Inspection on 12/04/07 for Hulse Avenue

This inspection was carried out on 12th April 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Hulse Avenue 05/01/06

Hulse Avenue 05/07/05

Hulse Avenue 04/05/04

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 09/07/2008.

CARE HOME ADULTS 18-65 Hulse Avenue 1a Hulse Avenue Collier Row Romford Essex RM7 8NT Lead Inspector Mr Roger Farrell Unannounced Inspection 12th April 2007 10:00 DS0000027856.V337538.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 DS0000027856.V337538.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. DS0000027856.V337538.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hulse Avenue Address 1a Hulse Avenue Collier Row Romford Essex RM7 8NT 01708 735944 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) Outlook Care Natasha Feeley Care Home 5 Category(ies) of Learning disability (5) registration, with number of places DS0000027856.V337538.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th January 2006 Brief Description of the Service: 1a Hulse Avenue provides accommodation and support for five people who have learning disabilities, some of whom also have a physical disability. Opened in 1992, it is run by Outlook Care Ltd, an organisation that specialise in providing housing and support services for vulnerable adults in North East London and Essex. It is a purpose built bungalow on a generous corner plot with a good-sized front parking forecourt. All residents have their own bedroom, some of which are equipped to help with physical disability. The layout of this excellent building is helpful for residents that use wheelchairs including wide corridors; special bath and shower facilities; and large communal rooms. The residents have their own vehicle, which has a tail-lift. There is also a large garden, with a patio and fishpond. The current weekly fee is £1099.17. DS0000027856.V337538.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit took place on Thursday 12 April 2007, with the inspector arriving at 12:15pm. He returned the following Monday for a couple of hours to complete checks on records. He left the manager a list of paperwork that needed to be sent, including contact details for relatives. These were received by the agreed deadline. There have been two headline events over the past year: One resident had said over a long time he wanted to move. He said he wished to be considered for a flat as he found this home too noisy. At times he expressed his frustration by hitting others. He successfully moved to another home last Christmas. The inspector has spoken to him at his new home and he says he is very happy with the accommodation and new housemate. His move on has eased the tension in this home, with the manager and staff saying the household is more relaxed, and some residents showing more ways of engaging with others, such as using more words; In June 2006 the registered manager, Sue Carillo was asked to take over the running of another, larger Outlook Care home. Natasha Feeley, the deputy, became the acting manager of Hulse Avenue. After six months it was decided that Sue Carrillo would remain at the other home, and Natasha Feeley was successful in gaining the manager’s post. Soon after this inspection she was confirmed as the registered manager for Hulse Avenue. This was the first time Natasha Feeley had dealt with an inspection by the Commission. She responded to the assessment in a helpful and efficient way. This included giving the inspector a detailed overview of the current medical and support needs of each service user; how they spend their time; and the contact they have with family and friends. Questionnaires were sent out to service users’ families. He is grateful to those who retuned comments, and who spoke to the inspector on the phone. The inspector also looked at the comments of relatives and visitors in the compliments file and the home’s quite recent questionnaire returns. This range of views have helped the inspector arrive at the positive conclusions set out in this report. What the service does well: The main conclusion is that this continues to be a very good service, and provides excellent facilities. The new manager has successfully stepped up from being the deputy, benefiting from the guidance of the last manager, Sue Carillo, and the line manager who had many years experience as a home manager. Natasha Feeley says that the team have been very helpful in supporting her with the increased responsibilities. They coped well with the DS0000027856.V337538.R01.S.doc Version 5.2 Page 6 challenges presented last year by the service user who was determined to move on. They can now point to the benefits that have been achieved by some residents who were nervous about the former occasional flare-ups. The following comment by a relative helps sum up the success of the home “If all homes were of this standard relatives of the residents could relax, but unfortunately not all homes are. My (relative) has been in 5 other homes, all of which I have had to complain about – standards and care – But I am pleased that my (relative) has found a loving and caring home where she appears to be very happy and contented.” Another relative wrote - “They are aware of the needs and capabilities of (each service user)….There are regular meetings and telephone calls.” What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000027856.V337538.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000027856.V337538.