Inspection on 01/05/07 for Integrated Care Services Limited

This inspection was carried out on 1st May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Integrated Care Services Limited 11/04/06

Integrated Care Services Limited 14/11/05

Integrated Care Services Limited 23/05/05

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 Integrated Care Services Limited 2a Tudor Gardens Kingsbury London NW9 8RN Lead Inspector Judith Brindle Key Unannounced Inspection 1st May 2007 08:35 Integrated Care Services Limited DS0000056792.V337151.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 Integrated Care Services Limited DS0000056792.V337151.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. Integrated Care Services Limited DS0000056792.V337151.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Integrated Care Services Limited Address 2a Tudor Gardens Kingsbury London NW9 8RN 020 8200 1158 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) Integrated Care Services Limited Mrs Moline Bamunuwatte Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Integrated Care Services Limited DS0000056792.V337151.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th April 2006 Brief Description of the Service: 2A Tudor Gardens is a registered home providing care and support to four adults with a learning disability. The registered owner is Integrated Care Services Limited. The registered manager is Mrs Moline Bamunuwatte. Mrs Bamunuwatte and her husband Mr Percy Bamunuwatte jointly run the Integrated Care Services company. They provide a similar service at one other local home. The home is located in a residential area of Kingsbury. The property is detached; there are two bedrooms, bathroom, lounge/diner and kitchen on the ground floor. Two more bedrooms, office/sleep-in room and bathroom/WC can be found on the first floor. There is parking space for two cars in the homes own drive, and a garden at the front of the property. There are a variety of local shops within walking distance. More shopping and leisure amenities are located in Wembley, Kingsbury or Harrow, which can be reached through public transport. Documentation/information about the care home is accessible to residents and visitors. Information in regard to fees was accessible in the care home and can be obtained by contacting the registered manager/provider. Integrated Care Services Limited DS0000056792.V337151.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place throughout 7.25 hours during a day in May 2007. There were no vacancies at the time of the inspection. The inspector was pleased to meet and talk with all the people living in the care home. The inspector also spoke with staff, and with a visitor. Staff were very helpful during the inspection, and supplied all documentation and information requested by the inspector. The registered manager Mrs Moline Bamunuwatte, and her husband Mr Percy Bamunuwatte were present for most of the inspection. The inspection focussed on spending time talking with residents and observing their interaction with staff and with other residents. Care practices were also monitored. Assessment also took place as to whether requirements from the previous inspection (April 2006) had been met. Documentation inspected included, all the resident’s care plans, complaints and accident/incident records, the staff rota, and medication records. The inspection included a tour of the premises. 27 National Minimum Standards (including key Standards) for adults were inspected. The inspector thanks all the people living in the home, a visitor and the staff for assisting in the inspection process. What the service does well: The care home has a positive atmosphere. Staff and residents make visitors feel very welcome. The care home has ‘homely’ features. The environment of the care home is generally well maintained. People living in the care home have the opportunity to be involved in aspects of the care home such as participating in completing household duties including cooking and housework. People living in the care home are supported and encouraged to be as independent as they are able. Staff have a good knowledge and understanding of resident’s needs, and were observed to be very sensitive and respectful to residents during the unannounced inspection. Residents spoke highly of staff and described them as helpful and caring. Integrated Care Services Limited DS0000056792.V337151.R01.S.doc Version 5.2 Page 6 People living in the home have contact with health and social care professionals as and when they need to. Staff are supported in accessing a variety of training, and they have all achieved relevant NVQ care qualifications. Residents confirmed that they were happy living in the care home. A visitor spoke positively about the care home. 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. Integrated Care Services Limited DS0000056792.V337151.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 Integrated Care Services Limited DS0000056792.V337151.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): Standard 1 and 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place for prospective service users to have the information that they need to make an informed choice about where to live, but this documentation could be further developed. Arrangements are in place to ensure that the manager assesses prospective resident’s needs. EVIDENCE: Records confirmed that there was information about the care home available for residents and visitors. This information could be further developed to ensure that the address and contact number of the Commission for Social Care Inspection is accessible in the service user guide. The service user guide is in written and pictorial format. The manager confirmed that people using the service had all been supplied with a copy of the service user guide. A resident spoke of being given some information about the care home. A resident had been recently admitted to the care home at the time of the inspection. He spoke of how he was settling in to the home, and confirmed that he was happy with his bedroom and that the staff were ‘kind’. Integrated Care Services Limited DS0000056792.V337151.R01.S.doc Version 5.2 Page 9 Records confirmed that the manager has had carried out a comprehensive initial assessment of this resident. There was also evidence of there having been a care manager assessment and a physiotherapy report of the resident’s needs. The registered manager spoke of having arranged that a care manager visit the newly admitted resident. The manager reported that hospital staff, the prospective resident, and the resident’s relative had also been involved in this process of assessment. This resident confirmed that he had been asked questions about his needs and wishes. He spoke of having been admitted from hospital so had not visited the care home, but that his relative had visited. Staff who spoke to the inspector were judged to have a good understanding of the needs of the person recently admitted to the home. Integrated Care Services Limited DS0000056792.V337151.