Inspection on 23/08/07 for Green The (3)

This inspection was carried out on 23rd August 2007.

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 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Green The (3) 14/08/06

Green The (3) 17/01/06

Green The (3) 11/10/05

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 Key Unannounced Inspection 23rd August 2007 10:30a Green The (3) DS0000007140.V341022.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 Green The (3) DS0000007140.V341022.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. Green The (3) DS0000007140.V341022.R01.S.doc Version 5.2 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 Ltd (trading as CMG Homes Ltd) Mr Simon Daniel Burrowes Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Green The (3) DS0000007140.V341022.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents with challenging behaviour Date of last inspection 14th August 2006 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. The home is a large detached Victorian property situated just to the north of Sutton Town Centre - close to local and central shops, transport links and this busy town’s many social, commercial and educational amenities. The main house has six single bedrooms, and communal space comprises of a main lounge and conservatory (which has been used as a smoking room), a separate dining room, and a kitchen. There are sufficient bathrooms and toilet facilities located throughout the home for the resident population. Across a courtyard there is a small laundry facility, a games room with pool table - and the manager’s office is located beyond this well-used feature. Upstairs, in this ‘coach house’ block, there is also a bed-sitting room - which acts as a separate self-contained ‘flatlet’, used for the encouragement and development of one service user’s independent living skills. There is limited parking on site at the front and side of the house, and onstreet spaces available on ‘The Green’, directly outside the house, itself. Green The (3) DS0000007140.V341022.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was conducted from mid-morning to late in the afternoon on an ordinary working day. The visit was unannounced. The inspector was assisted by the manager, Simon Burrowes and the deputy manager, Jason Waddick - in both exploring the outcomes of previous requirements and recommendations and in examining current documentation held in the home. The inspector also engaged with the majority of the service users at the home, a number taking him to see their bedrooms and engaging with him throughout his time in the home. CSCI Questionnaires were received back from those using the service as residents, relatives and as a GP to the service. The inspector is grateful for the time and attention and hospitality afforded to him during the inspection of the service. What the service does well: What has improved since the last inspection? The last inspection visit revealed some significant concerns relating to medication records and ‘prn’ (‘when required’) medication. These issues had been resolved fully at that time, and the status quo has remained at this visit, with just one query remaining for the manager to resolve concerning the timing of a single administration of such medication. Green The (3) DS0000007140.V341022.R01.S.doc Version 5.2 Page 6 The other major concerns arising from the last inspection visit related to staffing issues and the inspector is, in these regards, satisfied - to the extent that the requirement imposed by statutory notice concerning notification to the Commission of all new staff members starting at the home be removed. The pre-employment checking - and subsequent induction of staff to the service - have both been properly maintained since the serving of the statutory Notices regarding these issues last year; documentation seen evidenced this to the inspector’s satisfaction. Training in First Aid - an essential qualification, especially in this challenging environment - has now been provided for all staff save a single new-starter. The staffing input has now been restored to a level where all appear sufficiently well supported at the home - this involving the availability of direct and active management input to support the service and external auditing from the registered provider to ensure ongoing managerial competence. Reports concerning incidents within the home or relating to those using the service have also been efficiently reported to the Commission in a timely fashion, this satisfying the requirements of the remaining statutory Notice. 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. Green The (3) DS0000007140.V341022.R01.S.doc Version 5.2 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.V341022.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective and current service users can be assured they will have their needs thoroughly assessed, recognised and appropriately recorded by the service. EVIDENCE: The above judgement statement covers the service’s approach to the introduction of a newcomer to the home. The organisation has a dedicated Assessment Team that ensures that all necessary information is accrued prior to an admission to the home, and the actual service is involved in assessment / familiarisation visits to a prospective service user prior to admission. No new service users have been admitted to the home for the past two years; one resident was a hospital in-patient at the time of the inspection visit. The resident population of seven at the home has been constant since November 2004; two service users have resided at the home since 1996 & 1996, with an arrival in 2001, one in 2002 and three arriving in 2004. This group’s age-range spans from the early ‘twenties’ to ‘late thirties’ - the average being around 30. This constancy of service user population has been fundamental to the progress of a number’s wellbeing; their life skills programmes being constantly implemented and refined