Inspection on 11/10/05 for Green The (3)

This inspection was carried out on 11th October 2005.

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 no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Green The (3) 23/08/07

Green The (3) 14/08/06

Green The (3) 17/01/06

Green The (3) 10/02/05

Green The (3) 24/06/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Green The (3) 3 The Green Sutton Surrey SM1 1QT Lead Inspector David Pennells Unannounced Inspection 11th October 2005 11:30 Green The (3) DS0000007140.V254371.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Green The (3) DS0000007140.V254371.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Green The (3) DS0000007140.V254371.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Green The (3) Address 3 The Green Sutton Surrey SM1 1QT 020 8641 9348 020 8644 5399 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.caremanagementgroup.com Care Management Group Limited Mr Simon Daniel Burrowes Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Green The (3) DS0000007140.V254371.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents with challenging behaviour Date of last inspection 10/02/05 Brief Description of the Service: 3, The Green, Sutton is owned, managed and staffed by the Care Management Group (CMG). The home provides residential care for up to seven male adults with learning disabilities and associated challenging behaviour / mental health problems. Simon Burrowes, the home’s current Manager, had been, firstly as Deputy, in temporary control of the home since January 2004 - after the sudden departure of the previous registered manager. Simon has now been subject to a satisfactory registration interview and is now the Registered Manager. The home itself is a large detached Victorian property situated just to the north of Sutton Town Centre - close to local shops, transport links and this busy town’s many social, commercial and educational amenities. The home itself has six single bedrooms, and communal space comprises of a main lounge and conservatory (which is used as a smoking room), a separate dining room and a kitchen. There are sufficient bathrooms and toilet facilities located throughout the home. Across a courtyard there is a games room - and the manager’s office is located beyond this. Upstairs in this block, there is a bed-sitting room - which acts as a separate self-contained ‘flat’, used for the encouragement and development of a service user’s independence skills. There is limited parking on site and on-street spaces available on ‘The Green’. Green The (3) DS0000007140.V254371.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted from a weekday lunchtime, throughout the afternoon, to the approach of supper that evening. During this time, the inspector was able to meet the majority of service users (some of whom were in the house the whole time, some returning from activities out in the community), being invited by some to view their individual rooms. Both morning and afternoon shifts of staff were encountered, and the home’s manager, Simon Burrowes, was available to show the inspector around, to facilitate the inspection of paperwork, and to help the inspector to assess progress made since the last inspection visit – reviewing requirements and recommendations set at that time. It was encouraging to note that no requirements were outstanding from the last inspection report; only a few ‘long-term’ recommendations remain – see the end of this report. The inspector’s overall impression of the service being actively provided was very positive. This is a vibrant home that encourages risk taking and the expression of individuality – at times a difficult balance to get right with the service user group accommodated here. The inspector is aware of the fact that sometimes things ‘go wrong’ at the home – but this is more than compensated for by the excellent results gained for the majority of the time. What the service does well: Three relatives of service users responded to the Commission’s written survey. One service user’s relative replied positively to the Commission’s questionnaire and commented: ‘We are very happy with the way ‘X’ has progressed at 3, The Green, and he is very content there.’ Another relative, indicating that they were also happy with the way their relative was looked after, stated; ‘I could not wish for a better place for ‘X’ to stay; the staff are all brilliant.’ No relative indicated that they ever had made a complaint about the service and all were satisfied with the overall care provided. Six of the seven service users at the home also completed the Commission’s questionnaire – clearly with some staff help – but all again indicated that they were happy with the service, knew who to talk to if they were unhappy with the service, and felt the care provided was respectful, positive – and they liked living there. Green The (3) DS0000007140.V254371.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? 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. Green The (3) DS0000007140.V254371.R01.S.doc Version 5.0 Page 7 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 Green The (3) DS0000007140.V254371.