Inspection on 15/09/08 for Hindmans Road, 10

This inspection was carried out on 15th September 2008.

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

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

Other inspections for this house

Hindmans Road, 10 24/09/07

Hindmans Road, 10 15/03/07

Hindmans Road, 10 16/02/06

Hindmans Road, 10 01/09/05

Hindmans Road, 10 17/03/05

Hindmans Road, 10 18/08/04

Hindmans Road, 10 30/03/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2009.

CARE HOME ADULTS 18-65 Hindmans Road, 10 London SE22 9NF Lead Inspector Sean Healy Key Unannounced Inspection 15th September 2008 10:00 Hindmans Road, 10 DS0000007094.V363935.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 Hindmans Road, 10 DS0000007094.V363935.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. Hindmans Road, 10 DS0000007094.V363935.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hindmans Road, 10 Address London SE22 9NF 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) 0208 693 8950 0208 297 1207 PLUS (Providence & Linc United Services) Care Home 3 Category(ies) of Learning disability (0) registration, with number of places Hindmans Road, 10 DS0000007094.V363935.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 category; 2. Learning Disability - Code LD The maximum number of service users who can be accommodated is: 3 24th September 2007 Date of last inspection Brief Description of the Service: 10 Hindmans Road is a Care Home providing accommodation and personal care to three people with a learning disability, currently all men. Hexagon Housing Association, a voluntary organisation who leases the building to CHOICE SUPPORT, owns the building. The service is provided by PLUS, (Providence and Linc United Services) a voluntary organisation. The home is located in East Dulwich, close to shops, Peckham Rye Park, pubs, the post office and other amenities. The home consists of a two-storey building, one bedroom downstairs with en-suite facilities, and accessible to wheelchair users. All the home’s bedrooms are single. The home has a garden to the rear. Information about the service provided is made available to current and potential service users in the homes Statement of Purpose and Service Users Guide. The recent CSCI report is currently kept at the home. At 15th September 2008, the homes fees are set at £35.80- per week for a portion of the cost of accommodation and support. The majority of the cost of support and staffing are met by the referring social services authority, however these costs are not made explicit by the home in either resident’s contracts or statements of terms and conditions. There is an additional charge made for Hindmans Road, 10 DS0000007094.V363935.R01.S.doc Version 5.2 Page 5 food of £29.40 weekly, payable by each service user. Transport is not provided by the home and any costs are payable by each service user. Residents have to pay for other personal expenses such as hairdressing and personal shopping. The provider’s email address is: None available Hindmans Road, 10 DS0000007094.V363935.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality Rating for this service is 1 Star. This means that the people who use this service experience Adequate quality outcomes. This unannounced inspection site visit took place on the 15/9/08. The inspection ended on the 22/9/08 following benefits and risk assessment information, and following discussion with the multidisciplinary team about their involvement. The team manager, who has now applied to CSCI to become the Registered Care Manager, facilitated the inspection. Two residents were present for part of the inspection but were unable to give their views about how they felt living at the home. Observations were made of staff working with two residents. The inspection included discussion with the homes manager, and three of the support staff. The building was also inspected for health and safety, suitability for residents and cleanliness. Resident’s records and other documentation about how the home is run were examined. Two care assessments and care plans were examined to ensure that care needs were being planned for, and the manager and staff were questioned about these plans, to check that these plans were understood and being put into action. Three staff files were examined for recruitment and training information. Social services care management were spoken to about the care of one resident, seeking views about staffing levels and risk. Citizen’s advocacy views were also taken into account. What the service does well: There is a good and welcoming atmosphere in the home and good interaction between staff and residents. The staff help the residents in activities, and provide support for in house and community activities. Staff know residents well and communicate well with them always speaking in a friendly and respectful manner. The home is well decorated and maintained and resident’s rooms are well maintained and reflect their own choices and preference. Hindmans Road, 10 DS0000007094.V363935.R01.S.doc Version 5.2 Page 7 The manager provides a sensitive and encouraging approach to managing the home, and tries hard to ensure that residents and staff are safe and secure in the home. What has improved since the last inspection? What they could do better: The home must make sure that the care assessment and risk assessments for one service user about the risks of going out in the community are reviewed to show how this resident can be safely supported. The home must speak with the people who give them money for providing support for residents about how better information about the cost of their service can be given to individual residents. Person Centred Plans for residents should be completed so that they can get to do things they say they want to. The home needs to have the kitchen repaired and updated so that residents all residents can easily use it for learning to prepare food. One of the bathrooms must have repairs to tiles and flooring done as soon as possible. The home and organisation must always take up a CRB (police check) for new staff before they start work at the home. Hindmans Road, 10 DS0000007094.V363935.R01.S.doc Version 5.2 Page 8 The home must develop a better way of carrying out yearly checks on what needs to be done to improve the home and the way they are supported. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hindmans Road, 10 DS0000007094.V363935.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 Hindmans Road, 10 DS0000007094.V363935.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 5 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Prospective residents don’t have all the information to make a choice about where they live. The residents care needs assessments are not fully up to date regarding areas of potential risk. Residents are provided with contracts/statements of terms and conditions but more information about cost of services provided is needed. EVIDENCE: The home provides the information for current and prospective residents, in a Statement of Purpose, which shows services provided, and a range of information about staff experiencing training, the provider organisation, and how residents can complain should they need to. All of the residents have been in the home for many years and have the original complete care needs assessments on file. All care and support needs are clearly recorded in detail covering all areas of health, and social care needs, and these were reviewed in October 2007 with the involvement of social services and citizen’s advocacy. However important areas regarding the risk attached to a resident in going out in the community have not been updated to reflect the current practice of going out one-to-one with this resident. The care assessment for this resident must be updated regarding this Hindmans Road, 10 DS0000007094.V363935.R01.S.doc Version 5.2 Page 11 issue with the involvement of a social worker and specialist challenging needs advice. (Refer to Requirement YA2) There was a requirement made at the last inspection for the registered provider and manager to ensure that all residents are in possession of a statement of terms and conditions to include correct fees to be paid in relation to care and support. This has not yet been done. The home is one of a number of homes managed by the provider, that is part of a block contract with Southwark local authority, who are the commissioners for all of the resident’s services in this home. The commissioners have not broken down the cost of care and support for each individual resident, and therefore the provider at the moment cannot determine the cost of each individual residents cost of care. The residents nonetheless are entitled to know who is funding their care and how much it costs for their support, food and any other charges. Because this information is not readily available to the provider, and the provider is not making any charges to the residents directly, in the interests of allowing the residents to have the benefit of management focus on their care and support at this time, the requirement is now temporarily removed from this report. A new requirement is now made asking the registered provider and responsible individual to formally raise this issue with the service commissioners as deficiency. The registered provider must show evidence that this has been raised with the Southwark commissioners. (Refer to Requirement YA5) Hindmans Road, 10 DS0000007094.V363935.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Assessed and changing needs are reflected in all residents care plans and they are supported by staff to make decisions about their lives. Risk assessments are in place to protect residents but need to be updated to better protect residents and staff. EVIDENCE: There was a requirement made at the last inspection for the home to keep residents individual care plans up-to-date, and to ensure that they reflect current care review information. This requirement is now met. All of the three care plans inspected showed that they had been reviewed in January 2008 and that all of the residents have had a Person Centred care planning review in July 2008. The Person Centred planning review included include objectives about eating and drinking, repair of wheelchair, attending musical shows and booking a holiday. These are positive goals and were being actioned. However the Person Centred Planning document is still largely blank and the manager said it is an area for further development. It is recommended that the home progress completion of these documents so that a fuller picture of each residents Hindmans Road, 10 DS0000007094.V363935.R01.S.doc Version 5.2 Page 13 historical profile and areas for person centred development are written in a way that best suits each residents understanding. (Refer to Recommendations YA6) The care planning review, which took place in January 2008, was largely a result of review meetings, which took place in October 2007. This is a long time and it is recommended that care plans be reviewed as soon as possible following review meetings where changes are necessary. (Refer to Recommendations YA6) There is a range of information about health and social care needs, including: moving and handling, dressing/undressing, tidying bedrooms, using a hoist, eating, non verbal communications, health care, activities in the community such as visits to parks/shops and weekly outings to a sensory impairment workshop. Currently the home provides a service for two residents with profound Learning Disabilities and complex communication support needs. There is a vacancy at the home for the past seventeen months. There has been involvement from health care professionals such as; speech and language, challenging behaviour, and physiotherapy to help service users in care planning. The staff were seen to work sensitively with residents and regularly use objects of reference and other tools to enable choices to be made. Residents attend a sensory impairment workshop regularly where stimulatory equipment is used. Parts of the care plans about moving and handling and eating include the use of pictures so that residents and staff can more easily understand them, and there is information about when to use objects of reference such as clothing items connected with the task. This is a very positive improvement