Inspection on 11/11/08 for Hainault

This inspection was carried out on 11th November 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hainault 18/12/07

Hainault 16/11/06

Hainault 09/09/05

Hainault 04/05/05

Hainault 07/09/04

Hainault 11/05/04

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Ashlong House

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Edenvale

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Chatsworth Care - Dawson House

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Chatsworth Care - Tudor Lodge

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Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Hainault 35 Lesney Park Road Erith Kent DA8 3DQ The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Maria Kinson Date: 1 4 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 34 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Hainault 35 Lesney Park Road Erith Kent DA8 3DQ 01322335252 01322338106 j.woodland@mcch.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): MCCH Society Ltd Name of registered manager (if applicable) Jean Woodland Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 13 0 care home 13 learning disability Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD The maximum number of service users who can be accommodated: 13 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 34 A bit about the care home Hainault is registered with the Commission for Social Care Inspection to provide personal care for thirteen adults with a learning disability. The home opened in October 1988 and is operated by MCCH. Hainault is located in a large, detached, two storey building. The home does not have a passenger lift. The building is divided into three flats. Flat 1 can accommodate two people, flat 2 five people and flat 3 six people. All of the people that live in the home have single bedrooms, apart from two service users who share a room in flat 2. All of the bedrooms have a washbasin and three rooms have en-suite facilities. All of the flats have a lounge, kitchen, bath/shower room(s) and toilet(s). Flat 3 has spacious communal rooms. There is an office and a small sensory room on the ground floor and a spacious garden at the rear of the property. Visitors can park on the road or on the driveway in front of the property. Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 34 How we did our inspection: This is what the inspector did when they were at the care home Before the inspection we looked at all of the information that we had received about the home in the period since the last inspection. This included notifications, the annual quality assurance assessment form and feedback from people that use or have an interest in the service. Some of the feedback that we received about the service is included in this report. The site visit was carried out over two days in November 2008, and was unannounced. We spoke to four members of staff, the manager and two service users during the visit. We observed staff supporting people to prepare for activities, eat and drink and take their medicines. We were shown around the home by staff and some of the service users showed us or agreed that staff could show us their bedrooms. We viewed four bedrooms, all of the communal areas and some bathrooms and toilets. We examined some of the records that were kept in the home and looked to see how medicines were stored and managed in two flats. There were twelve people living in the home at the time of this inspection. The fees are one thousand and sixty three Care Homes for Adults (18-65 years) Page 7 of 34 pounds per week. The amount that each service user contributes to the fee depends on their individual financial circumstances. The fees do not include items such as personal clothing, toiletries and activities. This information was supplied to the commission on 11/11/08. What the care home does well People that expressed an interest in the service were encouraged to visit the home to view the facilities and meet the people that live and work in the home. Care records reflected peoples individual strengths, needs and interests. People were encouraged to suggest ideas and help set new goals during care planning meetings. People were supported to attend health care appointments and were referred to other professionals for assessments and advice, if necessary. The food provided in the home was varied and people were able to choose what they ate. Staff knew what people liked and disliked and what things were important to them. People were able to take part in a varied range of activities and pursue personal interests and hobbies. The complaints procedure was clear and easy to follow. Staff received safeguarding training and knew they should report concerns and allegations to senior staff. Care Homes for Adults (18-65 years) Page 8 of 34 All of the flats were nicely decorated and furnished. A good standard of hygiene was maintained throughout the building. Staffing levels were good. Extra staff were provided during busy periods or when people required extra support. Staff had access to relevant training. Fire safety arrangements were good and equipment was inspected and serviced at regular intervals. What has got better from the last inspection All of the service users received information in the contract about the terms and conditions of occupancy and fees. The management of medicines had improved. Staff kept good records about medicines that were recieved and used in the home. The manager accepted the findings from a recent investigation about medication errors and took action to try to stop the issue from occurring again. Care Homes for Adults (18-65 years) Page 9 of 34 The home had recruited some new senior staff. This provides support for the manager and better support for junior staff. Satisfaction surveys were sent to service users, relatives and other professionals to obtain feedback about the service. Work was carried out to improve the mains electricity system. The system was now reported to be satisfactory. Hot water temperatures were monitored and were maintained at a suitable temperature. Fire drills had had improved. What the care home could do better Contracts were provided but they were not always agreed and signed by the service user or their representative. Care records were not always reviewed and updated at regular intervals. The management of medicines had improved but there