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3. The home provides service users & other interested parties with full details to enable them to make an informed choice about choosing to live at the home. Service user’s needs and aspirations are assessed, understood and implemented at the home – through the thorough and considered exploration of behaviours, wishes and needs, fully including the service user’s views. EVIDENCE: The home’s Statement of Purpose now has a clear statement as to staff members’ qualifications and experience. The Statement of Purpose / Handbook is a good readable comprehensive document. Service users confirmed that they had been given copies of the home’s handbook / Statement of Purpose, which they can keep in their bedrooms. Charges (currently ranging from £1275 £1452 p.w.) are dependent on each specific contract agreed with the placing / funding authority, reflecting a service user’s individual needs; for instance, one service user receives a number of dedicated hours of 1:1 staff input, which clearly adds a ‘premium’ to the basic charge. Additional charges cover items such as toiletries, magazines and additional activities. Green The (3) DS0000007140.V254371.R01.S.doc Version 5.0 Page 9 One service user has been admitted to the home in last year; being admitted from another CMG home locally. This placement has clearly been a success story; the service user confirmed to the inspector that he is enjoying life in this ‘young mans’ environment – and his ‘challenges’ are being handled positively – resulting in a superior quality of life compared to that which he enjoyed before. Service users are in regular contact with health and social care professionals, including GP’s, Care Managers, and community based mental healthcare professionals, who are all able to check that assessed needs are being met. Green The (3) DS0000007140.V254371.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 & 10. The home creates and maintains care plans and assessment documents designed to ensure that the needs of service users are realistically met in a focused and individual way. Service users can be assured that their rights to individuality and selfexpression are protected, whilst acknowledging the community aspect of living at The Green. Consultation and sharing of information will involve, and take into account, the wishes and aspirations of the service user. Service users can generally be assured that risk-taking will be an integral part of the support / protection plans put in place by the home. Service users and staff can be assured that information kept personally relating to them will be kept appropriately safely in line with legislative requirements. Green The (3) DS0000007140.V254371.R01.S.doc Version 5.0 Page 11 EVIDENCE: Each service user has a principal Keyworker and Co-keyworker - staff training has been developed around promoting this role. Care plans are reviewed and updated after the collating of a monthly review - by the Keyworker - that reflects on achievements and changing needs. Care plans set out clearly the needs and preferences of service users, and identify the actions required to meet them. Care plans are reviewed and updated after the collating of a monthly review by the keyworker - this reflects on achievements and changing needs. Care plan reviews were now timetabled into a more formal cycle of structured reviews. The home is very keen to encourage those service users who are wiling and able, and with appropriate support, to manage their own financial affairs. The home has a good financial record-keeping process, a ‘transparent’ financial auditing system being used. The culture of the home encourages service users to be involved in all aspects of the daily life of the home; from the weekly expectation that the service user would cook an evening meal to the individual requirement to keep their rooms tidy and clean, the focus is on individual achievement and communal respect. Certainly the general ambience of the home suggested that most service users and staff got on well together. Examination of Service User Meetings minutes revealed that they continued to be infrequent; records were seen for only April and August in 2005. The manager again commented that such meetings were generally ‘reactive’ to an issue - and that meetings were not called unless there was a specific need to focus on an issue. It is again recommended that service users should be encouraged to agree a minimum period (perhaps 6-8 weeks) between house meetings, and that they should be held and minuted - to ensure that an equal opportunity for ‘lesser’ issues to be heard is also provided. Some strategy to make them more ‘attractive’ – a special food focus (?) - could be an incentive. Staff members support service users to take ‘responsible’ risks as part of the process of enabling them to maintain and develop their independent living skills. Potential risks and hazards are assessed (under broadly identified headings such as: Relationships / Community access / Aggressive behaviour / Electrical hazards / Fire precautions / etc), and are recorded in each service user’s care plan. Risk Assessments concerning the ‘problems’/ drawbacks of being located right on The Green in Sutton – difficult especially in the summertime – relating to both people and animals on the green (dogs are a great attraction to one service user) were in place to address this issue; potential problems have been successfully identified and handled. Green The (3) DS0000007140.V254371.R01.S.doc Version 5.0 Page 12 The registered provider, CMG, is registered with the Information Commissioner under the Data Protection Act 1998. Service