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, and 5. Quality in this outcome area is ‘good’. This judgement has been made using available evidence including a visit to this service. At previous visits the inspector has looked in detail at how two residents were helped to settle into the home. These arrangements were very good, with all the necessary assessment documentation having been completed. A new person had been referred to the vacant place, and again the manager’s approach was thorough. This included making sure the necessary information was received from the social worker, establishing contact with the service user’s family, and meeting the prospective new resident. Plans for this person to visit were on hold until it was certain that she could keep her current day placement, therefore not building up hopes until funding was more certain. New and established residents can be sure that a sensitive and thorough approach is taken when there is a vacancy. EVIDENCE: The inspector had been sent a copy of the updated ‘statement of purpose’ and the ‘service users’ guide’. These use lots of photos and pictures to help residents understand what the home offers, and includes the pictorial ‘licencee agreement’ with Outlook Care who own the building. At this visit the new manager showed the inspector more recent updates, including adding her details. There is a signed copy of the ‘licencee agreement’ on each person’s file. At a previous visit the inspector had looked at the care files for the two most recent residents to join the household. These contained the required range of DS0000027856.V337538.R01.S.doc Version 5.2 Page 9 assessment paperwork in line with Outlook Care’s guidance. This included the detailed ‘referral form (registered care)’; good background information from social workers; and detailed notes covering the early stage of introductions and move ins. Meetings had been held with the carers from the residents’ previous care homes. The main ‘person centred planning’ files had been set up at an early stage, with sections such as ‘likes and dislike‘ completed. At that time one of the new residents told the inspector how pleased she was, saying – “I like it here. I like the music…..[it has] nice big rooms. My bedroom is nice and tidy…..I like it best here.” A relative wrote – “There were no problems with the move in whatsoever. They do take account of what [my relative] and I say. Her bedroom was done according to her choice. She was shown cards and carpet samples….They do keep us informed about what is going on and what is planned.” The other resident’s family were also closely involved during his move, including attending the early reviews. At this latest visit the inspector discussed the assessment and planning that was underway regarding a new service user. So far this person’s family had visited. However, it was thought sensible to sort out some funding issues about day centre fees before arranging introductory visits for the service user. Nevertheless, the manager was making sure that the formal assessments were taking place. This included having the required referral forms and reports from the Havering Council social worker; and the manager completing the detailed Outlook Care ‘service user assessment’ with her line manager, with a record of their contacts and visits to talk with the prospective resident. Good consideration had been given to the person’s mobility needs, as she needs a wheelchair when away from her home. Again, this shows a responsible approach to helping judge if this home could meet this person’s support needs, taking into account how they would fit in with other residents and awareness of cultural considerations. Further, the manager of the home the established resident moved to three months ago told the inspector that she was very happy with the way this home had passed on information and linked up on the transfer arrangements. The inspector is confident in judging the important standard covering assessments as satisfactory – as are all other areas under this heading. DS0000027856.V337538.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10. Quality in this outcome area is ‘excellent’. This judgement has been made using available evidence including a visit to this service. The last report described the care records as up-to-date, giving a good description of how support is agreed, provided and monitored. This involves positive steps to make sure residents’ individual choices are heard and acted upon. This same high standard has continued under the new manager, with the addition of easier to understand medical notes. Residents are encouraged to have a leading voice in how their support is arranged. There is ready availability of advocacy, and a positive approach to involve relatives. One relative wrote - “I feel the home listen to needs and implement where necessary.” Another comment was - “Very rarely do I have to ask for information as normally it is provided in meetings or telephone calls.” EVIDENCE: The inspector looked at a range of service user files. This included the ‘care folder’; the ‘person centred planning’ files; the ‘finance folder’; the recently set up ‘health care action plans’; and the ‘support notes folder’. All files were again found to be well arranged, kept up-to-date; and where appropriate showed good signs of involving service users and their family representatives, such as signing the main six monthly reviews. DS0000027856.V337538.R01.S.doc Version 5.2 Page 11 The ‘person centred planning’ files have all the sections completed. This includes a comprehensive series of needs assessments under user-friendly headings, which lead on to the action plans and risk assessments. The main sections of the files are designed to fully involve the resident in their support planning, and understanding is helped by the use of pictures and photos. There are also details of ‘infringements of rights’ that set out the reasons for any restrictions, such as not hiding food or storing too many personal belongings in the main lounge. The ‘care folder’ had up-to-date reviews, with main twelve-page ‘pcp’ reviews held within the last six months – which are normally attended by relatives, and at times an advocate and a social worker. Some had additional attached reports, such as from a day centre. There are also three-monthly ‘minireviews’ that check that the main ‘action plans’ are being followed. Useful earlier