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): Standard 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. Arrangements are in place to ensure that all residents have a plan of care, with recorded personal goals, but some development in care plan records to ensure that they are developed with each person living in the care home. Residents are supported and encouraged to make decisions. Residents are supported to take risks as part of an independent lifestyle. There needs to be further development of risk assessments to ensure that people living in the home are safe. EVIDENCE: The care plans of all the people living in the care home were available for inspected. The care plans inspected included assessment information, and included some evidence that the people living in the home participated in their plan of care. Records confirmed that the needs of resident’s are regularly reviewed. A copy of a care plan review was supplied to the Commission for Integrated Care Services Limited DS0000056792.V337151.R01.S.doc Version 5.2 Page 11 Social Care Inspection following the inspection. This should record evidence of the person’s involvement in this review. There was some evidence of recorded staff guidance in regard to meeting the needs of some people living in the home that might challenge the service. The residents’ care plan files were bulky and included a variety of information from the previous placements as well as the present placement. In some files it was difficult to access succinct up to date information in regard to residents’ assessed needs, and the action being taken to meet those needs, including timescales for goals to be met. There was little evidence of a person centred approach to the care plan in regard to celebrating the individual, there life experiences, and recording in detail how their current requirements and aspirations are to be met by positive individualised support. This was discussed with the manager. The manager spoke of her plans to review the format of the care plans. Following this inspection the registered manager supplied the Commission for Social Care Inspection with a copy of a ‘service user plan’ which had been developed and improved and was in a more accessible format. It included a description of the person’s needs, goals and action to meet these needs, and when these goals are to be reviewed. This development is positive, but it should be evident that the person is as fully involved in the care plan as possible, and has signed it (if able). The care plans should include photos, pictures and be written in plain language. All the care plans should be in a format, which can easily used by people who are not familiar with the individual to deliver a personalised service quality service when necessary. There should be evidence that the care plans are working documents, and that they consistently reflect the care being delivered. A person living in the home confirmed that he had a key worker. Resident’s daily progress records were fully recorded and included positive and comprehensive information about each person living in the home. People living in the care home spoke of the varied choices that they make. These include shopping for clothes, toiletries and choosing preferred activities, and meals. Staff spoke of supporting residents to make decisions about their lives. This was evident during the inspection. The care home has a confidentiality policy. Records confirmed that residents were recorded on the electoral register. Staff and records confirmed that people living in the care home have varying levels of support with their finances. This is recorded in the individual financial assessments of residents. Some residents are supported by their relatives with their finances. Two residents finance records were inspected. Records of incoming payments and of expenditure were recorded, and receipts of purchases were available for inspection. The fee component paid by each person living in the home was documented in his or her care plan file. Integrated Care Services Limited DS0000056792.V337151.R01.S.doc Version 5.2 Page 12 There was some evidence of risk assessment, which had been reviewed, and included action taken to minimise risks and hazards, but these need to be further developed to ensure that all individual risks are assessed and that there is recorded staff (and resident) guidance to minimise assessed risk. Risk assessments including falls, bathing, the risk of using stairs, and moving and handling assessments, and health and safety risk assessments (other risk assessments may be appropriate) all need to be completed with involvement from people living in the care home, and recorded. The home has a missing person’s procedure. Integrated Care Services Limited DS0000056792.V337151.R01.S.doc Version 5.2 Page 13 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): Standard 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 have the opportunity to take part in a variety of activities including those promoting personal development, and being community based. Arrangements are in place to enable residents to maintain contact with family/significant others, as they wish. Resident’s rights are respected and responsibilities recognised in their