in care planning for residents in this home, and staff in the home say that they find it helpful and beneficial for residents. Others who visit the home have been involved in speaking out for residents say that this has been a very positive improvement also. One resident in the home has high physical support needs, particularly in relation to moving about the home. Care plans show a good level of involvement from health care professionals such as physiotherapy and occupational therapy. There is consistent involvement from the GP for all residents, and dental and foot care support is also provided. There are detailed plans showing staff how to support residents in personal care, and care plans include a broad range of activities for residents both in and out of the home. All for residents need full support with benefits and financial management. Each resident has their own bank account and the benefits are paid directly into these accounts. The homes manager is joint signatory the bank accounts and transactions can only be made by a written agreement from one of their staff to and from the provider organisations chief executive officer. The home has enabled all for service users to access active advocacy support. There was Hindmans Road, 10 DS0000007094.V363935.R01.S.doc Version 5.2 Page 14 a requirement made at the last inspection for the home to seek a formal agreement in writing with residents, and their representatives, to allow the home to manage their personal finances. This is now met and the home has made a formal request to social services for this to be agreed. Generally there are adequate risk assessments available in the home regarding resident’s health and personal care, and regarding fire and health and safety. There was a requirement made at the last inspection for the home to ensure that the risk associated with taking one resident outside of the home be reviewed involving social services and relevant clinical professionals. This requirement was met and the home had involved a social worker, and the multidisciplinary teams challenging needs team, in reviewing the risk of taking one resident out with one-to-one support. While this process resulted in a report six months previously from the challenging needs team, which showed the risk of going out one-to-one to be at an acceptable level, the management had not brought this process to a final conclusion, and no new risk assessments had been written. In the meantime almost all of the staff had been going out weekly one-to-one with the resident concerned. The home must use the information available to finalise the position regarding risk in supporting this resident in the community in liaison with social services and the challenging needs team and ensure that up to date risk assessments about travel in the community are written and understood by the care staff. (Refer to Requirement YA9) Hindmans Road, 10 DS0000007094.V363935.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents are supported to take part in activities, and to be part of the local community. Personal and family relationships are maintained and encouraged, and resident’s rights to choose when to be alone are now respected. Good food, of the resident’s choosing, is offered on a daily basis. EVIDENCE: Examination of residents care activities plans, and records of the activities have taken part in, together with discussion with staff and with the advocacy involved in the home, show that there has been improvement in the level and consistency of activities provided for both residents. Daily records showed that staff do work well and creatively to involve residents in the daily running of the home, in order to foster their abilities as much as possible. Activities plans and records for residents show the following activities being provided in weekly basis: bowling, sailing, attending church services, weekly attendance at an aromatherapy workshop and an Irish club for both residents. Hindmans Road, 10 DS0000007094.V363935.R01.S.doc Version 5.2 Page 16 All residents have some involvement from their families although to a limited degree. One resident has visits every two months, from his niece and nephew. All residents have friends they go to visit, and get involved in going to barbecues, birthday parties, and other outings. Discussion with staff, and with the advocate for a number of residents suggest that there has been an improvement too in activities within the local community, such as going to local shops and pubs and cafes. In previous inspections staff had expressed some difficulty in doing this, but now staff feel the manager of the home has provided support and encouragement to the enable these activities to happen. The reason for these difficulties were due to risk associated in supporting one resident in the community, and much work has now been done to alleviate concerns in this area. The homes records of food consumed by residents, and discussion that residents and staff, showed that there is good food and a healthy diet being offered to residents on a daily basis, which include offering them choices of preferred food. Hindmans Road, 10 DS0000007094.V363935.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Respectful and sensitive support is provided for Residents regarding personal care, health and emotional needs. Residents are supported to retain administration of their medication and medication is well managed. EVIDENCE: All residents have a personal care plan in place, which shows in details how to support them in getting up in the morning, toileting in bathing, and a range of other personal care needs. These were reviewed in January and June 2008. One of the residents, who has an important support needs regarding eating and drinking, has a good speech and language assessment in place, with written guidance through staff in how to provide support. Two residents are weighed weekly as part of their care support, and staff and the manager showed awareness of the importance of consistently doing this. There is involvement from a dietician for one resident, with written and picture guidance for staff in how to provide support, and the staff again showed a good knowledge