National Formulary. This is a good reference point for staff and clear guidance was in place for staff should there be an error in the administration of medication. DS0000025902.V317562.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (22,23) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and their advocates/relatives are assured that when complaints are raised – that they would be acted upon. Satisfactory arrangements were in place to ensure that service users are protected from abuse. EVIDENCE: A satisfactory complaints procedure is in place at the home and all service users were aware of this. From interviews held with service users, they were quite prepared to raise issues of concern, should they feel the need to. The management and staff encourage service users to raise concerns where possible and, in service user meetings that are held regularly. Service users may also speak with staff informally about issues that may have an adverse impact on them. At the time of the visit there were no complaints on record. During interviews with staff, they were clear on the service user’s right to complain and informed that they would encourage them to so do. This is positive. The fact that most of the staff had adult protection training is positive in reassuring service users that they are in safe hands. There were relief staff who are identified to do their training in abuse and were due to start imminently. Staff, as part of their induction are taken through the adult protection guidelines of the home and a copy of the Local Authority Adult Protection protocols is kept in the home for the benefit of staff. There was no evidence of adult protection issues in the home and this is positive. Staff interviewed demonstrated an understanding of whistle–blowing. There was strong evidence to support the fact that they would use this to promote the safety of service users. DS0000025902.V317562.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (24,25,30) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users enjoy an environment that is generally safe, clean and satisfactorily maintained. Improvements to some bedrooms make them more comfortable for the individuals occupying them. Some carpet renewal is required to the environment to enhance its appearance, which would have a positive impact on the home as a whole. EVIDENCE: On the day of the visit the home was clean and tidy and as one entered, there was a homely feel to the environment. The hallway leading up the stairs had been decorated and pictures adorned the wall and this gave the home quite a lift on entry. As stated in previous reports the home’s location is ideal and central to shopping and transport links. All service users are therefore able to get out and about in the community with some ease. Given that the visit was unannounced it was positive to see the décor in a good state. Service users were observed enjoying their communal areas in comfort although there was some concern with the level of noise made by the extractor fan in the TV room. External agencies such as the environmental health department visited in June 2006 and the last fire visit was April 2005. Lighting, DS0000025902.V317562.R01.S.doc Version 5.2 Page 21 heating and ventilation were generally satisfactory and service users expressed their satisfaction with them. The furnishings and fitting were in a good state of repair, except for the carpet along the first floor corridor. This is worn and took away from the pleasant state of the environment as a whole. One service user stated that it was okay, but did indicate that it was worn. This would need replacing. As part of the inspection, four service users allowed the inspector access to their personal bedrooms. It must be said that they all had their individual characteristics that were special to each person. In the main, they were all satisfied with their private spaces. Some individuals were more elaborate in personalising their rooms and this was really positive. There was a joy and confidence that was displayed by some, which was coupled with a strong sense of attachment to their spaces. It is a credit to the staff team for encouraging service users to own their private spaces. At the last inspection there was some concern over the condition of one the service user’s bedroom and this was put down to, in the main – the individual’s mental state. There have been some improvements since, as net curtains were purchased and storage boxes were introduced to help organise the various items that were previously strewn all over the room. Some intense work was put in with the service user by the staff and this included input from the service user’s advocate. The service user has agreed a frequency in tidying his room and this is positive. In discussion with the individual, it was indicated that more could be done to improve the appearance and comfort of the room. In the discussion, the carpet was one such area and it was glaring that this was in need of replacing. During discussions with the manager, she informed that the service user requested a room change and this was being looked into. It was noted that two bedrooms had carpet replaced since the last inspection. The home was clean and hygienic throughout the inspection. Laundry facilities were satisfactory and policies for the control of infection were in place. Service users are involved in doing their laundry as part of maintaining their independent living skills and most were quite happy with this. In valuing service users involvement and in maintaining a safe environment, three service users were awarded with certificates for COSHH awareness. Their achievements could be seen framed on the walls in the dining area and in discussion with two of them – they were pleased with this achievement. This is a positive outcome for service users and the home as a whole. DS0000025902.V317562.