thanks to the stability this long-term aspect brings. Green The (3) DS0000007140.V341022.R01.S.doc Version 5.2 Page 9 The home provides a service to each individual based on specific needs assessment and weekly charges are in the range of approximately £1,450 £1,820. One potential ‘dilemma’ that such stability at a home brings is a growing time ‘distance’ from the need to ensure that the home’s Statement of Purpose and Service User Guide is kept as up-to-date as it would be, if it were being used as a ‘live’ document everyday. It is recommended that these two familiar documents - both required by Regulation - be revisited, and reviewed / updated in the near future. Service users are in regular contact with both health- and social care-based professionals, including GPs, Care Managers, and community based mental healthcare professionals, all of whom are able to check that the ongoing assessed need of each individual is being met. The Lead Inspector has been involved in a number of meetings regarding individuals from The Green over the past twelve months or so, and in all respects the service has been noted for the individualised focus of the care provided. Green The (3) DS0000007140.V341022.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 & 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home creates and maintains care plans and assessment documents designed to ensure that the needs of service users are realistically met in an individual and focused way. Service users can be assured that their rights to individuality and selfexpression are protected, whilst acknowledging the community and supportive aspect of living at The Green. Service users can be assured that risk-taking will be an integral part of the support / protection plans put in place by the home. EVIDENCE: The manager and staff are commended in both this section and the next for their engagement, optimism and tenacity in encouraging the residents and in sourcing opportunities with regard to self-occupation and self-enjoyment. A relative commented that the home has a ‘fairly happy atmosphere’. Green The (3) DS0000007140.V341022.R01.S.doc Version 5.2 Page 11 Each individual at the home is recognised for their own individuality; all are male and of white British extraction. Staff are both male and female and of varying ages (from 20’s up to 66). There is a sense of close and concerned ‘community’ within the house, including the seventh member of the service, who lives and self-caters in their own small bed-sitting ‘flat’ that is located in the separate ‘coach house’ block at the rear of the home. Care plans and daily records tracked were comprehensive and current in content. Care plans are reviewed and updated after the collation of a monthly review by the dedicated keyworker, reflecting on achievements and changing needs; some of these were noted to be omitted for some months - a cause for auditing. Care plan reviews were timetabled into a cycle of structured reviews, though some local authorities were tardy in re-fixing cancelled appointments. The Regulation 26 visit reports evidenced the ongoing monitoring of the documentation - and corrective action required - by senior management. Activities within the home include enjoying books (a number visit the library), board games, arts and crafts and computers. A pool table is housed in the ‘coach house’ at the rear of the main building and table tennis is also played. Trips out from the home include visits to the cinema, bowling, swimming and restaurants / pubs. No individual has expressed a need to access religious services of any kind; the service is aware of local resources. Regular Resident Group meetings are held / minuted (evidencing monthly gatherings) - this providing an opportunity for planning, comment and discussion of issues requiring agreement within the household. A monthly CMG Residents’ Magazine is also issued for the interest of all, and annual Residents Forums are also held to bring together opinions form across the service. It was very evident from the individualised care plans that - based on an assessment of acceptable risk and safety criteria - staff encourage service users to take ‘reasonable’ risks, whenever possible - and to live their lives to the full. Guidelines (i.e. risk management strategies) for service users assessed as likely to be aggressive or to self-harm have also been drawn up, with the involvement of specialist [health] care professionals as appropriate. 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 individual service user’s care plan. The home is very keen to encourage those service users who are willing and able, and (where appropriate) with support, to manage their own financial affairs. The home maintains a good financial record-keeping process, with a ‘transparent’ financial auditing system being used. Green The (3) DS0000007140.V341022.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11 - 17. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users can expect their lifestyles at the home to be individually focused and aimed at personal development. Relatives / friends can expect a positive welcome from the home, but within the context of respect for a service user’s own choice and decision-making. Activities provided and pursued ensure positive engagement within the home and especially the local community, as far as is practicable - whilst acknowledging and respecting each individual’s needs and capacities. Service users can expect to be provided with a good standard of nutritious and interesting food, whilst acknowledging the right to their own stated choice and ensuring that mealtimes are a pleasant and enjoyable time. Green The (3) DS0000007140.V341022.R01.S.doc Version 5.2 Page 13 EVIDENCE: The manager and staff are commended in this section for their engagement, optimism and tenacity in encouraging the residents and in sourcing opportunities with regard to self-occupation and enjoyment. Everyone is encouraged / assisted to undertake