Inspection on 21/07/06 for High Road 410-412

This inspection was carried out on 21st July 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

High Road 410-412 19/10/07

High Road 410-412 27/02/06

High Road 410-412 19/10/05

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 09/07/2008.

CARE HOME ADULTS 18-65 High Road 410/412 410/412 High Road Ilford Essex IG1 1TW Lead Inspector Stanley Phipps Key Unannounced Inspection 21st July to 18th August 2006 12:45p DS0000063248.V305032.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 DS0000063248.V305032.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. DS0000063248.V305032.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service High Road 410/412 Address 410/412 High Road Ilford Essex IG1 1TW 0208 252 6256 0208 252 6517 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.caretech-uk.com CARETECH Community Services Ltd. Sarah Louise Gontsi Care Home 7 Category(ies) of Learning disability (0), Mental disorder, registration, with number excluding learning disability or dementia (0), of places Physical disability (0) DS0000063248.V305032.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service can only admit a person where mental disorder is a secondary need to that of a learning disability and/or a physical disability. 27th February 2006 Date of last inspection Brief Description of the Service: 410-412 High Road Ilford is a Residential Home for seven adults with Sensory, Learning Disabilities and Mental Health Difficulties. The home has recently been registered and has undergone refurbishment of an existing double fronted three-storey house situated on the main Ilford High Road. Since its original registration the home has changed owners in that as of 18th May 2006, the service has been acquired by a large private organisation under the provider name of CARETECH – Community Services Limited. The home is close to community facilities such as swimming pools, shops, Churches, a Mosque, Hindu temple and Synagogue. The home also has good transport access and is near Ilford station and regular bus services. There are seven bedrooms, all with a full en-suite, which includes either a bath or a shower. Six of the bedrooms have ceiling re-enforcements, in case of a need for a ceiling hoist. There is ramped access to the front of the premises and also to the garden area from the lounge/dining room. A statement of purpose is made available to all service users in the home and is kept in the main Office. Given the level of disabilities service users are likely to have, this document is also made available to relatives and stakeholders. A service user guide is also given to each service user upon admission to the home. Fees are currently charged at £1350 - £1880 per week. Items not included in these fees are clothing, hairdressing, toiletries, items of luxury of a personal nature and unlimited support to access the local community. DS0000063248.V305032.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and a key inspection of the service for the inspection year 2006/2007. This meant that all key standards were covered as well as any other standard for which a requirement was made at the last inspection. The visit was done over two days beginning at 12.45 on the 21/7/06 and ended on the 18/8/06, which was the last day of the inspection. It was spread over this period to ensure meeting with as much of the staff and relatives as possible. Although the home had been registered since the 18/8/05, the home has never been filled to capacity and because of this, it was difficult to measure outcomes for service users during that period. The service is still operating in some respects under the policy and procedural guidelines of the previous providerMr Gurdeep Singh. CARETECH were just about starting to introduce their systems in running the establishment and so the home was going through a transitional stage. The inspection found that the home was generally managed to good effect with the management and staff focussing on quality outcomes for the two service users currently in the home. At the time of the visit both service users were both very pleased with the services provided by the relatively small team at High Road. Both requirements made at the last visit were satisfied and the inspection found areas that required improving and they are detailed to the back of the report. As part of the inspection both service users’ files were assessed. The inspector interviewed three members of staff including the deputy manager and one service user. Detailed discussions were also held with the manager and the other service user. A number of records held by the home – were also assessed. Care practice was observed throughout the inspection. This report also took into consideration written responses returned by one professional from health and social care, one relative and both service users. Responses were not returned by a number of external professionals involved with the service. A tour of the environment took place during the course of the visit. It should be noted that due to the recent transition to the new provider, there was some anxiety amongst staff regarding the changes and a different way of doing things. One example of this is the level of involvement that the manager has in key decision making in the home. This also holds true for the staff for whom it is not yet clear how they are able to influence, for example, policies and procedures in the home. At the time of the visit CARETECH’s policies and procedures were being introduced wholesale and the message was reportedly, DS0000063248.V305032.R01.S.doc Version 5.2 Page 6 that staff and the manager had to just get on and adopt them. This may have some impact on the provision of quality care in the home, as the team at High Road were beginning to settle in, just around the time of the transition. In essence this would need ongoing monitoring. What the service does well: What has improved since the last inspection? What they could do better: The registered persons could ensure that updated information is made available in the statement of purpose and service user guide for the benefit of service users, relatives and stakeholders. DS0000063248.V305032.R01.S.doc Version 5.2 Page 7 Greater attention is needed to ensure that recordings on medication are promptly made following the administration of drugs. There are a number of areas in the home that required repairs and redecorating and they are detailed in standard