of the requirements of the dietician. Hindmans Road, 10 DS0000007094.V363935.R01.S.doc Version 5.2 Page 18 All Residents’ files examined showed health care needs are well managed with good input from a range of health care professionals. Residents are registered with a GP and regularly attend a dentist and chiropodist. A dietician is also involved in providing advice in the management of diet and weight. Mobility support is a significant issue in the home. There is good information in the relevant residents care plan in how to provide this, and staff were knowledgeable about this information. Staff have had training in using the hoist equipment and wheelchair and confirmed that they have had annual moving and handling training. There is support provided by psychology and psychiatry in the area of communications and motivation, and in the management of challenging behaviour. Healthcare and medication is being reviewed by the home every six months. At the last inspection the residents reviews and care plans do refer to a range of health care needs, and there was no overarching health action plan in place for residents encompassing the full range of healthcare needs. There was a requirement made for the home to address this issue, and this requirement is now met. There are now references in residents care plans showing how often residents will need to visit healthcare professionals, and good records are now being kept of contact residents have with healthcare professionals. There are health action plans for both residents in the final stages of development and there is now more specialist support in place in the management of epilepsy as required at the last inspection. The home has a medication policy, which was last reviewed in June 2006. The Southwark NHS PCT provides a visiting pharmacist who last inspected in November 2007. A report is on file showing good management of medication, and storage is good. There was a recommendation in this report asking that the home update the residents homely remedies list. This has not yet been done and it is recommended that the home address this. (Refer to Recommendations YA20) Hindmans Road, 10 DS0000007094.V363935.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home listens to residents and takes their concerns seriously, and residents are protected by the homes Adult Protection policy. EVIDENCE: The home has an up-to-date complaints policy. Neither the home nor the commission has received any complaints since the last inspection. There is a copy of this policy on each residents file and also a reference is included in the Statement of Purpose for the home. Staff interviewed were able to appropriately state what they would do if they received a complaint. The home has an organisational policy for protection of vulnerable adults. The manager and staff have had training in safeguarding adults. Two staff interviewed showed a good understanding of this policy. There have been no allegations or referrals made under the adult protection policy since the last inspection. Hindmans Road, 10 DS0000007094.V363935.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,27 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home is homely, comfortable and safe and is kept clean. Some areas in the kitchen and bathrooms need repair and updating to bring them up to a good standard. Toilet and bathrooms are designed to meet resident’s needs and specialist equipment is provided. EVIDENCE: The home is comfortable and homely and all areas are safe. All residents have their own bedrooms, and one has adapted en-suite facilities. They are well furnished and resident’s bedrooms are personalised. There is one bedroom on the ground floor and two on the first floor, and there is a separate living room/dining room and kitchen. There is a rear garden, which is well maintained and paved for easy wheelchair access. Improvements since last inspection: 1. A new sofa and curtains for the lounge have been bought Hindmans Road, 10 DS0000007094.V363935.R01.S.doc Version 5.2 Page 21 2. The lounge and staff sleep-in room have been redecorated and had carpet replaced 3. New lighting has been installed in the hallway and living room Areas for improvement: 1. The kitchen work surfaces have been adapted for wheelchair accessibility but are currently not used and need fixing or replacing if they are to be used by wheelchair users. 2. The storage area for saucepans and kitchen utensils is open and needs to be closed off or replaced with a new cabinet. Overall the kitchen is in need of modernisation. 3. One upstairs bathroom/shower room has loose wall-tiles and a cabinet under the sink, which needs replacing. Flooring also needs to be replaced. Currently this bathroom is unusable, but residents on this floor have another shower room available for their use The manager said that she is planning to have the work to bathrooms carried out and would discuss the kitchen issues with the housing officer, hopes that these could be also addressed. The home must include all of these areas in the homes development plan. (Refer to Requirement YA 24) The home is kept very clean, and is free from any clutter in the hallways and rooms. Hindmans Road, 10 DS0000007094.V363935.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34 and 35 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Staff are competent and experienced and qualified to provide the service. There is now better evidence about staff recruitment and employment but further improvements are needed to demonstrate it is well managed. Staff now receive appropriate training and are well supervised. EVIDENCE: At the last inspection there was a requirement made for the registered provider to ensure that at least three care staff are qualified to NVQ level 2/3 by 30/9/08. This requirement is now met. Currently there are four permanent care staff with 2.5 staff vacancies. Two of these are now NVQ2 qualified and a third is on the NVQ2 course. The current staff team consists of a manager and six and a half care staff. There are always at least two care staff on duty during the daytime with additional support provided by the manager at busy times. Two of these posts are currently