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (32,33,34,35,36) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive care and support from a committed and motivated staff team. This is enhanced through keeping staffing levels under review and providing training that is appropriate to the needs of service users. Improvement in the recruitment practices adopted by the agency now means that service users are in safer hands. Training in specific areas such as challenging behaviour is required for staff working at nights in maintaining a safer environment for all. EVIDENCE: Staff interviewed demonstrated a good understanding of the service users needs and were observed being committed and motivated to carry out their duties. They were also clear about the changing needs of service users and this took into consideration the needs of individuals that were getting older. Policies e.g. managing aggression enables staff to understand both verbal and physical aggression, when exhibited by service users. Staff were also communicating effectively with service users throughout the course of the inspection. Service users felt that they could engage with staff – feeling valued in the process. Over fifty–five percent of the staff team have achieved at least an NVQ level 2 in Care and this provides them with a good base in working with the service user group. From examining the records of DS0000025902.V317562.R01.S.doc Version 5.2 Page 23 service users, staff were able to liaise effectively with external professionals, as part of supporting service users. There is a good core of staff that has been providing care and support to service users at Green Lane. Despite this, there has been the high use of relief hours e.g. forty-one shifts, over a two month period. Since the last inspection, three staff including the previous manager has left the service. This coupled with sickness absence has attributed to the high use of relief staff. The organisation to its credit and very early on, had an acting manager in place, which provided some consistency to the service. The same individual was subsequently appointed to the permanent manager’s post. There was evidence of regular team meetings and training for staff, which helped to keep stability to the service. This impacted positively on service users as they were given good support to enjoy getting out as frequently as they wished. All service users were pleased with this. During previous inspections, it was identified that the recruitment practices of the organisation was unsatisfactory and needed improving. The Commission had set out clearly the areas that required improvement, as there was a lack of robustness and consistency across the organisation in recruiting staff and maintaining staffing records in line with regulation. As a result, arrangements were made earlier in the year (2006) to monitor progress and change. It was established that there was significant improvement in this area. The recruitment practices in relation to new staff had improved with systems in place to ensure consistency across the organisation’s services. The records held on existing staff had also improved and the organisation was held in high esteem for the work it carried out to ensure that its recruitment practices – promoted the safety of service users. At the time of the inspection, the manager had a training and development plan in place for staff working at the home and this included the relief staff. A range of training had been provided to include: support planning, medication awareness, adult protection, mental health awareness, report writing, first aid (certificated and non-certificated), food hygiene, fire safety, elderly care and LDAF training. As part of planning ahead the manager was liaising with the Alzheimer’s society for training e.g. identifying symptoms in people living with this condition. This is positive. Training on the new medication system was planned for all staff and it was intended to include service users as well. Each staff has a training and development file, which carried details of all the training they had undertaken. To add to this, there is structured induction program in place for staff and one of the most recently employed staff went through this induction. She was DS0000025902.V317562.R01.S.doc Version 5.2 Page 24 satisfied that the induction prepared her for her role in providing care and support to the service user group. During her interview she demonstrated a sound understanding of the philosophy of the service and the needs of the service user group. In another interview with one of the relief workers, she also demonstrated a good understanding of the service users’ needs. The individual had been working for some time with the organisation and did mostly night duty. It was established during the interview that one service user presents at times a challenge to staff, but is usually manageable. It was identified that though experienced, this individual did not have training in the area of managing aggression and violence, or challenging behaviour. Working alone at nights without such training puts both the individual and the service user/s at risk. A lone–person working risk assessment had been developed previously. However, on its own, it would not be adequate in minimising risks. All staff working on nights, including relief staff should have training in managing challenging behaviour or managing aggression and violence. There were sound arrangements in place for briefing staff, which included regular supervision and team meetings. This is complimented by annual appraisals that were booked for the staff. Supervisions were however, above the minimum frequency for most staff in an attempt to provide support to them. The new manager was keen to ensure consistency across the staff team and recognised that they were getting used to working with a different management style. During staff interviews, they confirmed that they felt supported by the manager although some individuals were more comfortable than others. The manager was made aware of this at the inspection. From observing a team meeting there was a sense of encouraging dialogue and seeking views from the staff. The staff meeting was also used to give direction and to discuss practice and quality issues. This should be effective in improving standards of care and the overall quality of service provision at 626 Green Lane. DS0000025902.V317562.