twenty-four and twenty–six of this report. The ventilation system in the kitchen required improving to promote the safety and comfort of staff and service users. It would be useful for the registered persons to develop strategies for staff and service user involvement in the home. Policies and procedures is one such area that should be included. Adequate arrangements must be made to ensure the safe handling of laundry in the home. To ensure staff competence, a training analysis and plan, which includes training specific to needs of the service user group is needed. This also includes arrangements for the registered manager to achieve her NVQ qualifications. Quality monitoring is an area that needs to improve and this should encompass carrying out an internal audit of the service, regular monthly provider visits and having an annual development plan for the service. The health and safety of service users could be enhanced through a number of key assessments and actions outlined in standard 42 of this report. The registered persons may wish to consider as part of this, the provision of automatic bedroom door systems for service users. This may also add to their independence. DS0000063248.V305032.R01.S.doc Version 5.2 Page 8 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. DS0000063248.V305032.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000063248.V305032.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (1,2,3,4) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users benefit from having detailed assessments prior to moving into the home. This ensures that their needs and aspirations are identified in determining whether the home could provide a service to them. A transitional plan enables service users to visit the home prior to agreeing to live there. Service users and/or their relatives also have information about the service to enable them to make an informed choice about living there. Prospective service users would however benefit from having updated information about the service. EVIDENCE: A statement of purpose and service user guide was made available to both service users during the course of their admission to the home. At the time of the visit, both had a copy of the service user guide and the statement of purpose was provided to them at the time of deciding whether they would like to live in the home. The documents detailed what the service is about and more importantly what they could expect from it e.g. whether they would have to pay for their personal care, toiletries, holidays and or their personal effects. They were relevant during the period of the service user’s admission to the home and were in line with regulatory requirements. However, they needed updating to reflect the current situation in the home e.g. the changes in staffing and the new organisational structure. From assessing the case records of both service users, detailed preassessments were seen on file and they were carried out and designed by the DS0000063248.V305032.R01.S.doc Version 5.2 Page 11 registered manager. They were very comprehensive and covered all aspects of need for each individual and this is usually carried out in the service user’s own environment. Some of the areas covered included health, communication, physical needs, daily living skills, work, education, culture, external support requirements, social care needs, religion and personal support needs. For each of the areas identified, there was an, ‘action required’ statement and this enabled one to have a microscopic view of not only the needs but also what was required to satisfy those needs. Therefore, service users would not be admitted to the home if their needs could not be provided for. This is a strong area of the home’s operations. Each of the service users had in place a transitional plan, which evolved from the pre-assessment information. Service users, their relatives and other professionals had significant levels of input in this. One example was where a service user required physiotherapy and it allowed for arrangements to be put in place in order for this particular need to be met. This was agreed prior to the admission and the manager and staff were proactive in ensuring that the relevant support was in place to meet that need. It meant that neither of the service users in the home was at risk of not having their needs and aspirations met. This whole process is well structured and organised in the best interests of service users, despite the fact that the transitional period for one service user – was shorter than the other. Both service users had the benefit of visiting the home as part of determining its suitability in meeting their needs. One service user commented: ‘the first time I saw it I liked it - the staff and the home were nice’. It was clear that this individual was pleased with the opportunities provided to see the home and meet with staff. Records and discussions held with both individuals confirmed that they had trial stays at the home before agreeing to live there and this was a positive outcome and experience for them. DS0000063248.V305032.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. 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 the service. A comprehensive plan of care details both the assessed and changing needs of service users at High Road. Staff engage with service users to ensure that they are able to achieve what is best for them. This involves taking risks, which are undertaken within the risk management framework of the service. This ensures the safety of service users. However, more could be done to involve service user participation in all aspects of the home. EVIDENCE: Comprehensive service user plans were in place for both service users. They were specific and generated from a care management assessment and the home’s own detailed pre-assessment. There was evidence of the involvement of service users and their relatives in the process, which ensured that their needs and wishes were appropriately represented. The plans also contained, quite clearly, areas of care that is provided by the home as well as what is provided externally. One example is where an individual attends a day centre five days per week and is supported by a worker external to the home – and this is a part of the agreed package of care for the individual concerned. DS0000063248.V305032.R01.S.doc Version 5.2 Page 13 Both plans viewed contained treatment and rehabilitative elements, for example, action to be taken in