users’ personal files are now stored in lockable filing cabinets. Staff files were also kept confidentially under lock and key - in the manager’s office. Green The (3) DS0000007140.V254371.R01.S.doc Version 5.0 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 & 17. Service users can be assured that the service provides opportunities for them to engage in activities both within and outside the home, and to adopt a lifestyle suited to their individual needs and preferences. Relatives / friends can expect a positive welcome from the home, within the context of respect for a service user’s own choice and decision-making. Service users can expect to be provided with a good standard of nutritious and wholesome food, whilst acknowledging the right to their own stated choice and ensuring that mealtimes are a pleasant and enjoyable time. EVIDENCE: Service users completing and returning a comment card to the Commission all indicated they felt they liked living at the home, that thy felt well cared for, being treated well by the staff and they felt safe - with their privacy being respected. Green The (3) DS0000007140.V254371.R01.S.doc Version 5.0 Page 14 Each individual service user is encouraged to develop a programme of activity and engagement, which enables them to develop their own personal skills base, and to build relationships outside the home. Engagements in the local community cover attendance at designated Learning Disability centres, to social activity centres and to specifically educational outlets Service users have a variety of ‘employment’ - paid or otherwise - which develops self-esteem and encourages engagement with the world outside the home. One service user has a job at a local Charity shop, another volunteers help at the local Salvation Army luncheon club, one has a job as a ‘pot man’ in a local pub, and another helps out another public house. The home is again to be commended for its tenacity in seeking out various opportunities in an economic climate that does not encourage such projects. Arts & crafts, table tennis, pool, karaoke, books, videos and computers are the variety of opportunities pursued at home. Cinema, bowling, ice skating, attending the library, colleges and social clubs are examples of external activity – as well as other social activities such a going to the pub and out with family / friends. Family contacts are clearly vitally important to most service users. Some family contacts are local, and service users can visit independently, whereas some relatives are some distance away and visit, or even contact, the home very infrequently. The home does make efforts to keep in contact. One service user is married and spends times with his wife, her family and their child. Visitors to the home are enabled either to spend time in the service user’s own room, or the conservatory is made available to them. The dining room is also available and more suitable for official-style meetings / encounters. The manager spoke to the inspector of the move to develop a ‘deal’ with the service users concerning their dietary input(s). It must be acknowledged that the service users at the Green are all adults who are quite well able, generally, to express their opinions - very forcibly if necessary. The approach to encouraging healthy eating is to provide a range of healthy options at the lunchtime meal – but then to allow a ‘freer hand’ (responding to service user choice) at main meal times in the evening. It is hoped that the lunchtime meals may well be appreciated enough that they slowly are pulled into service user’s expressed choices in the evening. Temperature records for the kitchen fridge were readily available; however the temperature record books for both the small refrigerator and the freezer in the office were not available; such records must be kept carefully as ensuring food safety is a statutory duty within the home which is regarded as ‘food premises’ within the context of environmental health legislation. Green The (3) DS0000007140.V254371.R01.S.doc Version 5.0 Page 15 Green The (3) DS0000007140.V254371.R01.S.doc Version 5.0 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, & 20. Service users can be assured that their personal, health care and emotional needs will be recognised and met by the home’s daily service input and through longer-term assessment and care planning programme. The systems adopted by the home regarding medication ensure the safety and consistent treatment and support for each service user. EVIDENCE: Service user and relative’s questionnaires indicated that care and support provided by the home was appropriate and sensitive to the needs of the individual. Routines are flexible and guidance and support is ‘second nature’ to the staff - who are able to ‘live alongside’ the service users, integrating support and assistance as appropriate. Service users clearly choose their own clothes and initiate their own day-today activities; service users are supported in activities and their daily routines by staff in general - and keyworkers in particular. Each service user clearly is treated as an individual, and keyworkers are jointly responsible for the ongoing encouraging engagement with fulfilling pursuits. Green The (3) DS0000007140.V254371.R01.S.doc Version 5.0 Page 17 Each service user has access to local community health services, including local GPs for all, and other paramedical services as appropriate and preferred (accessing two different chiropody services, for instance); local community opticians and dentists are also used. Service users are encouraged to take control of their healthcare needs (e.g. arranging their own appointments), in accordance with the homes philosophy of promoting privacy, dignity and independence. A number of service users are supported through psychiatric ‘visits’ on a regular basis. The home has excellent liaison contact with mental health services and those professionals associated with Learning Disability services in Sutton. Record keeping in regard to service users health care appointments is well ordered and weight charts are maintained on a monthly basis. ‘PRN’ (‘when required’) guidelines for medication were closely examined and it was agreed that some written description was missing for some service users; such detail is necessary to assist staff in deciding the circumstances when such ‘discretionary medication’ should be administered. One descriptive sheet relating to a service user was, unfortunately, out of date. It was good to see that the doctors had agreed to sign the additional ‘PRN’ sheets individually – thus supporting the staff with endorsing the guidance. Generally, medication administration sheets were in good order, up-to-date and well maintained. Individual medication histories for each service user are in place. Only inhalers were self-administered by service users. Documentary evidence of medication competency assessments was available for inspection in respect of all those staff ‘authorised’ to handle medication in the home; currently eight staff are designated as trained and responsible to administer medication. Green The (3) DS0000007140.V254371.R01.S.doc Version 5.0 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Service users can be confident that their comments and complaints are responded to, with appropriate action being taken in a timely fashion. The home provides adequate support to service users to ensure that they are protected from harm and any form of abuse. EVIDENCE: The home’s complaints procedure is available included (in symbols) in the home’s Statement of Purpose / Information Handbook and contains information about how a complainant can contact the Commission should they wish or need to do so. The procedure states clear timescales so that a complainant knows what to expect and the associated timeframes for the resolution of such reports. Record of all concerns / complaints made about the home is available for inspection on request. Two complaints had been competently handled and resolved (within the 28 day timescale) during the last twelve months. Most issues raised at the home are ‘opened up’ and dealt with immediately by staff - to ensure that no tensions build up, or issues escalate, unnecessarily. The CMG Company’s training for staff under the title: “Dignified Management of Conflict” (Simon Burrowes is a trainer) - alongside the “Understanding Challenging Behaviour” course provided ensures that service users are only restrained when absolutely necessary, and even then treated with respect in such challenging situations to avoid issues of possible abuse. To ensure the greatest transparency, the home holds the records of all uses of ‘Digman’ and these fully documented reports are sent to the Commission at the same time as the home first reports these incidents to their Senior Management Team. Green The (3) DS0000007140.V254371.R01.S.doc Version 5.0 Page 19 Sixteen ‘Digman’ incidents were recorded in this respect within the past twelve months – a commendably low number, considering the volatility of the situations encountered at the home, and the highly challenging behaviour exhibited by individuals who use The Green; service users use the service positively well the rest of the time. The manager is clear about adult protection issues, and has participated in a number of ‘vulnerable adult’ conferences, as appropriate, to the house. A safe is provided in the manager’s office, this ensuring that items handed in for safekeeping are properly protected and kept safe. Storage in the second staff office is secured to the wall and houses day-to-day items of value. Three service users manage their own financial affairs one service user is subject to a Power of attorney. Service users received personal allowance to deal with as they wish – though through staff support they are encouraged to be thrifty and to manage their limited resources well. Records are kept of personal allowances management. Two service users, who are without close relatives to represent an opinion for them, are in contact with a local ‘Advocacy Partners’ worker, ensuring an ‘outside’ voice for them. Green The (3) DS0000007140.V254371.