was little guidance for staff about the use of as required medicines. The stock level of one medicine was incorrect. The carpet in the large lounge in flat three was stained. This made the room appear less welcoming. Although the manager and company had tried to reduce the use of temporary staff there were still a high number of support Care Homes for Adults (18-65 years) Page 10 of 34 worker vacancies which meant the home had to use bank and agency staff regularly. Efforts were being made to resolve this issue. Recruitment procedures were followed but information about the checks that were carried out was not always recorded in sufficient detail. There were no records to show if staff were physically and mentally fit for the role they were undertaking. There were systems in place to monitor the quality of care provided in the home but the findings were not always shared with the home or used to improve the service. Accident records were completed but there was some variation in the standard of information recorded. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Care Homes for Adults (18-65 years) Page 11 of 34 Maria Kinson 33 Greycoat Street London SW1P 2QF 02079792000 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 12 of 34 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 13 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Before people moved into the home a series of meetings, assessments and visits were carried out to obtain information about the persons support needs and to see if they liked the home. Evidence: The registration certificate was displayed in the reception area. We were not able to assess the arrangements for admitting new people to the home as the home had not admitted any new service users in the period since the last inspection. However we did talk to the manager about the admission procedure and about the arrangements that were being made for a new service user to move into the home in the future. The manager had attended various meetings and was involved along with other professionals in assessing the service users needs. The manager had arranged for one room to be converted into a multi-sensory, soft play area in preparation for the service users admission. The service user had met some of the people that live and work in the home during Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: visits. Visits were arranged to suit individual needs and include short visits to look around the home and have a drink or longer visits such as weekend and overnight stays. All of the people that used the service had contract. Contracts provided clear information about the facilities, fees and type of support that the home provides. Information was provided in both words and pictures to assist service users understanding. Some contracts were not agreed or signed by the service user or their representative. The manager said some of the service users would not be able to understand or sign the contract and did not have any relatives who check and sign the contract on their behalf. The manager should explore the possibility of other people such as care managers and advocates signing this document. See recommendation 1. Care Homes for Adults (18-65 years) Page 15 of 34 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Care plans provide detailed information about service users support needs and preferences but were not always reviewed regularly. Service users were able try new experiences and were supported to make decisions. Evidence: We examined the care records for three people that lived in flats 2 and 3. All of the files included detailed information about peoples individual support needs, preferred routines and specific guidance about how people wanted to be supported. For instance one person liked to take their medicines with yogurt and another person liked to have a wash in the morning and a bath in the evening. There was information about the foods that service users liked and disliked, about the support that they required to eat independently and about the type of cup they liked to drink their tea from. The plans reminded staff to promote peoples independence and to encourage people to make decisions for themselves. We saw evidence that plans were followed. For instance the records for one service user stated they liked to get up late. The service user was still in bed when we arrived in the flat at eleven am. The plan for another service user stated that they liked to go to bed after nine thirty pm. The records that we looked at Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: for this service user indicated that they went to bed at various times, all of which were after nine thirty pm. There was some variation in the frequency that plans were reviewed and updated. Some of the plans, guidelines and risk assessments that we looked at were reviewed and updated in May, September and October 2008 but other documents such as a pen portrait, risk assessments and epilepsy guidelines for one resident were dated September and December 2007. See recommendation 2. Some of the people that live in the home could not tell staff what they liked or disliked but were able to make their needs known in other ways. The staff that we spoke to told us how people were supported to make choices. We were told that one service user was able to select which breakfast cereal they wanted to eat if the staff member laid them out. This information was also recorded in the service users care plan. Another service user was able to select what they wanted to eat from the refrigerator or freezer. Some of the other service users could tell staff what they liked to eat and were able to suggest ideas for the weekly menu. We saw evidence during the inspection that service users were able to make decisions for themselves. For instance one service user usually attends a day centre on one of the days that we visited the home. The service user told us that they were at home because they didnt want to go to the centre and said they had been shopping instead. All of the files that we looked at included risks assessments. Staff identified issues that could affect peoples safety and wellbeing and developed strategies to prevent or minimise the risk of people being harmed. One service user did not like to wear any footwear. It was acknowledged that this was the service users choice but guidelines were introduced to try to avoid the service user