managing a specific type of diabetes and arrangements for physiotherapy for the individual. There was also evidence of referrals made to other specialists such as the speech and language therapist. The plans also detailed how individuals were to be supported and this was in line with their individual needs – which were predominantly of a physically disabled nature. It was clear that this did not prevent the service users from leading good quality lives as other aspects of their care and support e.g. social, developmental (education) were included in their individual plan. This is a strong area of the homes operations. The manager and staff worked closely with service users in enabling them to make decisions about their lives. This could be evidenced by one service user’s preference for hip-hop music, which he culturally relates to - and this is encouraged. This individual also enjoys computer games and the management has made a computer available in the home where he could have this opportunity. Plans are in place to take this to another level by acquiring internet-access and he was looking forward to this. The service user confirmed that he enjoys going on the computer. Another good example is where one service user as part of maintaining her independence wanted an automatic opening facility for her bedroom door and again staff engaged with her to achieve this outcome. She is now able to move in and out of her room with ease and comfort and this is positive. Although service users were provided with information about the service, it was noted that this could be improved by ensuring that this is kept updated (See standard 1- statement of purpose and service user guide). Service user involvement in the home could be enhanced through consulting with them about developments in the home as well as designing information in formats that would enable to contribute to the development of the service. At the time of the inspection there were understandably an absence service of user surveys and service user meetings, as both of the service users were relatively new to the home. The registered manager explained that service users views are informally acquired and that the current individuals have a dialogue about the aspects of the service. However, it became knowledge that plans were in place to move in two new service users with no evidence of consultation with the existing service users. As a result of this development, structural changes were on the way to one of the front rooms by converting it into a specialist bathroom for the benefit of the prospective service users. There was no evidence of service user involvement and or consultation in this process. The registered persons need to devise strategies for involving service users as far as possible in all aspects of the home. There was evidence that risk assessments were in place and were generally satisfactory. This process was undertaken with the involvement of the individuals concerned and as such enabled them to carry out activities in a safe DS0000063248.V305032.R01.S.doc Version 5.2 Page 14 manner. During the visit an observation was made that one of the service users was using a wheelchair without footplates. This was raised with the manager and she explained that the individual uses the wheelchair in this way to assist with his rehabilitation. However, it was made clear that this should have been risk assessed and documented to that effect. It is also important to link the risks assessed to the support needs of individuals and this should be ideally done in all cases. The manager indicated that she would make the adjustments identified. DS0000063248.V305032.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (11,12,13,14,15,16,17) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users enjoy opportunities for personal development by taking part in activities that is best suited to their needs. They are encouraged to use community facilities and enjoy leisure activities of their choice. Sound arrangements are in place for promoting their rights and involving relatives in their care. Their nutritional needs are also provided for as part of leading a healthy and fulfilled lifestyle at High Road. EVIDENCE: There was evidence that service users are encouraged and given opportunities to develop practical life skills. One example could be drawn from a service user who does ceramics at a day centre she attends. In speaking with her she indicated that she loves attending this facility, as she gets the chance to do what she enjoys best. For the other service user, there was evidence that the staff were exploring opportunities for full time education for this individual. However, it was agreed with the service user that this option might be too much at this stage. His key-worker was, however, exploring a referral to the Chadwell Centre, which is a specialist facility, where he could develop and enhance his practical skills in areas that he needed to. One service user had DS0000063248.V305032.R01.S.doc Version 5.2 Page 16 the input of speech and language therapy and both had opportunities for fulfilling their spiritual needs. However, neither took this up and this was their choice. There was evidence that service users were encouraged to keep up with activities that they were previously engaged with. An example of this was where one of the service users had been attending a day centre for up to five days a week previously. This now continues to her benefit and she confirmed that she enjoys going there. From records seen staff worked with service users and their relatives in seeking activities that are culturally suited to their needs. One service user enjoys going to the Jamaican market, which is something he could not easily do in his previous location and this is now facilitated. He also enjoys going out window-shopping over sports gear and this is also encouraged. In his individual support requirements, he spoke of wanting to pursue a college course that interests him as well as being assisted to regularly access the community. Records seen bore evidence that the staff at High Road were working well in line with his ideals. In speaking with the sister of the service user she indicated that the staff were excellent in promoting her brother’s independence and lifestyle. Evidence was available to demonstrate that service users were engaged in activities of that were suited to them. For one individual this involved going on a horse-riding holiday where she could make