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28 & 30. Service users can expect to live in a clean, warm and comfortable environment designed to meet their individual needs and providing adequate services and domestic facilities. Service users can be assured that, once the emergency call bell facility has been restored, the home will be a safe environment in which to live, without unnecessary risk. EVIDENCE: The home, a detached Victorian building, stands in its own grounds overlooking a green at the north end of Sutton town centre. This enables service users and staff to easily access a myriad of resources - leisure, shopping, transport and other services. The house has been generally well maintained, with the staff being able to access the handyperson team of CMG to address general maintenance issues, or to access appropriate service engineers for the specialist equipment in the home. A concern relating to the faulty emergency call system - provided for the protection of staff and service users – is covered in Standard 42. Green The (3) DS0000007140.V254371.R01.S.doc Version 5.0 Page 21 Although an ‘existing home’, The Green’s main building provides bedrooms of a size well in excess of the minimum national standard; the smallest bedroom is 12.3 sq metres in dimension, and the largest is 18.2 sq metres. Communal space on the ground floor is also clearly well above the minimum required but necessary to ensure that service users have sufficient space to be themselves and not to ‘overcrowd’. The Independent Living Flat measures 18.9 sq metres and has its own bathroom entirely separate to this (‘ensuite’). The bedrooms seen certainly reflected the individual characters of the service user - and were clearly their ‘domain’. Some rooms - due to service user’s behaviour - were inevitably better maintained / decorated / furnished than others. Destructive behaviour is no respecter of furniture. The state of decoration at the home was generally good; a programme of general redecoration is provided, and can be invoked as and when necessary. Each bedroom has a TV aerial point and, in most cases, sufficient electrical sockets (many electrical appliances are used by these younger service users). Facilities for service users to lock away their valuables and possessions in their own rooms have now been provided: locks have been fitted on cabinets in each room. 3, The Green, as an ‘existing home’ is permitted to have its existing facilities accepted as the ‘standard’. The independent living ‘Flat’ has its own bathroom. The house itself provides the remaining six service users with a bathroom (with toilet) on each floor, and a separate toilet is available as well. Even taking into account the need of staff to use the facilities as well, this is a reasonably good ratio of facilities to the number of service users. The main lounge is spacious and comfortably furnished; service users informed the inspector that the conservatory is a popular place to meet visitors and to ‘have a smoke’. The dining room is also a good size and the ‘annexe’ and garden provide space for sports pursuits. The ground floor hallway carpet in the main building is in a poor state of cleanliness and repair; it should be urgently re-assessed and considered for replacement. Furniture and furnishings in the first floor office must be improved to make the environment more pleasant to sit in and more ‘office-like’ to encourage a culture of professionalism, and to make staff members feel a little more ‘valued’. The home was clean and odour-free on the day of the inspection (and equally has been on other visits to then home made by the inspector). The service users room’s cleanliness is self-managed - though staff intervention may be invoked if the situation was becoming too difficult for a service user to manage. The cleanliness of communal areas is a joint responsibility between service users and staff. Green The (3) DS0000007140.V254371.R01.S.doc Version 5.0 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36. Service users can be assured that they will be supported at all times by staff who are experienced and competent in their work, being provided in sufficient numbers to meet their identified needs. Service users can expect to be provided a service that generally ensures their safety and protection from abuse – though management vigilance is needed to ensure that full checks are undertaken using the (usually) thorough recruitment processes, and ongoing staff support arrangements. EVIDENCE: With regard to NVQ training, the manager is undertaking his Level 4 (Registered Manager’s Award) training, and the deputy manager was completing her Level 4 NVQ as well. Another care worker is a qualified social worker - and therefore has a more than equivalent qualification. Another care worker is soon to complete their Level 3 portfolio. One more care staff member is just commencing their level 2 NVQ. The manager stated that a number of staff members were keen to ‘get going’ on their NVQs – but the Company’s scheme – for historical reasons – could not take on any further trainees at present. The home is therefore inevitably going to ‘fail’ the aim to have 50 of the staff (total of sixteen staff employed) trained to minimally Level 2 NVQ by the end of this year. This is an important focus for the Company to get right as soon as practicable. Green The (3) DS0000007140.V254371.R01.S.doc Version 5.0 Page 23 Nine staff members currently hold a First Aid qualification – enabling the home to cover the rota with a qualified person in this discipline. Other staff training undertaken in the past twelve months has included: ‘Fire Safety’, ‘Adult Protection’, ‘Keyworking’, ‘Staff supervision’, ‘Understanding Challenging Behaviour’, ‘Understanding Mental Health’, “Digman” (see Standard 23), ‘Person Centred Planning’, ‘Manual Handling’, ‘Food Hygiene’ and ‘Managing a Team’. The home provides staffing levels of at least three staff on duty throughout the day, with two staff available at nights. The home has a flexible approach to staffing levels, with the rotas indicating that an additional member of staff can be provided