being harmed. There were assessments about the support that people required in the home or community to stay safe, about undertaking activities and about the use of specialist equipment. Risk assessments were easy to read and follow but were not always updated regularly. See recommendation 2. Care Homes for Adults (18-65 years) Page 17 of 34 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Staff treated people as individuals and encouraged them to be as independent as they could be. Service users were supported to take part in activities in the home and community and to pursue personal interests. A varied choice of food was provided to meet peoples needs and tastes. Evidence: Some service users attend local day care services. Staff told us that some of the service users liked attending the centre and wanted to go even when they were unwell. One service user had been unwell on holiday and was very tired after the journey home. Staff advised the service user to rest and have a day off from the centre. It was clear that the person was eager to return to their usual routine and see their friends. Two people were supported by a dedicated staff member to undertake activities in the home and community. Staff arranged activities and outings to meet their individual Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: needs. One service user undertakes regular work with a local organisation called Tuck by Truck. The company supports people with learning disabilities to prepare and sell snacks in local offices and workplaces. One service user was an independent traveller and was able to decide what they did each day. During the inspection some people were doing puzzles and watching television, one person was supported to attend a medical appointment, one person went to the gym and two service users went out for lunch. There were individual activity programmes for most of the service users. This helped the manager to ensure that there were sufficient staff on duty to support people in the community. Activities were recorded in the daily care records. Recent entries indicated that people were supported to visit their relatives, went bowling, for a walk in the woods, played dominoes, attended an aromatherapy session and visited local shopping centres, a garden centre and cafe. Staff supported some of the service users to take an annual holiday. We were told that some of the service users had recently returned from the Isle of Wight and Bognor Regis and two people set off on the day of the inspection for a short overnight stay in a hotel and a theatre trip. Some service users liked to do similar things each day, other people liked to decide what they wanted to do and where they wanted to go as they went along. Staff were flexible and changed things around to meet individual needs and circumstances. Some people liked to spend time in their room, other people liked to spend their free time in the communal areas or watch staff in the kitchen. Staff respected peoples decisions to get up late and to go to bed when they wanted. Service users had unrestricted access to the home and grounds but were not permitted to go into other peoples bedrooms unless they were invited. One service user spent long periods outside the home and often missed the evening meal. Staff said they heated the meal when the service user returned home or prepared an alternative dish. There were good supplies of fresh and frozen food in the home and people were offered regular drinks. We looked at the menus in two flats. There was evidence that service users in some of the flats were able to contribute ideas about what they wanted staff to include on the menu . Menus were varied. Records were kept about the food that was prepared in the home and about alternative dishes that were provided for people that didnt want or like the food that was listed on the menu. We observed staff serving the evening meal in flat three. The meal looked and smelt appetising. Care Homes for Adults (18-65 years) Page 19 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Support was tailored to peoples individual needs and preferences. Staff worked in partnership with other professionals to monitor and address health issues. Medicines were stored securely and the records that were kept about the receipt and administration of medicines had improved. Evidence: There was information in the care records about service users preferences and routines. Staff that we spoke to knew how service users liked things done and what they disliked. The records for one service user indicated that they wanted to have a bath of an evening and a wash in the morning. We could see from the records that the service users wishes were followed. Staff arranged for people to see their GP when they were unwell and accompanied people to health care appointments if necessary. Staff from the local community learning disability team provide ongoing support and advice. We looked at four medicine charts to see if medicines were managed properly. All of the medicines listed were in stock. The concerns that we identified at the previous inspection about receipt of medicines had been addressed and a new handover sheet Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: was introduced to reduce the risk of errors. There were no gaps on any of the charts that we looked at. This indicates that people received their prescribed medicines, when they were due. We found the stock level of one medicine was incorrect when we deducted the amount given from the amount received in the home. There are two possible explanations for this. Either staff signed for medication that they did not give or they had not carried forward medicines that were leftover from the previous months supply. See recommendation 4. Some medicines were only given if necessary. Although staff prepared guidelines about how people liked to take their medicines it was not always clear in the records when and why staff should give medicines that were prescribed on an as required basis. Most of the people that live in the home would not be able to tell staff that they feel unwell or that they need these medicines. Staff told us that one person that was very anxious took a certain medicine prior to chiropody treatment. There was some information in the persons care records about this issue but no clear guidance for staff about giving this medicine. See recommendation 3. The manager notified