information has been carried forward, such as original assessments and previous reviews. Recently, new style ‘health care action plans’ have been started. These are a major step forward in including service users through the use of widgets and pictures. Last year the inspector said that staff should be helped to keep better notes on the day-to-day help they provide. There is good evidence that this advice has been followed. The daily notes include good typed point-by-point guidelines on helping with personal care. There is other good practical advice, such as checklists to help residents tackle tasks such as cleaning their bedroom. The manager’s description of current care needs included good signs of improving abilities. The most assertive and able resident was determined in his wish to move on. His frustration became the main issue for other residents, notably the occasional risk to their safety. The staff showed great dedication in dealing with the flashpoints. Nevertheless, the move on has been welcomed as it has eased tension. The inspector heard that the more relaxed atmosphere has helped some residents become more able, such as one person using more words to let staff know what he wants. This has included him deciding that he wanted to change bedrooms. DS0000027856.V337538.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 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. This involved looking at individual activity programmes, and hearing about group activities. Each resident has a good range of activities away from the house. Satisfaction with outings and holidays is a topic residents talk about with the inspector. Residents are given very good support to follow activities of their choice. They also say they are happy with the meals. EVIDENCE: The manager gave details of each resident’s regular weekday involvement in training and activities centres. The ‘pcp’ files have sections on ‘Places I like to go’ and ’How I spend my week’. This includes using the St Bernard’s Centre, Western Road Life Skills Centre, Yew Tree Lodge and Melville Court. Other regular activities include a drama club, music and movement sessions, the Spilsbury disco evenings, and a visiting massage service. Included in weekly programmes are practical skills training such as helping with meals and cleaning tasks. The inspector also looked at the ‘daily activities’ sheets, and the monthly resumes. One resident attends church regularly. Good use is made of the home’s vehicle, which is suitable for wheelchair users. This helps DS0000027856.V337538.R01.S.doc Version 5.2 Page 13 maintain a busy schedule of leisure activities, such meals out, bowling, going to theatres and the cinema, trips to the coast; and plane spotting at airports. One weekly programme seen by the inspector showed a high level of involvement by a relative who helps his family member use a range of community services. Events over the past four months have included a couple of pantomimes; ‘The Lion King’ followed by tea at The Ritz; a ‘Chas and Dave’, and a Sixties concerts; and going to a Charles Dickens Festival in Rochester. Residents have a number of regular forums where they can voice their views. This includes monthly meetings with an advocate; monthly house meetings; and a periodic ‘house committee’ meeting. On display was up-to-date information about Outlook Care’s service user forums. Two residents submitted pieces for a recent organisation-wide competition. One resident has been helped to maintain links with her family in Holland, including visits. The inspector looked at the ‘menu file’. The preferred approach is to offer residents choices a day ahead, and a record is kept of what each person has had. This includes the diet of one person who needs a soft and thickened diet. Arrangements for meals on both days were satisfactory, with residents saying that they were happy with the meals they had chosen. DS0000027856.V337538.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21. Quality in this outcome area is ‘good’. This judgement has been made using available evidence including a visit to this service. The descriptions of contacts with doctors and other health care workers - along with the high standard of records - means that there is a strong evidence of good personal and health care support. This was summed up by a visiting health care worker at the last announced inspection who wrote – – “Staff are always friendly and knowledgeable about clients‘ needs. Clients appear cheerful and well cared for during my visits. Staff communicate well with myself and the psychiatrist regarding medication reviews and health needs.” Another health care professional said – “I have been involved with the staff at 1a Hulse Ave on a number of occasions through the treatment of patients and have been most impressed by their interest and enthusiasm involving the care of patients.” EVIDENCE: DS0000027856.V337538.R01.S.doc Version 5.2 Page 15 Earlier the inspector talked about the good standard of recording personal support plans, including the individual guidelines – and this now includes the new health care booklets. There are also annual health care planning grids; details of medication, including reviews; letters about medical appointments; and individual tracking sheets for each type of practitioner – GP, dentist, optician and so on. Files also have details of involvement of physiotherapists, occupational therapists, and a speech and language therapist – and where appropriate a psychiatrist. The manager described the support they receive from their local GP practice, and as with her predecessor praised the helpful approach of the practice manager. The manager gave an overview of the arrangements for the service user with the highest physical needs. She had recently had a wheelchair reassessment and she told the inspector that the adjustments were better. This person uses an overhead hoist, and this had been checked and serviced. There