educational or occupational activities; one is due to start a four-day-a-week painting & decorating course, another taking a similar number of days to study animal care & horticulture. SCOLA, NESCOTT and Merton Colleges are used; another attends three times a week, whilst another is studying computers. The Cheam Centre is also used for those needing a more focused educational input, one person undertaking a long day studying cooking and numeracy & literacy; another enjoys cooking and leisure. Part-time jobs are held by some - such a being a ‘pot-man’ at a local pub (another also held a similar post until very recently). Another works at a charity shop for one day a week, and another assists at the Vine Project on three days a week. The staff members are always on the ‘outlook’ for any opportunity which could be taken up one of the users of the service. Physical activity in general is positively encouraged - though with greater success with some than others. A number of residents go to the gym to keep trim. Residents were planning and looking forward - on the day of the inspection visit - to visit another CMG home that afternoon to join in a CMG v local police / fire brigade personnel football ‘friendly’. Holidays are planned for each individual according to expressed wish; two staff and two residents had very recently been on an all-inclusive trip to Tenerife. Others have recently been to Cornwall. Some, as well as going away with the home, also have holidays with family members. Residents make a partcontribution to the funding of holidays. The home has a people carrier, which can take a maximum of seven people (including staff) on trips out. Five had enjoyed a recent day trip to Brighton with staff escorting them. Family involvement is recognised as vital to promote self-identity and to encourage contact with the outside world. In almost every person’s respect, visits are either enjoyed to their parent / relative’s homes, or they visit at 3, the Green. Those without direct face-to-face contact do have telephone communication. 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 for use - and lends itself to more formal / officialstyle meetings / encounters. Green The (3) DS0000007140.V341022.R01.S.doc Version 5.2 Page 14 One resident has the responsibility and pleasure of having a wife and two children - who are familiar faces around the house, whilst contact away from the home is also positively encouraged and facilitated. One resident at the home cooks their own meals in their self-contained flat, and another cooks for themself in-house. Many residents are encouraged to participate according to skills and abilities in the catering activities. Relatives commented that ‘meals seem good and reasonably varied’ - though a concern about ‘too many chips’ was also expressed. Green The (3) DS0000007140.V341022.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. 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 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 should ensure the safety and consistent treatment and support for each service user, provided that tight attention is paid to all relevant records. EVIDENCE: Care and support provided by the staff is appropriate and sensitive to the need of the individual - encouraging ‘self-help’ as much as possible. Routines are very flexible and guidance and support is ‘second nature’ to the staff - who ‘live alongside’ service users, integrating support and assistance. Relatives have stated that they feel ‘the general day-to-day care is very good.’ Service users clearly choose their own clothes and initiate their own day-today activities; staff support service users in their daily routines - keyworkers in Green The (3) DS0000007140.V341022.R01.S.doc Version 5.2 Page 16 particular. Each service user evidently is treated as an individual, keyworkers being responsible for the ongoing persuasion / encouragement of engagement with fulfilling and enjoyable pursuits. All have access to local community health services, including local GPs for all, and other medical services - as appropriate and preferred (accessing different chiropody services, for instance). Local community opticians and dental surgeries are used. Service users are encouraged to take control of their healthcare needs (e.g. arranging their own appointments), this promoting privacy, dignity and independence. A number of service users are supported with psychiatric ‘visits’ (either ‘in house’ or clinic based) on a regular basis. The home has good liaison contact with mental health services and also the 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 an ongoing monthly basis. Medication records were examined and found to be generally in good order. Monthly medication audits have been introduced in-house, and the regulation 26 Registered Provider visits by senior management are also highlighting any shortfalls. The last CSCI inspection visit had revealed some significant concerns relating to medication records and ‘prn’ (‘when required’) medication. These issues had been resolved immediately after the concerns were raised at that time, and at this visit - the status quo remained. External management audits have closely monitored medication record compliance - and continue to do so - to the benefit of the service. Just one immediate query was raised - which remained for the manager to resolve - concerning the recording / timing of a single administration of such medication. Green The (3) DS0000007140.V341022.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. 