vacant. The staff say that they feel they are able to do their job and get good support from the manager, although they feel that it is very busy. They said the manager is available to provide extra support a number of days a week and also does shift work with the residents about three days a Hindmans Road, 10 DS0000007094.V363935.R01.S.doc Version 5.2 Page 23 week. Advocacy also commented that staffing levels should at least be maintained at the current levels in consideration of the high care support needs of the residents, and that recruitment to one of the vacant staff posts would be beneficial to residents care. This inspection supports this view. Given the comments from staff and advocacy and the level of activities it recommended that one of the staff vacancies be recruited to. (Refer to Recommendation YA33) There is a six-month induction and probation period in effect for new staff at the home. Good records are being kept of this induction, and staff are being consistently schedule to training relevant to the needs of the home. This includes health and safety, fire safety, moving and handling, first aid, understanding challenging behaviour, medication, complaints and adult protection. There was a requirement at the last three inspections for the staffing levels at the home to be reviewed. This requirement has now been met. At previous inspections there were occasions noted where the assessed staffing levels of two to one required for supporting one resident when out in the community were not being met, without any formal agreement with social services or the commissioning agent. The home has now involved the challenging needs team in liaison with social services to review the need for two to one support, and this has resulted in a pulling together of information which shows that it is relatively safe for staff to support this resident one-to-one in the majority of community activities. Three staff stated that they each go out one to one now to selected outings and activities, one to one, on a weekly basis without any incident, but stated that there are more crowded or busy places that they would not go. However the home has not yet formally finalised the review of risk assessments and guidance for staff to reflect these changes. The information gathered also shows that there is a need to look more closely at in house activities for this resident as much of the challenging behaviour occurs at home. The home needs to update risk assessments and care plans so that areas/times where additional staff support are needed are identified. (Refer to Requirements under Standard 9 of this report) There was a requirement made at the last two inspections for the registered provider to ensure that recruitment and employment information for staff is kept at the home for inspection. This requirement has been met, but there are a number of areas, which still need further improvement. Examination of five staff employment records showed that there is now a pro-forma system for keeping a copy of the recruitment information on staff. This showed that all staff had been recruited under an equal opportunities process and that all had appropriate references taken up, and had a CRB in place at commencement of employment. There is a significant improvement in the employment information available at the home. However one staff who started work for the organisation in November 2007 was allowed to start without the provider carrying out their own CRB check. The employee provided a CRB, which had Hindmans Road, 10 DS0000007094.V363935.R01.S.doc Version 5.2 Page 24 been done in August 2008, and the employer did not receive another completed CRB until January 2008. The registered provider must ensure that all new care staff have a current CRB carried out prior to commencement of employment. (Refer to Requirement YA34) The recruitment information held at the home stated that two references were taken up but did not state the names of the referees or their relationship to the employee. Neither was there details provided about the qualifications of staff or whether each required a work permit. The provider must ensure that these details are updated in the staff employment records held at the home. (Refer to Requirement YA34) Examination of three staff files and discussion with the manager and three care staff show that staff are now receiving supervision almost every month and annual appraisal for staff is now happening. These also showed that staff training has improved and that all staff now have a training plan and a training record showing a range of training appropriate to residents care needs is happening. This now includes training in autism and in non-verbal communications. There was a requirement made at the last inspection regarding this issue and this is now met. Discussion with staff and the manager and examination of two residents care plans also highlighted that skills teaching training for staff would be beneficial to engaging residents in domestic activities in the home. (Refer to Recommendations YA35) Hindmans Road, 10 DS0000007094.V363935.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents do now benefit from a well run home. The home quality assurance systems are not yet fully operational and don’t yet include residents views in development planning. Health and safety is generally well managed but residents aren’t yet fully protected by the homes risk assessment processes for supporting residents. EVIDENCE: Since the last inspection a new manager has been appointed and has applied to register with CSCI. She is NVQ4 qualified in management and has relevant experience in the management of learning disability services. She has almost completed the NVQ4 care component. Discussion with the manager and showed a need and desire on her part to do further more in depth training in risk assessment and writing guidance for staff in the management of risk and Hindmans Road, 10 DS0000007094.V363935.R01.S.doc Version 5.2 Page 26 in the management of challenging behaviour. Given the nature of support for one resident and the need to improve relevant risk assessments as discussed under Standard 9, this is highly recommended. (Refer