daily lives. Meals are chosen by people living in the care home, and are varied and wholesome. EVIDENCE: People living in the care home kindly spoke of the variety of activities that they chose and enjoyed. Two residents went to two different colleges during the inspection. One person living in the care home spoke of doing cooking at Integrated Care Services Limited DS0000056792.V337151.R01.S.doc Version 5.2 Page 14 college; another spoke of being in the process of completing two years study at college. Both residents spoke of enjoying their college courses, and records confirmed that people living in the care home had completed several educational courses. A person living in the home spoke of his plans to carry out some voluntary work. Another resident spoke of his love of sport and of how he is given the opportunity to enjoy his hobbies within the care home. This included receiving a sports magazine on a monthly basis and being able to purchase books and visit sports grounds. Two people living in the care home spoke of regularly using their own computers. One person kindly showed me examples of documents and records that he had completed on his computer. Other residents spoke of clubs, and of day resource centres that they attended. One person living in the care home spoke positively about the plans she had for celebrating her birthday. Residents spoke of holidays that they had planned and of holidays that they had taken, which included abroad. A person living in the home spoke of participating in household duties, such as cleaning and cooking, and doing her laundry. Residents spoke of accessing and enjoying the opportunities in their local community, such as having meals in local restaurants, and going to the bank and post office. It was evident that the service has a commitment to enable people who use the service to develop their skills, including social, emotional and independent living skills, and to provide support to make informed choices. People living in the home spoke of the contact that they had with their family and friends. It was evident that the residents were supported in maintaining and developing relationships with their family and friends. People living in the home reported that they could choose preferred meals. A resident was observed to be given his choice of meal at lunchtime during the inspection. Staff confirmed that people living in the home were asked on a daily basis what they would like to eat the following day. Meals eaten were recorded and were judged to be varied and wholesome. Staff and people living in the home had understanding of healthy eating. Staff who spoke with the inspector were understanding of some residents specialist dietary needs. Snacks and drinks were offered regularly during the inspection. Fresh fruit was accessible during the inspection. Integrated Care Services Limited DS0000056792.V337151.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 18,19,20, 21 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that people living in the care home have their personal and healthcare needs are met. Medication is stored and administered safely, but there could be development in regards to ‘in house’ staff medication administration training. EVIDENCE: Residents spoke of the support that they received from staff with their personal care needs. Personal care needs assessment was documented in care plans inspected, but this documentation could be further developed to ensure that resident’s preferences and needs are more clearly documented with recorded staff guidance to meet those needs. Staff were seen to respond appropriately to the varied and individual personal care needs of people living in the care home, and to respect their privacy and dignity. A person living in the care home spoke of the flexible times for going to bed and getting up. Records confirmed that residents had choice in regard to going to bed. Integrated Care Services Limited DS0000056792.V337151.R01.S.doc Version 5.2 Page 16 The manager confirmed that she had discussed with a person living in the home and obtained their wishes in regard to dying and death, and that she had plans to broach this subject in a sensitive manner with other residents and their relatives (if agreed by the people living in the home). A previous inspection requirement was judged to have been met. A resident spoke of receiving bereavement counselling. Records, staff and people living in the care home confirmed that resident’s healthcare needs are met by the service. This includes dental, chiropody and optician care and treatment. Appointments with the community nurse, physiotherapists were documented. A person living in the care home reported that she had had several hospital appointments for various ailments and that she had others planned. It is recommended that assessment of the environment be carried out by an occupational therapist, particularly in regard to the varied mobility needs of the people living in the care home. The home has a medication policy/procedure. A copy of this procedure was supplied to the Commission for Social care inspection following this inspection. It was recorded on this document that staff had read and signed it. The medication in the home is stored as required. Medication administration records that were inspected were fully recorded. Allergies are recorded in this documentation. The manager spoke of staff having received medication training from the pharmacist. She reported that all staff received ‘in house’ medication training prior to staff administrating medication to people living in the care home, a support worker confirmed this. There needs to be recorded evidence that an assessment has been carried out to ensure each member of staff (who administers medication) is competent to handle, record and administer medication, and that competence and compliance is monitored. This was discussed with the manager. Integrated Care Services Limited DS0000056792.V337151.