contact with animals as this is something she enjoys. This allowed her to stroke the animals and is also a useful form of physiotherapy. This individual also recently went on a seven-day holiday to Lambourne End. The service user also enjoys cinema and plans were in place for her to experience a theatre. It was reported that she uses a trampoline while at the day centre and this is remarkable. Other activities included reading, music and doing number puzzles. In working towards meeting service user’s needs, there was evidence to confirm that relatives and friends were an integral part to the whole process. One service user goes home regularly to his family and they visit the home regularly and are aware of his care and support needs. In determining the suitability of the placement, a key consideration for this individual was living in an area closer to his friends and family networks. High Road now gives him this opportunity and as such, the management and staff are now working with this individual to re-establish his network of friends. He is really pleased about this. For the other service user it is very much the same as her relatives are involved in what happens with regard to her care. As a matter of fact, they are integral in relation to the home understanding and meeting her cultural needs. Evidence was provided that a birthday celebration had been recently organised for her and a large family contingent visited to share the special moments. In DS0000063248.V305032.R01.S.doc Version 5.2 Page 17 keeping in line with her culture, a Chinese buffet was arranged. The service user stated: ‘had a good time’. This is a strong area of the homes operations. It was observed during the inspection that the home adopted a flexible routine with both service users. Each service user had their personal preferences and routines and staff respected and understood them. The staff approach was one that promoted independence and examples of this included one service user having an automatic door entry system, and a Neptune bath chair. These facilities meant that there was less reliance on the staff with regard to access and personal support. The ethos of the home is one in which staff engaged positively with service users, for example, sitting and sharing a meal with them. Service users also have unrestricted access to the home and staff were observed addressing them by their preferred names. Satisfactory arrangements were in place for handling service users mail. All staff interviewed demonstrated a clear understanding of promoting and respecting the rights of service users. The inspector observed lunch on the first day of the visit and the meal was attractively set out, wholesome and nutritious. Menus are decided with individual service users and meals consumed are recorded. There was a good supply of food and drink in the home and service users spoken to indicated that they could have what they like when they like. The home has arrangements in place to ensure that the specialist dietary needs of both service users were taken into account. In interviewing one service user he indicated that he gets his rice and peas, stew chicken and plantain when he requests this. He stated ‘I enjoy that’. The meals took into account the cultural preferences of both service users and this is positive. The other service user has her main courses at the day centre during the week, but has breakfast, evening and weekend meals in the home. Some of examples cultural provision in this case included the use of Jasmine tea and noodles. DS0000063248.V305032.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (18,19,20) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users enjoy personal support in accordance with their needs and wishes and the staff team is proactive in ensuring that both their physical and emotional needs are met. Improvements in the medication practices in the home are required to ensure the safety of service users requiring support with medication. EVIDENCE: In observing care practices at the home both service users, though requiring quite different forms of personal support, were provided this to a very high standard by staff working in the home. The home has a key-worker system and positive relationships were developed in supporting the service users. Staff understood through the service user plans and by engaging with them, their preferences in relation to personal support needs. One example of this is where a service user indicated that he did not wish to be pushed in a wheelchair if he is able to do it himself and that he prefers to be asked whether he needed assistance. The interactions on the day strongly indicated that staff knew when and the individual was to be supported. It was also observed that the staff were flexible with regard to service users going to bed and waking up. The progress made by one service user since being at the home was a direct result of the work that staff had put in with the individual. This included paying attention to the use of make-up and personal presentation e.g. the use of DS0000063248.V305032.R01.S.doc Version 5.2 Page 19 jewellery and/or other accessories. Arrangements were in place for the individual to have hand massages and manicures from visiting professionals. Both service users dressed in clothing that was linked to their culture and taste. On the one hand, one service user was observed using his sports wear, while the other presented in a more traditional style. There was evidence of occupational therapy, physiotherapy and, speech and language therapy being accessed for the benefit of service users in the home. This is a strong area of the home’s operations. The case files of both service users were assessed and there was evidence that adequate arrangements were in place to meet the healthcare needs of service users. All staff interviewed demonstrated a sound knowledge of the healthcare needs of the two service users and knew what interventions they should make should a service user’s health deteriorate. Service users were registered with a GP and the registered manager was clear about how to access services such as the opticians, dentist, district nurses, physiotherapist, chiropodist and the audiologist. An arrangement is in place with a local pharmacist to supply drugs and advice to the home. Given the fact that both service users were at the home for a short period, some of the healthcare services had not yet been accessed at the time of the inspection. Service users are supported to attend their outpatient’s appointments by staff in the home. A satisfactory medication policy was in place at the home and staff with the responsibility of handling medication did have training in this area. Medication storage was satisfactory and the arrangements for stock control and monitoring were generally good. However, the medication charts contained several gaps, which did not give confidence that the staff are able to safely support service users with their medication. The manager informed that they were due to change over to a new system and that CARETECH the registered provider had some training planned for August 2006. For most of the staff, this would be refresher training and should bring about the improvement required in safely managing medication in the home. At the time of the visit, neither of the service users was able to manage their medication independently. DS0000063248.V305032.