the commission about a series of medication errors that occurred in the home. This issue was investigated under local authority safeguarding procedures. We assessed some of the recommendations that were made as a result of the investigation. The manager had completed medication competency assessment training and a new handover sheet was introduced to help prevent and identify errors. Care Homes for Adults (18-65 years) Page 21 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Complaints and safeguarding procedures were easy to follow and understand and provide good protection for people that use the service. Evidence: The home had a comprehensive complaints procedure, which includes a timescale for responding to concerns and contact details for the commission. The home had received one complaint about the management of medicines and care issues in the period since the last inspection. The concerns were investigated under local authority safeguarding procedures. One service user told us that they would speak to the manager if they were unhappy or wanted to make a complaint. We checked the personal money records for two people. Adequate records were kept about the use of personal money. The records showed that people were able to purchase items that they liked and receipts were kept for most purchases. Staff had access to safeguarding procedures. The procedure advised staff to notify social services and CSCI about allegations of abuse. All of the permanent, agency and bank staff that we spoke to had attended abuse training. Staff said they would report allegations or unexplained bruising to senior staff or the manager and would record what they saw or were told in the service users notes. In the period since the last inspection the manager had referred two allegations to the local authority for investigation under their safeguarding procedures. One member of Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: staff was dismissed as a result of an investigation. The manager told us about significant issues and events that occurred in the home. Care Homes for Adults (18-65 years) Page 23 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home was maintained to a satisfactory standard. All areas were clean, tidy and comfortable. Evidence: The company are planning to build a new home in the grounds of the existing home. The manager could not provide any new information about the project. In the period since the last inspection a new carpet and furniture was purchased for one of the flats and some areas were redecorated. We were told that a new variable height bath was due to be fitted in one of the flats. We visited all of the flats and looked at four bedrooms. The home was clean, tidy and odour free. Food was stored appropriately and was labelled once it was opened. The building was well maintained overall but some of the internal decoration in the toilets, corridors and bedrooms looked worn and tired. The carpet in the large lounge in flat three was stained. See recommendation 5. No significant health and safety issues were identified. Bedrooms were personalised with photographs, pictures, and items that reflected peoples interests and hobbies. A number of people had their own television and music Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: system. Each flat has its own kitchen, lounge, bathroom, toilets and laundry facilities. Some of the flats had a separate dining room and additional communal areas. Communal areas were pleasantly decorated and furnished. Although the building is large all of the rooms that we saw looked homely and welcoming. The home has a large garden. The lawn and grounds were maintained to a satisfactory standard. Care Homes for Adults (18-65 years) Page 25 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The use of temporary staff remains high but efforts were being made to address this issue. Recruitment checks were completed but the form that provides evidence of this was not always completed in full. It was not clear if staff were physically and mentally fit for the role they were undertaking. Staff were trained and supported to deliver good quality care. Evidence: Fifty four percent of care staff had a vocational qualification in care at level two or above. Staff had a good understanding of the principles of care and were able to give us examples of how they followed these principles when they were supporting service users. Two service users said they liked living in the home and said staff were kind. In the period since the last inspection the manager had recruited some new senior staff. All of the units had a senior member of staff that was responsible for overseeing care practices and supervising junior staff. The use of temporary staff remains high. The home told us that they used temporary staff on 738 shifts during a three month period. One member of staff said the frequent use of temporary staff put extra pressure on the permanent staff and was unsettling Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: for service users. See recommendation 6. Efforts were being made to address this issue. The home did not appoint any new care staff during a recent recruitment drive but a significant number of applications were received when the vacant positions were re advertised. The manager said the shortlisting process was due to take place soon and interviews would then be arranged. The manager told us that she always tried to use temporary staff that had worked in the home before and were familiar with service users, if possible. All of the agency and bank staff that we spoke to worked regular shifts in the home. The company had recently introduced dedicated bank support workers. Dedicated bank staff work in one home as opposed to various MCCH homes. Staffing levels were increased during peak periods such as early mornings when people required support to get ready for work or the centre and late afternoon when people returned home. Extra staff were rostered to cover activities and appointments. There were extra staff on duty on the day of the inspection because one service user had a dental appointment, some of the service users were going out and two service users were going on holiday. The commission had agreed that staff recruitment records could be kept at head office if a form outlining all of the information and checks that were undertaken in respect of each staff member was kept in the