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 can be assured that their comments or complaints will be taken notice of, investigated and acted upon within the registered provider’s stated procedural timescale. The home provides adequate support to service users to ensure that they are protected from harm, neglect and any form of abuse. EVIDENCE: Complaints have been handled well by the manager; five complaints have been raised in the past year, with two being substantiated, and one partially so. The Complaints Procedure is openly displayed and available in symbols and large print. A relative commented that a complaint made by their relative at the home was dealt with promptly. Relatives indicated they were aware of the Complaints Procedure. Two adult protection issues have been raised in the past twelve months - the Commission has been involved in monitoring the home’s conduct in relation to these issues, and is satisfied that they have been handled with competence and a sound knowledge of dealing with the individuals concerned. Green The (3) DS0000007140.V341022.R01.S.doc Version 5.2 Page 18 It was noted that the home was still in possession of the 2002 version of the London Borough of Sutton’s Vulnerable Adult guidelines; this had been superseded in 2005 by a new version of the Multi-Agency Policy, which should have been copied to the home at the time of the document’s renewal/update. The manager - who is clearly conversant with the new procedure - has committed to obtaining a copy of the new document. The ‘adrenalin’ content of the house (with seven quite assertive males) is sometimes high, and the number of times that the use of ‘Digman’ - the dignified management of challenging behaviour - has been used is consequently quite high - a total of fifteen incidents across the year. Some such incidents also related to protecting a resident from the effects of selfharming. All such incidents have been handled well, being fully recorded and notified to the Commission and all significant others. The Registered Provider provides training for staff on ‘Dignified Management’ (Simon Burrowes has previously been a trainer for this process) - alongside the “Understanding Challenging Behaviour” course, which ensures that service users are only restrained when absolutely necessary, and even then treated with respect in such challenging situations to avoid issues of potential abuse. Most residents handle their own financial affairs - whilst one resident has their monies managed by their funding local authority, and one is subject to Power of Attorney. The home maintains a good financial record-keeping process, with a ‘transparent’ financial auditing system being used, which again is checked by the external Regulation 26 monthly visit audits. Green The (3) DS0000007140.V341022.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users can expect to live in a generally clean, warm and comfortable environment designed to meet their needs and providing adequate communal services and domestic facilities. Service users can be assured that, once the bedrooms have been reassessed for adequate fittings and furnishings, the home will be a comfortable, safe and hygienic environment in which to live, without unnecessary risk. EVIDENCE: The house, a detached Victorian building, stands in its own grounds overlooking a green at the north end of Sutton town centre. This enables those using the service and assisting staff to easily access a myriad of resources leisure, shopping, transport and other facilities. Green The (3) DS0000007140.V341022.R01.S.doc Version 5.2 Page 20 The house has been, again, 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 recent ‘flash flood’ had severely affected the ‘coach house’ ground floor - as this (the office and pool table area) is provided absolutely at ground level due to its previous [transport] purpose. There is a need to consider providing some form of drainage gully along the front of the previous coach-width opening, to promote drainage should such a deluge hit again. The activity area had just been recarpeted and was all the better for this improvement. Carpet replacements in the main hallway and lounge were completed in 2006 and new kitchen units and equipment also installed - leading to a substantial upgrade in the quality of the service user’s ground floor environment. The main lounge is spacious and comfortably furnished, and the conservatory is a popular place to meet visitors and - until recently - to ‘have a smoke’. It is recommended that the approach to smoking (and the use of this conservatory area) be reviewed prior to the winter in the light of current legislation - as the majority of those resident, and a number of staff, do smoke. The dining room is also of a good size, and the ‘coach house’ and the garden provide space for sporting pursuits. A new shower room facility on the ground floor was reported to be a ‘total success’ - clearly a useful new resource for the home, including addressing cultural needs, and which now provides a variety of bathing possibilities, alongside the main formal bathroom upstairs. Little has changed with regard to the general premises layout in the past year; it was most encouraging to see more furniture in one bedroom, where a resident had clearly been assisted to keep their possessions intact, rather than them being destroyed as had often been the case in the past. This is an underlying problem with the fabric of the house, in that challenging behaviour can severely compromise the premises’ continued wellbeing. It is recommended that for the other bedrooms, an audit would be beneficial to ensure that the ‘basics’ continue to be provided to a suitable and good level; attention to the furniture and furnishings in bedrooms needs reviewing for sufficiency and quality (for instance, a high window in one room had no curtaining, and the curtain rail to the lower window was poorly fixed - see the requirements section for further issues). Whilst respecting the right of people who use the service to control over their own space, the issue of maintaining ‘quality surroundings’ for all should not be lost or compromised. The home remained clean and odour-free during the inspection. Service user’s room cleanliness is self-managed - though staff intervention may be invoked if the situation was becoming too difficult for a service user. The cleanliness of communal areas is also a joint responsibility between service users and staff. Green The (3) DS0000007140.V341022.