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (22,23) Quality outcome in this area is good. This judgement has been made using available evidence including a visit to the service. A satisfactory complaints policy and procedure is available for the benefit of service users and their relatives. Sound procedures were also in place at the home to ensure the protection of service users coming into contact with the service. EVIDENCE: Both service users as part of their feedback gave a positive indication that they knew what to do if they were unhappy with the services at High Road. They also have good family involvement and from an interview held with one of the relatives, it was clear that she was aware as to how to complain. At the time of the inspection there were no recorded complaints. However, there was one compliment made regarding the progress of a service user. Three staff were interviewed in relation to the complaints procedure and supporting service users with specific physical and learning disability needs to complain. They demonstrated an understanding of the service users right to complain and their role in enabling this process. Satisfactory protocols were in place for protecting service users from the various types of abuse. This included a satisfactory adult protection procedure and a bullet point action plan developed by the manager for staff to follow, should staff suspect, witness or came across an allegation of abuse. A whistleblowing policy was also in place and all staff interviewed showed a good understanding of the actions they needed to take in dealing with matters of abuse. As part of their interview, each staff is asked a POVA related question and this according to the manager is strategic – in identifying awareness as well as training priorities. There were no adult protection issues in the home at the time of the visit. Some of the staff had POVA training from their previous DS0000063248.V305032.R01.S.doc Version 5.2 Page 21 employment however CARETECH plans to provide training for all staff in August 2006. DS0000063248.V305032.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (24,25,26,27,28,29,30) Quality outcome in this area is good. This judgement has been made using available evidence including a visit to the service. At High Road service users enjoy an environment that is spacious, generally safe, hygienic, decorated to a good standard and designed with the needs of service users in mind. Fixtures and furnishings are modern and service users benefit from being able to access all parts of the home. However, improvements are required in several areas to include bedrooms, parts of the dining room, moving soiled laundry through the home and the security arrangements in the main lounge. EVIDENCE: The premises offer each service user adequate bedroom and communal spaces that were in line with the national minimum standards and this included accessibility for service users including wheelchair users with a physical disability. It is on the High Road and as such is accessible to all local shops and amenities. The building was generally satisfactory and contains two bedrooms on the ground floor with five on the first floor with lift access. It was bright, airy, clean and free from offensive odours. There was evidence to confirm that the service generally complied with the local fire and environmental health requirements. DS0000063248.V305032.R01.S.doc Version 5.2 Page 23 At the time of the visit a planned maintenance and renewal programme for the fabric of the home was not in place and this could have been due to the service being recently taken over by CARETECH – the new registered provider. There is a maintenance person to look after repairs as they are reported. However, there were areas requiring repair in both the communal and private areas. One such area is the appearance of damp patches on the base of a column where the dining area meets the living room, as well as minor redecorative work to one of the walls on the opposite side of the column. There is a large lounge with two glass doors that are designated fire doors, but they both have key operated locks. In discussing with the staff team they were concerned that if they did not lock these doors, particularly at night, then it presents a risk to the service users and staff in the home. This needs to be addressed by the registered persons in the interest of safety for all concerned. All bedrooms were spacious and met with the regulatory requirements in relation to new built properties. They are all single rooms with en-suite facilities and are wheelchair accessible. Service users were observed using wheelchairs in these rooms quite comfortably. The furnishings in all bedrooms were of a very high standard and in viewing the two occupied rooms it was evident that they were extremely personalised. All bedrooms had adequate natural lighting and had the capacity for ensuring service user’s privacy. In one case a service user had the benefit of an automatic closing facility for her bedroom door and she was very pleased with this as it promoted her independence. Re-decorative works needed to carried out over the two ground floor bedrooms doors and in a similar vain over the kitchen door. Toilets and bathrooms were adequate in number as each service user had their own facility. There was one communal toilet and bathroom on the ground floor for service users and this is a short walk away from the dining area. Around the time of the inspection there were plans to convert one of the quiet communal areas to the front of the building