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place for ensuring that complaints are taken seriously and handled objectively, but the action taken in response to a complaint/concern needs to be documented. Arrangements are in place to ensure that service users are protected from abuse, neglect and self-harm. EVIDENCE: The care home has a complaints procedure. This procedure should be further developed in the service user guide, and statement of purpose to ensure that all residents and significant others know the process for communicating a complaint or concern. The complaints procedure should be available in a variety of variety of formats This procedure includes required information, such as timescale for responding to complaints. There have been two recorded complaints this year. These records confirmed that people living in the care home knew how to make a complaint. There was no recorded evidence that action had been taken to resolve these complaints. The manager spoke of the action having been taken in response to the complaints. This was judged to be appropriate. There needs to be evidence that any complaint made under the complaints procedure is fully investigated. The home has an accessible local authority safe guarding adult’s procedure. The home protection of vulnerable adults procedure needed to clearly record Integrated Care Services Limited DS0000056792.V337151.R01.S.doc Version 5.2 Page 18 when an incident needs to be referred to the Local Authority as part of the local Safeguarding procedures in place. Following the inspection the manager confirmed that this procedure was being amended and reviewed. Records and staff confirmed that staff had received training in Safeguarding Adults. A staff member who kindly spoke with the inspector knew how to respond in the event of an alert. There should be evidence that people using the service and/or their representatives have been made aware of what abuse is and of the safeguards in place for their protection should they need them. Integrated Care Services Limited DS0000056792.V337151.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 24, 26 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment of the home is safe, homely and comfortable. The premises are suitable for the care home’s stated purpose, but there could be some minor improvements made to the environment. Residents bedrooms are individually personalised, meet their individual needs. The care home is very clean, and odour free. EVIDENCE: The home is a detached house located in a residential street. The home is in keeping with the other houses in the area. The home is close to a variety of amenities that include shops, restaurants, cafes and banks. Local transport facilities that include train and bus services are located within a short walk from the home. The inspection included a tour of the premises. The home is furnished in a homely manner. People living in the home were observed to move freely Integrated Care Services Limited DS0000056792.V337151.R01.S.doc Version 5.2 Page 20 within the communal areas of the home. There is a sitting room/dining room and kitchen/dining room located on the ground floor. There are several areas of the care home that should be redecorated. The registered manager spoke that she had plans to redecorate the communal areas of the home. The vinyl flooring in the kitchen near the sink was loose. This needs repair due to possibly being a trip hazard. A rug in the kitchen was a possible trip hazard (particularly in regard to the residents varied mobility needs). The manager informed the inspector following the inspection that she had removed this rug in regard to the safety of those living and working in the care home. A toilet seat in the upstairs bathroom was not secure and needs repair or replacing. Following the inspection the manager confirmed that she had a date planned for these maintenance issues to be carried out. In regard to the mobility needs of people living in the care home it is recommended that the registered manager consider putting a handrail on the wall opposite the banister of the stairs. The garden is well maintained. Residents spoke of spending time in the garden. I spent time speaking with residents in the garden. A resident kindly showed the inspector his bedroom. It included several personal items and the resident spoke of being very happy with his room. Another bedroom inspected was observed to be personalised meeting the individual need and lifestyle of the occupant. All the residents who spoke to the inspector reported that they were happy with their bedrooms. It was evident from talking to people living in the home that they are encouraged to see the home as their own. The laundry facilities are located in the garage away from food storage and food preparation areas. The home was generally clean; some areas such as light switches and bathroom extractor fan could be cleaner. The manager spoke of the action to be taken to improve the system of home cleaning. Disposable gloves were observed to be accessible to staff. People living in the home spoke of being involved in cleaning their own bedroom. The home had a food and safety check from Environmental Health Department. This was satisfactory, and records confirmed that the home was carrying out appropriate monitoring of food safety. Integrated Care Services Limited DS0000056792.V337151.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 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. Staff receive training to ensure that they are competent and skilled in regard to carrying out their roles and responsibilities. Arrangements are in place to ensure that residents are supported and protected by the care home’s recruitment policy and procedures. Arrangements are in place to ensure that staff receives regular supervision. EVIDENCE: Staff were observed to be respectful to people living in the care home. Residents spoke very positively about staff, and confirmed that they have confidence in the staff that care for them. Comments included ‘the staff are lovely’, ‘I really like my key worker’. Records, talking to staff, and to people living in the care home confirmed that staff had a good understanding of residents varied needs. Staff spoke positively of the ‘good team work’ in the home. A staff member confirmed that she had received an induction programme, and