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34 & 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users can rely on the home providing adequate staff in sufficient numbers and being competent, to provide a service that strives to meet the service users’ individually identified needs. The home’s recruitment and staff support mechanisms are generally organised so as to ensure the safety, protection and wellbeing of service users, though attention must be focused on ensuring adequate professional training to a sufficient level to encourage the development of informed best practice. EVIDENCE: Mention is again made in this report of the office environments within the home - it is imperative that such areas are well organised and furnished to enable the task of record keeping and storage to be properly undertaken. One major concern arising from the last inspection visit related to staffing issues and the inspector is, in these regards, satisfied that the concerns have been dealt with - to the extent that the requirement imposed concerning Green The (3) DS0000007140.V341022.R01.S.doc Version 5.2 Page 22 notification to the Commission of all new staff members starting at the home can now be removed. Pre-employment checking - and subsequent induction of staff to the service have both been properly maintained since the serving of the statutory Notices regarding these issues last year; documentation seen evidenced this to the inspector. Training in First Aid - an essential qualification, especially in this challenging environment - has now been provided for all staff - save a single new-starter, who will be nominated for such training at the first opportunity. As well as the manager now starting to undertake his Registered Manager’s Award at NVQ Level 4 with another training company (the previous initiative had failed), one support worker has a Diploma in Social Work, one a nursing degree, and four further staff members are undertaking their NVQ at Level 2 or equivalent. The care team of fourteen staff (plus one is on maternity leave) will still clearly not, therefore, achieve the standard inspection requirement that at least 50 of them should be qualified to minimally NVQ Level 2 ‘by the end of 2005’. It was again stated that a number of staff members were keen to ‘get going’ on their NVQs. The registered provider must again address such deficits and evidence, in an action plan, their intentions to address this shortfall. The staffing input levels have now been restored to a rota’d level where all both users of the service and staff - appear sufficiently well supported at the home - this including the availability of direct and active management input to support the service, and external auditing from the registered provider - to ensure ongoing managerial and service-related competence. Some of those using the service did comment, however, that they would appreciate meeting those in senior positions more often / informally within the home. Monthly staff meetings at the home were well recorded, and evidenced wideranging discussions concerning the service provision. There is a quarterly CMG staff magazine, which enables staff get an idea of the ‘bigger picture’ of CMG as a growing care services company, and a six-monthly Staff Forum is also held to seek out opinions and feelings about the Company’s progress. Audits of staff records (which are securely kept) showed staff induction and supervision in place, and the manager is clearly getting to grips with these tasks now that staffing levels have improved. Relatives commented that they would prefer to see ‘more trained staff’, whilst commenting that ‘In general, staff are very good and helpful’. Staff changes had been noted by relatives, with some concern that there should be ‘more trained staff ’. Green The (3) DS0000007140.V341022.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 42 & 43. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home operates management systems that will ensure that service users benefit from a well-run, competently managed and safe environment. Service users can be assured that their rights and interests are well served and protected through the home’s approach to policies & procedures, and the dayto-day conduct of the home. Record keeping still requires a stronger focus. Service users can be assured that their welfare, health and safety is safeguarded through the home’s adherence to appropriate guidance and regulatory framework concerning best safety practice. Green The (3) DS0000007140.V341022.R01.S.doc Version 5.2 Page 24 EVIDENCE: The manager’s role at ‘The Green’ is extremely complex and demanding, and the full-staffing complement situation must now be capitalised on, in the manager ensuring that he holds the ‘strategic’ role of the manager - guiding, auditing and directing, rather than so much actively participating in the day-today activities of the home. The manager reported that he has access to reviewing the budget headings for the service, allowing him to ‘manage’ the service in a more creative / informed way. Management responsibilities are being clearly shared / cascaded and delegated through to the senior staff team - this enabling the manager to have a chance to take an overview of the home’s operation. Although the manager has still not completed his NVQ at Level 4 (he has reported that he is ‘starting again’ with a different training agency), the management approach to the home is clearly robust and he is well supported by senior management, who are evidently conducting thorough Regulation 26 visits to the house. Quality assurance measures adopted by the registered provider include these unannounced visits by representatives of the registered provider which are thorough and clearly being carried out on a regular basis - reports are being forwarded to the Commission. Quality Assurance surveys are sent out to relatives, friends / representatives or advocates of service users to encourage feedback about the quality of the service provided. The responses are received centrally and collated, prior to being sent on to the home itself. Feedback from those using the service - through the CSCI questionnaire revealed a positive regard for the service provided in almost every aspect generally, with only a single dissenting voice in any particular area questioned. A Company-wide consultation Forum for service users meets regularly, and CMG regularly publishes the monthly ‘Resident Times’ as well as the more global quarterly in-house staff magazine. The home also has a substantial Quality Assurance file - which requires focused work and challenges the management to assess such issues locally. CMG has a comprehensive set of policy and procedures which cover the broad spectrum of needs identified for care homes; they have been very recently revised and the inspector is impressed by the clear focus and guidance provided by these documents. Green The (3) DS0000007140.V341022.R01.S.doc Version 5.2 Page 25 All maintenance and servicing contract issues were up to date, and evidenced by certification produced on request on the day of the inspection visit; health & safety monitoring and recording was also being kept well - e.g. temperatures for fridges etc - which were being consistently kept. One issue did arise with regard to health and safety, in discussion with the manager and staff; it was agreed that an assessment of the risks posed by hot radiator surfaces would be undertaken with regard to certain areas - such as the communal bathroom and a bedroom where a bed was pulled close to a radiator surface. The manager assured the inspector that immediate corrective action would be undertaken in this regard. Reports concerning incidents within the home or relating to those using the service have also been efficiently reported to the Commission in a timely fashion, this satisfying the requirements of the remaining statutory Notice imposed at the last inspection visit. Green The (3) DS0000007140.V341022.R01.S.doc Version 5.2 Page 26 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 X 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 3 25 2 26 1 27 3 28 1 29 3 30 3 STAFFING Standard No Score 31 3 32 1 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 4 12 3 13 4 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 3 3 3 X 3 3 Green The (3) DS0000007140.V341022.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES 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 YA6 Regulation 15(2) Requirement Monthly reviews of progress of a person using the service must be actively maintained if they are to form part of the overview process; monitoring is needed of these to ensure compliance. Suitable drainage must be provided to the front of the ‘coach house’ to ensure that flash flooding does not again compromise the flooring of the leisure area and office. Furniture, decor & furnishings must be reviewed in bedrooms to ensure appropriate facilities are provided to each resident according to their need. A copy of the assessment and a rolling plan of redecoration plan to be sent to the Commission by the deadline stated here. The high window in one bedroom must be provided with curtains, and the curtain rail to the lower window properly fixed. DS0000007140.V341022.R01.S.doc Timescale for action 31/10/07 2. YA24 23(2)(a) 31/10/07 3. YA26 16(2)(c) 31/10/07 4. YA26 16(1)(c) 15/10/07 Green The (3) Version 5.2 Page 28 5. YA26 16(1)(c) The front upstairs bedroom be provided with new furniture and furnishings, and redecorated to encourage a more positive regard to the room. 30/11/07 6. YA26 23(4)(c) The fire-resisting door, which 30/09/07 sticks on the newly laid bedroom carpet, must be attended to - to ensure the self-closure mechanism operates unhindered. Furniture & furnishings in the 30/11/07 staff offices must be improved to make the environment more pleasant and more ‘office-like’ to encourage a culture of professionalism, and to indicate the value staff and their written / recording work are held in. Previous timescale not met. A minimum of 50 of the care 31/03/08 staff team must be qualified, nominally to NVQ Level 2 in care. An action plan must be sent to the Commission stating how this deficit will be rectified. Standard of 31/12/05 exceeded; issue carried forward from previous inspection visits. The registered manager must qualify in Management & Care at NVQ Level 4 (the ‘RMA’). Issue brought forward from previous inspection visits. 31/03/08 7. YA28 23(3)& 12(5) 8. YA32 18(1) 9. YA37 9(2) 10. YA42 13(4)(c) Assessment of the risks posed by 30/09/07 hot radiator surfaces must be undertaken with regard to certain areas - such as the communal bathroom and the bedroom where a bed was pulled close to a radiator surface. Green The (3) DS0000007140.V341022.R01.S.doc Version 5.2 Page 29 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 YA1 Good Practice Recommendations That the registered persons review the home’s Statement of Purpose and Service User Guide / Information Handbook to ensure that it remains current for those using the service and is ready for any further referrals /admissions. That the home should access a copy of the current London Borough of Sutton’s Vulnerable Adult multi-agency policy and procedure - to replace the presently held out of date document. That a formally adopted approach to using the conservatory as a smoking room should be formalised before the inclement weather sets in, to meet the current legislative requirement’s exemption for residential premises. 2. YA23 3. YA28 Green The (3) DS0000007140.V341022.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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. Extracts may not be used or reproduced without the express permission of CSCI Green The (3) DS0000007140.V341022.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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