into another specialist bathroom. The pros and cons of this development in terms of safety and privacy were discussed with the area manager with proposals to be submitted to the Commission. At the time of compiling this report nothing had been received, although work had started just before the 18/8/06. A drawing was shown to the inspector during a visit on the 18/8 and this brought some concern in relation to the means of access to this bathroom and more importantly arrangements for handling soiled linen. The latter would be covered under standard 30 of this report. The communal spaces for service users were adequately sized, as there is a large lounge area with an open plan diner as well as a separate lounge adjoining the dining area. In the main lounge area there were entertainment DS0000063248.V305032.R01.S.doc Version 5.2 Page 24 facilities i.e. TV and music centre as well as a computer workstation. This allows for activities arranged with service users and the furnishings were of a high standard. The kitchen is large and well fitted out to enable service users to access as part of their own skill development. However, the ventilation in the kitchen was mainly through a small window, which proved to be inadequate. The kitchen was uncomfortably hot and staff and one of the service users informed of the level of discomfort they feel while using it. The rear garden was also domestic in size and the laundry is located to the rear of the building. This is also wheelchair accessible. At present relatives if wanting to meet in private could do so either in service users private rooms or in the quiet lounge. The home was generally designed taking into consideration the specific needs of service users with physical disabilities. Ceilings in bedrooms were reinforced for equipment requiring overhead tracking, as were bathrooms. Call alarm systems were in place and lighting switches were accessible to service users. For one service user she had an automatic door and she was pleased with this. There were adequate facilities should wheelchairs require recharging and all bathrooms were generally fitted with aids to enable service users to safely use them. The passenger lift is designed to enable wheelchair users to safely manoeuvre in and out of it and this was observed on the day of the visit. The premises were clean and hygienic on the day of the visit. The laundry is to the rear of the building and is equipped to ensure that soiled and foul linen are cleaned in a safe manner. There were adequate facilities for staff to clean their hands and policies and procedures for infection control were in place. Staff interviewed had training in health and safety and were aware of infection control measures in relation to the home. The manager confirmed that the services and facilities complies with the Water Supply (Water Fittings) Regulations 1999. However, one area of concern in light of the installation of the new bathroom is the arrangements for taking soiled laundry from that bathroom to the laundry room. The current arrangements are that they are taken down a side entrance to the laundry via a door in the currently adapted bathroom. From the plan seen staff would no longer be able to use this route, as the door would be blocked off by the installation of the bath. The registered persons would have to demonstrate how they comply with standard 30.2 of the national minimum standards for younger adults in promoting the health and safety of service users. DS0000063248.V305032.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (31,32,34,35,36) Quality outcome in this area is good. This judgement has been made using available evidence including a visit to the service. Service users benefit from a staff team that is committed, well supported and clear about their roles and responsibilities. Satisfactory recruitment practices now ensure that service users are in safe hands. Staff have some degree of competence and knowledge about what they do. However, further training is required to ensure that the service users receive the best possible care at High Road. Sound supervisory arrangements are in place to support staff in carrying out their duties. EVIDENCE: All staff interviewed, including the deputy manager demonstrated a sound understanding of the philosophy of the service at High Road. They had a copy of their job description and the General Social Care Council’s code of conduct, and embraced their responsibilities in a confident manner. Most had been recently recruited and had a period of induction that was in line with guidance. From interviews held with them, it was clear that they supported the philosophy of the home and had accessed the policies and procedures of the service. This was useful as on both visits the quality of staff interactions with the service users was extremely effective. On the first visit the staffing structure included the manager and support workers, while by the second visit a deputy manager was recruited and had started. The manager was also in the process of recruiting senior support workers during the course of the second visit. From discussions held with her, DS0000063248.V305032.R01.S.doc Version 5.2 Page 26 the calibre and quality of candidates was quite good and this is potentially, a positive outcome for service users. From assessing the experience and qualifications of the staff, all had previous care experience, most in learning disabilities. From the current group, over sixty per percent had acquired their NVQ level 2 in Care and were comfortable with the service users. They also showed an understanding of their specialist needs and were observed communicating effectively with them, although not in a universal way e.g. using Makaton. This would be an area for the registered providers to look at. Staff were quite motivated and keen in working with the service user group and this is positive. The recruitment files of three staff were assessed and found to be in order. This included CRB checks, two written references, fully completed application forms, health declarations, requests for further information (where applicable), evidence of induction and supervision. The recruitment process was in line with the GSCC code of conduct and all staff interviewed had a statement of their terms and conditions. The inspector was also able to see the interview notes and responses so that a thorough audit of the recruitment process could be undertaken. The process was robust and thorough and this was an