home. Two forms were examined. The forms indicated that all of the required checks were undertaken but some of the detail about checks was missing. For instance one form indicated that a criminal records bureau disclosure was obtained, the disclosure number was recorded and the date it was received but the section about whether it was an enhanced or standard disclosure was incomplete. Information about proof of identification was obtained for both applicants but some of detail such as the passport expiry date and number was incomplete. See recommendation 7. The form did not provide any evidence about the staff members physical and mental heath status. See requirement 1. Two members of staff provided written feedback about the service. They told us that they usually received adequate training and support. In the period since the last inspection some members of staff had attended safeguarding, IT, care planning, medication, food safety, fire safety, SCIP, moving and handling, epilepsy, health and safety and COSHH training sessions. The company provides a comprehensive programme of induction training for new staff. The programme includes first aid, medication, moving and handling, fire safety, food hygiene, health and safety, infection control and safeguarding training. Staff work alongside an experienced member of staff for a period and complete a workbook to demonstrate that they understand their role and responsibilities. Staff said that there were opportunities to discuss their work and training needs. The record of supervision dates showed that supervision was taking place more regularly and efforts were being made to include dedicated bank staff. Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: Care Homes for Adults (18-65 years) Page 28 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home was well organised and managed. There were systems in place to monitor the standard of care provided in the home, but it was not always clear if the findings were used to improve the service. Equipment was tested and serviced at regular intervals. Evidence: The manager was assessed by the commission in December 2007 and was found to have suitable qualifications and experience to manage a care home for people with a learning disability. The manager has the registered managers award (RMA). Staff said the manager was approachable and supportive. The manager communicates effectively with the commission. We were told about significant events and allegations and about any action that was taken in respect of these issues. Some work was taking place to monitor the quality of care provided in the home. The company carried out regular visits to assess the conduct of the home but did not always provide the manager of the home with a copy of their report. In other MCCH Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: homes the monthly visit includes an assessment of specific issues such as complaints, services users money or records. There was no evidence that this was taking place during the visits to Hainault. Staff completed regular walking route checks to assess health and safety and maintenance issues and a weekly returns form was completed and sent to head office about significant issues. The manager sent satisfaction surveys to some of the people that use the service, relatives and other people that had an interest in the service. The results indicated that people were satisfied with the service overall but there was no indication that the findings were used to improve the service. The manager should prepare an action plan to address issues raised in the surveys. See recommendation 8. The fire risk assessment was dated 2008. Fire safety equipment was tested and serviced at regular intervals. There had been two fire drills in recent months, one when some of the night staff were on duty and one when some of the day staff were present. Information about how staff responded to fire drills had improved. Fire safety training was provided for staff and records were kept about the sessions. The London Fire and Emergency Planning Authority (LFEPA) visited the home in February 2008. Health and safety records were sampled. All of the records including the mains electricity installation report were satisfactory. Hot water temperatures were monitored. The cupboard containing potentially hazardous cleaning substances was locked. We looked at some recent accident and incident report forms. There were seperate forms for reporting accidents and incidents and an additional form for reporting information about injuries. Some staff had not completed the correct form and the information on some of the forms that we looked at was only partially completed. For instance there was no surname on two forms and no information about one persons contact details. The incident form includes a section about the action the manager took to prevent a re occurrence. This part of the form was not completed. See recommendation 9. Care Homes for Adults (18-65 years) Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 31 of 34 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 34 19 Recruitment records must include a statement about the staff members physical and mental health. 01/04/2009 To ensure that service users are supported by people that are fit for the role. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 4 5 6 20 20 Contracts should be agreed and signed by the service user or their representative. Care records should be reviewed and updated every six months or more frequently if peoples needs change. A system should be implemented to ensure that the remaining balance of all medicines are correct. Guidelines should be developed about the use of as required medicines. This information should be kept with the medicine chart. Page 32 of 34 Care Homes for Adults (18-65 years) 5 6 7 8 24 33 34 39 The carpet in the large lounge in flat three should be professionally cleaned to remove the stains or replaced. The use of temporary staff should be reduced to provide better continuity of care. The staff recruitment form should be completed in full. Regular audits should be undertaken to assess the homes performance and to identify and address concerns. The manager should receive copies of regulation 26 reports. Staff should receive training about accident reporting. 9 42 Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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