was also a record of wheelchair servicing, with two residents using wheelchairs in the house, and a third who uses one when out. Medication is provided by Boots in their monitored dose bubble cassettes, with printed recording sheets. Medication is locked away in a cabinet in the dining area. This was neatly arranged, as were the records, which the manager checks each week. There is a profile for each resident who has prescribed medication, with a photo attached. There were also copies of each staff members’ annual drug handling appraisal. Other useful information included useful guidelines on particular drugs. The supplying pharmacist carries out occasional checks, the last being in November 2006 to look specifically at arrangements for the resident who has swallowing difficulties. Staff still operate a system of double signing when they give out medication. A manager from Outlook Care does unannounced medication checks, and provided a detailed report, including recommendations on improving practice. There have been no known errors over the past twelve months. At an earlier visit the inspector looked at the file of the service user whose health deteriorated, and he passed away. His records showed that there had been regular reassessments by a broad range of health professionals, including physiotherapist; dietician; and speech therapist – there being up-to-date advice on such matters as exercises, swallowing and weight monitoring. Discussions are taking place with an advocate about residents having the chance to talk about their wishes if they become ill, and following death. DS0000027856.V337538.R01.S.doc Version 5.2 Page 16 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 manager is fully aware of the action to take if there is a complaint or a suspicion of abuse. Residents and relatives are made aware of how they can raise concerns, and can be confident that these will be followed through. This includes having an independent advocate available from ‘People First’. One relative wrote - “I have made complaints in the past to the social services and Inspectors about other homes, but have not had to do so since my (relative) has been at Hulse Avenue. This home is of a very high standard and is a ‘Home From Home’ situation.” EVIDENCE: The organisation’s complaints pack is available at the home. This includes a named complaints coordinator, large print and pictorial guides, a complaints contact card, and a logging form. Details on how to make a complaint are on display in the office and on the residents’ notice board. The five complaints logged since the last visit were about the behaviour of the resident who has now moved on. The policies and guidance relevant to the safeguarding standard are also available. This included ‘Infringement of Service Users’ Rights Procedures’; ‘Whistle blowing’; ‘Abuse Management’; and versions of local guidance. This guidance was taken into account when restraint became a consideration last year. The previous manager said - “All staff have done the two-day ‘positive response’ training. It was excellent…Overall I think the matter was handled well. [The social worker] was really helpful. I think positive lessons have been learnt, especially on how to monitor and diffuse difficult events.” All staff have signed to say they have been given a copy of the General Social Care Council’s Code of Practice. DS0000027856.V337538.R01.S.doc Version 5.2 Page 17 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, 26, 27, 28, 29 and 30. Quality in this outcome area is ‘excellent’. This judgement has been made using available evidence including a visit to this service. This is an excellently designed and maintained building that is well suited to the needs of residents, including those with a physical disability. All these standards are rated at the ‘commendable’ level. EVIDENCE: The inspector again found the premises comfortable, bright and clean. There are good design features that are helpful for people who use wheelchairs including level access to all parts of the bungalow, forecourt and garden; wide corridors and doorways; and communal rooms with sufficient travel and tuning dimensions. This well constructed premises is in keeping with the immediate neighbourhood. It is well placed for access to local services and shops, and the residents have their own minibus with a tail-lift. All fittings, furniture; and adaptations are of good quality, there being good attention to contemporary style home-making. The external re-decoration is in good order, and the maintenance of the garden has improved now that outside gardening contracts are used. There is a large patio, and protected pond. DS0000027856.V337538.R01.S.doc Version 5.2 Page 18 The organisation uses a fire safety consultant to carry out an annual risk assessment, and provide staff with refresher training. Three of the single bedrooms are a tiny fraction below 10sqm. The bedroom of the resident with the highest dependency needs who uses a special wheelchair measures 14.7sqm., with private access to the adjoining specialist bathroom. There is a tracking hoist. The other person who needs a wheelchair has a room that is just over 10sqm, however this is not problematic as she is able to selftransfer. The inspector looked at a sample of bedrooms. These are appropriately furnished, individually decorated, and each shows a high level of personalisation showing resident’s individual tastes and interests. All have well positioned home entertainment equipment. Each bedroom has the required range of furniture and fittings, including vanity units. Bedrooms are fitted with smoke detectors, and all radiators have heat protective covers. The bedrooms of the two wheelchair users have electronic over-arm closers, and external doors. The bathrooms, shower-room and separate toilet facilities are suitable to the needs of residents. The large bathroom has ample space to allow assistance to the high dependency resident. This has been fitted with a different specialist bath with a riser action and is in a peninsular position. The lounge is spacious, and has a conservatory extension, with new blinds fitted this year. The combined kitchen and dining-room also have good space, with new work surfaces, some of which are at the right height for those who use wheelchairs. The laundry has been refitted, and has good working space, and was found to be clean and safely arranged. All stocks of bedding were fresh and in good condition, as was the case with residents’ clothing. The kitchen and laundry have suitable hand-wash basins, and there was a good stock of protective gloves, aprons, and paper-towels. The last independent infection control audit awarded 100 for general household cleanliness. There is now a part-time cleaner. DS0000027856.V337538.