improvement since the last inspection. At the time of the visits, a staff training and development plan was not in place, although staff did have some training, and evidence of further planned training was produced. The manager informed that CARETECH has a Training Portfolio pro-forma for staff, but it was evident that a training audit for staff had not been completed. The manager had good records of the staff training to date. However, a needs analysis needs to be undertaken to prioritise training for the staff so that they could provide a more effective service. All staff had started their induction with emphasis on the statutory mandatory training. Examples of training that needed prioritising, includes LDAF, qualified first aid training and managing challenging behaviour. There were satisfactory arrangements in place for the manager to brief staff. The forums included informal approaches, team meetings, handovers and formal supervision, which has started in earnest. With regard to supervision both the deputy and the manager has had supervisory training and this is important in effectively supporting staff. Staff interviewed described their supervision as useful, but also indicated that they could approach the manager at any time. Appraisals had not been carried out as most of the staff were relatively new. However, the manager was aware of the importance of carrying them out. Service users, therefore, benefit from a well-supported staff team. DS0000063248.V305032.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (37,38,39,40,41, 42) Quality outcome in this area is adequate. This judgement has been made using available evidence including a visit to the service. A dedicated manager leads the service in the interests of the service users. As a result service users benefit from receiving individualised care in an open and transparent manner. The overall quality of the service would be enhanced once arrangements are put in place for the manager to complete her NVQ level 4 training. Improvements could also be made in areas such as quality assurance service, staff involvement in policies and procedures and health and safety in improving the service as a whole. EVIDENCE: The registered manager has acquired her NVQ level 3 in Care and has started her NVQ level 4 in management and Care, which is required by this standard. In discussion with her she indicated that she required an assessor in order to complete this course. The registered provider needs to address this to enable the development of the manager and the service. That aside, the manager has a wide range of related training and experience, e.g. working as a deputy manager previously, which she uses for the benefit of service users and staff. She also undertaken all her mandatory training, had training in ‘understanding DS0000063248.V305032.R01.S.doc Version 5.2 Page 28 brain injury’, conflict management and is a mentor for LDAF trainees. One good example of her work includes the pre-assessment format and transitional plans that are currently used by the home. They are incredibly detailed, userfriendly and designed with the service user in mind. In addition to this, feedback received from service users, staff, relatives and a health and a social care professional, all indicated that the home is run with service users in mind. The comment returned by a professional referred to the care as excellent. The manager was observed working directly with service users along with her managerial duties and it was clear that positive and professional relationships were maintained. Feedback from service user surveys, informed that they were always listened to and staff shared their experience as, one in which they could express their views and make contributions to the service. This is positive. The manager also exhibited clearly her commitment to equal opportunities in providing the service to a diverse group of service users. As part of maintaining quality in the home, the manager has internal systems in place such as monitoring for shift co-ordinators, medication and guidelines for key-workers. She also ensures that policies and procedures are updated, accessible to all staff and that they read them. This gives her a basis to monitor their implementation. Importantly, the quality assurance policy is very detailed and covers objectives such as handling service user finances, staff training and skills, medication, health and safety and user participation – all of which is just a sample of the areas covered. She also developed an action plan for the home dated 2006 and focuses primarily on service users. At the time of the visit the focus was on service user plans. It was acknowledged that service user surveys could not be carried out as both service users were recently admitted. The manager, however, as part of her ongoing monitoring, checks with service users and their relatives as to their satisfaction with the service. Given the recent takeover of the service, it is important that external monitoring of the service is regular. Prior to acquisition of the service, monthly provider visits were infrequent and since the 18th May 2006, (CARETECH’s Acquisition of the service) there has only been one report that has been made available to the Commission. This needs to improve. There also needs to be an internal audit of the service and the production of an annual development plan for the service. During the course of the inspection, policies and procedures were examined and for the most, were compliant with legislation. They were accessible to staff and service users although not in a format that service users could easily relate to. One of the observations was that CARETECH’s policies were being introduced into the home alongside the existing policies used by Sunnyside (previous provider). There was no evidence at the time as to how either the manager of the home are involved in policy development. From interviews held with the manager and staff – it was very much a case that the policies sent are DS0000063248.V305032.R01.S.doc Version 5.2 Page 29 to be used now. This should be reviewed to enable staff to embrace and take ownership of the policy changes/development as specified in national minimum standard 40.5 for Younger Adults. Staff involvement in this area could enhance the way in which they work with service users. In examining the records held on service users, they were updated, held secure in a locked facility and under the supervision of staff. The management of