to Recommendation YA37) The staff at the home say that they feel her management support and supervision is very beneficial and that they are now more confident to do their jobs. The care plans for residents, staff recruitment records and staff supervision and training has significantly improved since the current manager took up her post. Monthly visits to the home by the registered provider have also now become consistent. The home is part of a larger registered charity that also provides support for residents and other homes. At organizational level there is a six monthly conference for residents, with a separate consultation group where residents representatives visit homes to ask for residents views on how the organisation is run. There are monthly monitoring visits carried out by senior manager looking at management in care within the home, and the manager has identified a range of early is in the CSCI annual quality return (AQAA) which could be entered on a development plan for the home. However given the level all of need regarding communications and learning disability, this group of residents cannot easily participate in the organizational consultation process, and the home itself does not have an individual means of carrying out annual surveys, or quality audits. Following a requirement made at the last inspection there is now independent advocacy support available to residents, and the home has begun the process of involving them in the consultation process for improving the quality of care. However the home does not yet have an annual quality assurance audit or development plan in place, and it is now a requirement that action is taken to put these systems in place to meaningfully include residents in the homes development planning. (Refer to Requirement YA39) Health and Safety in the home is well managed. The home has an adequate health and safety policy, which includes risk assessment, fire safety, food hygiene, moving and handling, and all of these are included in the staff induction and training programme. Fire equipment checks are being done on a weekly basis and the home has certificates for electrical and gas appliances which are up to date. Appropriate hoists and wheelchairs are in use and are maintained. Risk assessments for residents need improvement. (Refer to Requirement under Standard 9 of this report) Hindmans Road, 10 DS0000007094.V363935.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 2 3 3 4 X 5 2 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 X 26 X 27 2 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 2 X Hindmans Road, 10 DS0000007094.V363935.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA2 Regulation 12.1 a Requirement The registered provider and manager must ensure that the care assessment for the resident discussed in this report under Standard 2, is updated regarding the number of staff needed for support when travelling in the community. This is to ensure that the homes current practices are in line with assessed needs. The registered provider and responsible individual must formally raise the issue regarding the deficiency in provision of information to residents about charges for support with the local authority commissioners. Evidence must be provided showing that this has been raised, showing any responses or decisions reached. This is to ensure that resident’s rights to access information about the cost of their care are protected. The Registered Provider and manager must ensure that one residents risk assessments regarding support in the community are revised and DS0000007094.V363935.R01.S.doc Timescale for action 31/03/09 2. YA5 5.1 31/03/09 3. YA9 12.1 & 13.4b 31/01/09 Hindmans Road, 10 Version 5.2 Page 29 supported by written guidance for staff, as discussed in this report, Standard 9. This is to better protect staff and this resident. 4. YA24 23 The registered provider and 31/03/09 manager must ensure that the repairs to the kitchen and one bathroom as discussed in this report under Standard 24 are included in the homes refurbishment/development plans. This is to ensure that residents live in a comfortable and well-maintained home. The Registered Provider must 31/03/09 ensure that employment information about all of the staff that work at the home is kept up to date regarding references, staff qualifications and work permits as discussed in this report Standard 34. This is to ensure that residents are better protected by the homes recruitment practices The Registered Provider must 31/03/09 ensure that a current up to date enhanced CRB check is taken up for in respect of each new employee before commencement of employment The registered provider and 30/06/09 manager must ensure that the home has in place an effective annual quality assurance audit system, and a development plan, which includes the expressed views of residents, and which is written in a format best understood by them. This is so that their views are fully included in the homes development plans. 5. YA34 19 Schedule2 6. YA34 19 7. YA39 24 Hindmans Road, 10 DS0000007094.V363935.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard YA6 YA6 YA20 YA33 YA35 Good Practice Recommendations The registered provider and manager should complete both residents Person Centred Planning documents The registered provider and manager should review residents care plans as soon as possible following formal care reviews as discussed in this report The registered provider and manager should review both residents homely remedies lists as recommended by the visiting pharmacists report The registered provider and manager should recruit to one of the staff vacancy posts to improve the quality and consistency of care provided The registered provider and manager should include Skills Teaching in the homes training schedule so that the residents can work towards developing day to day living skills within their home The homes manager should undergo further training in risk assessment, writing guidance for staff, and in the management of challenging behaviour 6 YA37 Hindmans Road, 10 DS0000007094.V363935.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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