additionally to cover ‘peak’ periods of activity / need; for instance escorts to college may necessitate another staff member being available during the middle of the day. The manager’s hours are (quite rightly) usually supernumerary to calculating service user / staff ratios. A small group of ‘bank workers’ are employed - to cover staff shortages, after extra shifts have been offered, as appropriate, to current staff members. This ensures that agency staffing is not used, and that the service users receive continuity of care from people they are familiar with, and who know the home – and its routines - well. A staff member had fairly recently been dismissed, subsequent to a nonattended disciplinary hearing called to investigate their having been found asleep during a supposedly ‘waking night’ duty at the home. A new staff member had been recruited to the home subsequently. On enquiry and examination of the new staff member’s employment file, it was evident that the staff member had been allowed to commence work (during the manager’s absence on annual leave) without CMG either [as can be dome in extenuating circumstances] undertaking a PoVAFirst check, or awaiting the satisfactory return of their Criminal Records Bureau check. All staff members must be checked by the Criminal Records Bureau - at the Enhanced Level prior to being cleared for starting work at the home. On further enquiry following the inspection visit, this fact was verified to the Lead Inspector by the Regional Operations Manager for the home – and the said staff member was immediately withdrawn from work at the home pending the arrival of the full CRB check. This serious omission in employment processes is the reason for the scoring of this specific standard with a ‘major shortfall’. On the day of the inspection, subsequent closer examination of the same staff file, revealed that the Induction Checklist was not signed or dated by the employee; the Policies & Procedures Checklist was only half completed (it is supposed to be completed within the induction week – which had passed four weeks previous to the inspection visit), and there was only one Reference in evidence on their file. Initial fire and food hygiene training documentation was Green The (3) DS0000007140.V254371.R01.S.doc Version 5.0 Page 24 all seen, and found in order. Clearly a more careful approach to induction is necessary on the staff member’s return to work. The manager is responsible for the supervision of the Deputy, Team Leader and seniors, and they supervise the remaining staff. There is now a monitoring system in place, keeping an up-to-date record of the supervisions each member of staff receives, designed to ensure success in achieving this standard. Staff appraisals - exploring and indicating development and training needs are also in place. Staff meetings are held at least every two months – in the past four months they have been held, commendably, on a monthly basis. Green The (3) DS0000007140.V254371.R01.S.doc Version 5.0 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41, 42 & 43. The home operates management systems that ensure that service users benefit from a well-run, competently managed and safe environment. Service users can be assured that generally their rights and interests are well served and protected through the home’s approach to record keeping, policies & procedures, and the day-to-day conduct of the home. Service users can be assured that their welfare, health and safety is, in general, safeguarded through the home’s rigorous adherence to appropriate guidance and regulations concerning best safety practice. EVIDENCE: Simon Burrowes, the registered manager is currently undertaking NVQ Level 4 in Management and Care; he has transferred his Course to that provided at the Chartered Management Institute in Sidcup, Kent – he aims to complete the qualification by February 2006. Simon has more than three year’s management experience working in the home, where he has worked since February 1991. Green The (3) DS0000007140.V254371.R01.S.doc Version 5.0 Page 26 Simon receives support from his line manager, Lisa Rowland Hall - the home’s Regional Operations Manager. Unannounced visits by representatives of the registered provider are clearly being carried out on a regular basis and the subsequent reports are being forwarded to the Commission. Such visits involve checking documentation, inspecting the premises and interviewing both service users and staff. The management and care practice approach of the home is clearly a very ‘open’ and inclusive one. The staff team are encouraged to participate in the day-to-day operation of the home, and to voice their opinions at staff meetings, handovers, and through more informal contact with the homes management team on a daily basis. The registered provider, CMG, has recently undertaken an ‘across the board’ Residents’ Questionnaire – whose results are analysed first on a company-wide basis and then action-planned, and subsequently a house-focused process is undertaken using its own specific results. A 58 response rate has been achieved this year; an increase of 15 on the same exercise conducted in 2004 – hopefully an indicator of service users’ feeling of its value. Service users have a regular CMG Newsletter entitled: “Residents Times”; a new staff newsletter (The CMG Guardian) is also ‘hot off the press’ – thus keeping both service users and staff informed of news