records was in line with Data Protection and associated statutory requirements. Evidence was also available to support the fact that service users had some input into their service user plans and hence access to their files. Information held on service users was accurate. There was evidence that the management and staff were aware of their responsibilities under health and safety. Staff as part of their induction are taken through safe working practices in the home and during interviews indicated that they had access to the health and safety guidance in the home. Records indicated that the home had a health and safety visit on the 10/5/06 during which four requirements were set. At the time of the inspection they were satisfied, making the home a safer place for service users. Adequate arrangements were in place in the event of a fire although fire drills needed to be carried out. Fire equipment was strategically located throughout the home and in line with regulatory requirements. Satisfactory arrangements were also in place to ensure maintenance of the lift, electrical appliances and electrics, and gas, portable appliance testing (most of which were new) and wheelchairs. An area that needed attention was the completion of risk assessments for safe working practices in the home. The manager had in place risk assessments for: individual moving and handling, fire, food hygiene and had started the risk assessment for infection control. It remains for her to complete food hygiene and infection control risk assessments. There was also the need to complete the COSHH risk assessments for those substances used by the home. During the course of the visit it became apparent that the emergency stopcock for the upstairs water supply was located beneath paving blocks in the front driveway and is approximately three feet underground. Given the type of service i.e. learning and physical disabilities – were there to be a water emergency on the first floor then service users could be put at risk. The registered persons would be required to demonstrate that the current arrangements are satisfactory, in line with relevant legislation and minimises risks to service users. They may wish to consider having, for example, an internal cut off point for the water supply on that floor. At the time of the visit one service user showed the inspector to his bedroom and he was mobilising in a wheelchair. Though he managed to open his door it took some doing. The registered providers may wish to consider at some point DS0000063248.V305032.R01.S.doc Version 5.2 Page 30 in the future installing automatic door closing systems in bedrooms for service users. One service user already has this facility and prides herself on maintaining her independence in accessing her bedroom. DS0000063248.V305032.R01.S.doc Version 5.2 Page 31 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 2 2 4 3 4 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 2 27 3 28 2 29 3 30 2 STAFFING Standard No Score 31 3 32 3 33 X 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 2 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 2 x 2 3 2 2 3 2 x DS0000063248.V305032.R01.S.doc Version 5.2 Page 32 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 4,5 Requirement The registered persons are required to review the statement of purpose and service user guide in line with regulation and preferably in a format that is suitable for the service user group. The registered manager is required to ensure that medication is recorded promptly on the relevant charts at all times. The registered persons are required to carry out repair works to the damp patches in main lounge as specified in standard 24 of this report and to: review the security arrangements with respect to the unlocked fire doors in the main lounge. The registered persons are required to carry out redecorative works over the two ground floor bedroom and kitchen doors respectively. The registered persons are required to provide a suitable system of ventilation in the kitchen e.g. air DS0000063248.V305032.R01.S.doc Timescale for action 07/10/06 2 YA20 13(2) 30/09/06 3 YA24 23(2)(b) 30/09/06 4 YA26 23(2)(b) 30/09/06 5 YA28 23(2)(p) 31/10/06 Version 5.2 Page 33 6 YA30 7 YA35 8 YA37 9 10 YA39 YA39 11 YA42 cooling/circulation mechanism to promote a more comfortable environment for service users and staff. 13 The registered persons are required to demonstrate that suitable arrangements are in place to take laundry (including soiled items) to the laundry room. (See Standard 30) 18(1)(c)(i) The registered persons are required to: 1) Carry out a training needs analysis for staff, 2) Have in place a training and development plan for staff and 3) Ensure that training specific to the needs of service users e.g. LDAF, challenging behaviour, ‘qualified first aid’ is provided. (Also See standard 35 of this report). 10 (3) The registered persons are required to make provisions to enable the registered manager to complete the NVQ Level 4 in management and Care 24 The registered persons are (1)(a)(b) required to carry out an internal audit of the service. 26 The registered persons are required to carry out monthly provider visits regularly with reports made available to the Commission. 13 The registered persons are required to ensure the health and safety of service users and staff by: 1) Conducting risk assessments on food hygiene, infection control and COSHH substances 2) Carry out regular fire drills and 3) demonstrate that the arrangements for cutting off the water supply to the first floor in an emergency, are safe and minimises risks to service users. (See Standard 42 of this report). DS0000063248.V305032.R01.S.doc 30/09/06 15/11/06 15/11/06 30/11/06 30/09/06 30/10/06 Version 5.2 Page 34 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 2 3 4 Refer to Standard YA8 YA39 YA40 YA42 Good Practice Recommendations The registered persons should devise strategies to enable service user involvement in the home. The registered persons should have an annual development plan in place for the service. The registered persons should devise strategies for involving staff in the development of policies fro the service as a whole. The registered persons should consider providing automatic door entry systems for the bedrooms of service users. DS0000063248.V305032.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000063248.V305032.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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