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (37,39,40,41,42,43) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good management systems remain in place to provide a quality service to at 626 Green Lane. The registered persons have acted upon most of the previous requirements and this has brought about significant improvements to the quality of care that service users are receiving. Some policies are still in need of reviewing to ensure that staff have the best possible guidelines in doing carrying out their work. EVIDENCE: There has been a change in manager at 626 Green Lane and the current individual has been a registered manager from at a similar project run by RCHL. She brings to the service several years experience in the field of mental health and has undertaken several courses e.g. advanced supervision, diversity, project management, counselling, the VRQ in mental health, person centred planning and reportedly completed her registered managers award. At the time of the visit she was awaiting her certificate. She is also well supported in her role by the assistant director of operations. DS0000025902.V317562.R01.S.doc Version 5.2 Page 26 Her role involves monitoring and implementing policies and procedures, managing an internal budget, supervising staff, ensuring service users receive a service in line with the national minimum standards and the organisation’s aims and objectives and, for the overall operation of the service. From the evidence gathered at the inspection, she was well engaged in working with staff, service users and external professionals in improving the service at 626 Green Lane. At the time of the inspection, the manager was in the process of applying to the Commission to become the registered manager for the service. The work of the manager is complimented by the input of the assistant director of operations who provides line – management support to her. In addition to this regular and detailed monthly provider monitoring visits are carried out on the service with reports – sent to the Commission. These reports do reflect the quality of service that individuals are receiving and identifies actions to be taken where there are shortfalls in the service. An annual development plan has been developed for the home and this is positive. This contained the views of stakeholders, relatives and service users. The organisation was at the time of the inspection also undertaking its quality audit of the service and this involved service users and staff working at the home. A system is in place for reviewing policies and procedures, but some were in need of review. There was evidence that as required from the last inspection- some policies and procedures were reviewed e.g. the disability policy. The assistant director of operations indicated that, this is done by the Human Resources personnel and is circulated to the homes, once completed. However, several policies still required reviewing. One example included moving and handling (2000)- this is important due to the changing needs of the current service user group i.e. they are becoming older with as many as two, using wheelchairs for outdoor trips. Other policies included Fire safety (2001), Food safety (2001), Racial harassment between service users/staff (2001), and adult protection (2001). Staff do have access to the policies, but it is of little use to them, if they are outdated. This needs to improve. Service users do have access to their files and this is clear as most are involved in their care planning. It was noted that even the policy relating to this is over five years old. As stated earlier in this report, there was an improvement in the quality of records held by the organisation, particularly in relation to staff. Service users are now assured that staff working with them, have been thoroughly vetted. Other records held by the home were updated and secure. There was an improvement in this standard as fire drills were carried out more frequently. Service users safety is therefore - more assured. Health and safety In the home was of a high standard as risk assessments for all safe working practice topics were carried out. Electrical and gas certificates were in place DS0000025902.V317562.R01.S.doc Version 5.2 Page 27 and the electrical PAT testing was carried out. Water temperature checks were also frequently carried out, as were the fridge/freezer temperatures. A Legionnaires check was carried out in May 2006 and this was satisfactory. As stated earlier a door alarm was fitted to reduce the risk of intruders and a risk assessment was carried out on this. Service users are involved in health and safety issues and share a responsibility for maintaining safety in the home. A record of accidents and incidents was in place and the manager installed rails around the pond in the garden, as a safety mechanism. Service users and staff therefore, live and work in a safe environment. A business and financial plan is in place for the service and there were adequate systems in place to ensure quality and financial monitoring of the service. The manager receives supervision on a four weekly basis and was happy with the support she was getting. Insurance cover for the home was in line with the minimum requirements set by standard 43 of the national minimum standards for younger adults. Service users’ involvement in the business and financial planning of the service, results from their responses and participation in events held by the organisation e.g. annual general meetings and the internal audit of the service. Lines of accountability are clearly set out in the statement of purpose. It was noted that the organisation has created a Diversity statement of intent and policy. As a result, diversity champions representing directors, senior management, staff and service users have been appointed. They are to steer, champion, design and implement key performance indicators set out in the organisation’s business plan. This should have a positive impact on the service and its service users. DS0000025902.V317562.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 x 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 2 25 2 26 X 27 X 28 X 29 X 30 4 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 X 3 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 x 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 X 3 2 3 3 3 DS0000025902.V317562.R01.S.doc Version 5.2 Page 29 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13(2) Requirement The registered persons are required to ensure that 1) all changes to medication are recorded and dated and 2) Staff refer to drug charts when administering medication. The registered persons are required to replace the carpet on the first floor landing. The registered persons are to replace the carpets in the service user’s (PD) bedroom. This is part of a previously made requirement. Timescale – 31/05/06. The registered persons are required to provide training in managing aggression and violence and/or challenging behaviour for staff (Including relief staff and staff on night duty). The registered persons are required to update and/or review its key policies and procedures. (Also See Standard 40). Timescale for action 21/01/07 2. 3. YA24 YA25 23 23 31/01/07 31/01/07 4. YA35 19 28/02/07 5. YA40 12 31/03/07 DS0000025902.V317562.R01.S.doc Version 5.2 Page 30 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 DS0000025902.V317562.R01.S.doc Version 5.2 Page 31 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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