from other CMG locations, and other developments, company-wide. CMG has a comprehensive set of policy and procedure manuals which cover the broad spectrum of needs identified under the headings of: Mission Statement / Staff Policies / Service Management / Service & Care Delivery / Health & Safety / Residents Welfare, and Emergency Procedures. The home / CMG is registered with the Information Commissioner - under the Data Protection Act 1998 and, as such, is committed to ensuring that the eight principles of Data Protection are fully complied with. CMG ensures the general maintenance and refurbishment of equipment to ensure it keeps up to standard. The regular checks, and the servicing and maintenance of equipment was fully evidenced and showed that the statutory obligations to provide a safe working environment are taken seriously. The manager and his senior staff are clearly well versed in the general health and safety aspects of the home, all appropriate steps being taken to ensure the safety of service users and staff alike. Health and safety issues are generally very well managed - through delegated responsibilities - within the home. Hazardous substances are correctly stored and COSHH sheets were seen. Staff training ensures full First Aid cover around the clock - and training in disciplines such as food hygiene, manual handling and the safe and dignified handling of conflict are well in place. Green The (3) DS0000007140.V254371.R01.S.doc Version 5.0 Page 27 It is recommended that a maximum number of Fire Drills be agreed with senior supervision management; the imposition of monthly and three-monthly drills (so sixteen per year) is excessive, and may well cause complacency to set in. The emergency call bell system - designed, probably, for the greater protection of staff - or isolated service users - had been out of order for about forty days at the time of the inspection visit. Although this is never - or rarely used - its absence could cause a real dilemma for a staff member who was facing a challenging situation. In this home no staff member should be left isolated with service users who may have a history of violence / abuse. The overall CMG management of the service – through the Regional operations Manager up to the managing director - clearly ensures the effective management, the financial viability, and accountability of the home. The company has a business and financial plan and the company also employs support staff - in ‘Human Resources’ and ‘Staff Training’ focuses, to enable the more effective running of the establishment. Green The (3) DS0000007140.V254371.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 2 X 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 3 1 2 3 CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Green The (3) Score 3 3 2 X Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 2 3 DS0000007140.V254371.R01.S.doc Version 5.0 Page 29 Are there any outstanding requirements from the last inspection? NO 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 YA17 Regulation Requirement 16(2)(h) (i) Records of fridge and freezer temperatures must be carefully documented and held; the ability to evidence best food safety practices must be emphasised at all times. 13(2) & 17 Information and guidance – especially relating to ‘prn’ (discretionary) medication must be rigorously maintained and immediately updated as necessary. Timescale for action 11/10/05 2 YA20 18/10/05 3 YA28 13(4) & 23(2)(d) The ground floor hallway carpet 24/12/05 in the main building should be assessed and considered for replacement urgently. Furniture and furnishings in the first floor office must be improved to make the environment more pleasant to sit in and more ‘office-like’ to encourage a culture of professionalism, and to indicate the value staff are held in. DS0000007140.V254371.R01.S.doc 4 YA28 23(3)& 12(5) 15/12/05 Green The (3) Version 5.0 Page 30 5 YA34 19 That all staff must be checked by the Criminal Records Bureau at the Enhanced Level prior to being cleared for starting work at the home. Induction training must be carefully monitored and completed – for all new staff starting work at the home. The emergency call system provided for the protection of staff and service users must be reinstated urgently. 11/10/05 6 YA35 17 – Sch 4 & 18(1)(c) 15/11/05 7 YA42 23(2)(c) 30/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA16 Good Practice Recommendations It is recommended that service users should be encouraged to agree a minimum period (perhaps 6-8 weeks) between house meetings, and that they should be regularly held and minuted – to ensure that an equal opportunity for ‘lesser’ issues to be heard is also provided (16). A minimum of 50 of the care staff team must be qualified nominally to NVQ Level 2 in care by 2005 (31). The (registered) manager must be qualified to NVQ Level 4 in Management and Care by 2005 (37). It is recommended that a maximum number of Fire drills be agreed with senior supervision management; the imposition of monthly and three-monthly drills (so sixteen per year) is excessive and may well cause complacency to set in. (42) 2 3 4 YA31 YA37 YA42 Green The (3) DS0000007140.V254371.R01.S.doc Version 5.0 Page 31 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Green The (3) DS0000007140.V254371.R01.S.doc Version 5.0 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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