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 and 36. Quality in this outcome area is ‘good.’ This judgement has been made using available evidence including a visit to this service. This home has a stable, experienced and well-qualified staff team. Comments made by residents and relatives praise the support provided. Written comments included - “They are always looking for ways to improve the service.” - “What do they do well?…Their attitude to caring and the continued enhancement of clients’ needs.” - “I believe the care home and staff have the right attitude, and if they continue in this vein then everything will remain okay.” EVIDENCE: The team is made up of the manager; deputy (30 hours); 5 full-time and 2 part-time support workers. There are 287 total care hours excluding the manager’s time. At this visit there were no vacancies, three staff having joined in the past year - but two staff were on long-term sick leave. These hours were being covered by familiar bank staff or regular staff doing extra hours. The normal level of cover is two staff on both the early and late shifts (7am through to 9.30/10pm), with one person on waking duty at night – with shift overlaps for handovers. All staff take turns at doing the night shift. The level of qualification exceeds the expected level, with seven of the nine staff having an NVQ at level 2 or above. DS0000027856.V337538.R01.S.doc Version 5.2 Page 20 The organisation has a very good record on training and induction. The inspector was given copies of each person’s training profile. This shows that all have done training in all the expected core areas, including safeguarding procedures; first aid; food hygiene; and manual handling. Additional training has included ‘Working with Dementia’, ‘personal safety’, and a mini-bus driver awareness scheme. The inspector checked a sample range of staff files. This showed that the required checks are carried out, including - written references, CRB certificates, and documents that prove identity, as well as a recent photo. DS0000027856.V337538.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39,40, 41, 42, and 43. Quality in this outcome area is ‘good.’ This judgement has been made using available evidence including a visit to this service. Outlook Care are very good and running their services in an open and accountable way. There are a number of in-house and external service audit systems; good ways for residents to make their views known; and clear policies and procedures. This works well in providing monitoring and safeguards for those who use their services. The new manager said she has found the team, and her line managers very supportive. One worker said – “The team has come together…..everyone is willing and things get done. Natasha is a pleasure to work with…she works with you to see that everything gets done.” EVIDENCE: At this visit the inspector asked to see a range of documentation and certificates covering health and safety. This included fire safety arrangements; electrical, gas and water safety checks; periodic building safety checks; and insurance cover. The last inspection by and environmental health inspector was in June 2006 with satisfactory findings reported. The last inspection by a fire DS0000027856.V337538.R01.S.doc Version 5.2 Page 22 safety was in October 2003. However, there was an independent fire risk assessment carried out in September 2006 – and the recommendations made at that time have been followed through, including replacing some door closers. The manager presented all the records in an ordered and efficient way, reflecting the good office arrangements. There are a range of quality assurance systems. This includes regular ‘monthly visit reports’; specialist audits such as the medication arrangements; and external accreditation schemes like ‘ISO9002’, ‘Investors in People’, and ‘Positive About Disabled People’. The company operate a quality assurance scheme – called the ’Continuous Improvement Programme’ (CIP). This includes steps to ensure that staff are familiar with all current policies, guidelines, and practice forms. This has also included doing some policies and procedures in an ‘easy read’ format. Recently, managers have been doing a ‘self-assessment of their service. This positive approach to quality monitoring leaves them well placed to tackle the ‘AQAA’ assessments being introduced by the Commission this year. Natasha Feeley is currently doing the NVQ 4, and will be supported to do the Registered Manager Award. DS0000027856.V337538.R01.S.doc Version 5.2 Page 23 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 3 2 3 3 3 4 3 5 3 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 4 25 4 26 4 27 4 28 4 29 4 30 4 STAFFING Standard No Score 31 3 32 3 33 3 34 4 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 4 4 4 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 3 3 3 4 3 DS0000027856.V337538.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000027856.V337538.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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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