that they completed a period of probation. Records confirmed that new staff Integrated Care Services Limited DS0000056792.V337151.R01.S.doc Version 5.2 Page 22 receive comprehensive induction training. The manager confirmed that staff are supplied with a copy of the staff General Social Care Code of Conduct. A copy of this document was accessible in the care home. The staff rota was displayed. The inspector was informed that there were 2-3 staff employed during the day and one staff on duty at night. Staff informed the inspector that staff from the Organisation’s other care home, work in 2a Tudor Gardens for some shifts or part of a shift. This was not evident from the records. The registered manager needs to ensure that there is a record of all the shifts/hours of every staff member staff who work in the home. Records and staff confirmed that appropriate and varied staff training takes place in the care home. This training includes moving and handling, first aid, food and hygiene training and fire awareness training. Other training includes care planning training, effective communication, and managing people who challenge. The manager reported that all staff had completed an NVQ care course. A staff member spoke of having recently achieved an NVQ level 3 care training course. Records inspected recorded evidence that staff had completed these courses. Records and staff confirmed that management facilitate staff members to undertake training that is focussed on delivering improved outcomes for people living in the care home. Two staff personnel files were inspected. These included required documentation such as evidence that an enhanced Criminal Record Bureau check had been carried out. The manager confirmed that people living in the home are involved in the recruitment process and that she welcomes their views. Records and staff confirmed that staff supervisions sessions and appraisals take place regularly. Staff job descriptions were available for inspection. Integrated Care Services Limited DS0000056792.V337151.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37,39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management approach of the care home creates an open, positive and inclusive atmosphere. The registered manager is qualified, competent and experienced to run the care home. Arrangements are in place to ensure that effective quality assurance and quality monitoring systems are in place to monitor and improve the quality of the service provision by the care home, but this should continue to be further developed, and a comprehensive annual development plan be completed. Arrangements are in place to ensure that so far as reasonably practicable the health, safety and welfare of residents and staff is promoted and protected, but there needs to be evidence of some fire equipment checks and advice be sought from the fire service in regard to doors needing to be left open in the care home. Integrated Care Services Limited DS0000056792.V337151.R01.S.doc Version 5.2 Page 24 EVIDENCE: The manager has the required qualification and experience, and is competent to run the care home and meet its stated aims and objectives. She has had several years experience in a management role in supporting and caring for adults with a learning disability. She informed me that she had recently achieved the Registered Manager’s Award qualification. The manager has a clear understanding of the key principles and focus of the service, and is keen to constantly improve the service. The home has required policies and procedures in place, which are accessible to staff. The manager should develop ways of ensuring that policies/procedures that are particularly relevant and accessible to people living in the home. The registered manager supplied the Commission for Social Inspection minutes of a meeting (March 2006) in regard to quality assurance monitoring systems in the home. This recorded some aims and objectives, and action that is being taken to monitor the quality of the service (and another of the Organisations homes). This included monitoring of complaints, staffing, the environment, and in regard to the monitoring of the needs of people living in the care home. A business plan of this care home and of another service owned by the organisation dated 2005 was available for inspection. The registered manager needs to complete an annual development plan for the care home which demonstrates that there is an up to date business plan and that the home provides a quality assurance, and monitoring process to ensure efficient running of the home which gives value for money, and delivers effective outcomes for people who use the service. This document needs to include evidence that the views of stakeholders (people living in the home, relatives, staff, health and social care professionals etc) are obtained and that action is taken to improve, and develop the service in response to these views. The home has required health and safety policies/procedures. There was recorded and verbal evidence that health and safety is generally closely monitored in the care home. The home has a fire risk assessment and carries out regular fire drills. It was evident that a specialist contractor had carried out checks of the fire alarm system and emergency lighting, but there was not a record that the fire fighting equipment (fire extinguishers etc) had been serviced since 2005. Some doors within the care home were propped open. If doors are needing to be left open during the day the registered person needs to consult with the local fire service and seek their advice as to which systems need to be put in place to enable doors to be left open safely. The fire risk assessment needed to be updated to include the issue of doors needing to be left open during the day, but closed at night. Following the inspection the registered manager Integrated Care Services Limited DS0000056792.V337151.R01.S.doc Version 5.2 Page 25 reported that the fire risk assessment had been reviewed since the inspection. The last recorded visit from the local fire service was on 21/02/06. Radiators in the care home are have protective covers. Certificates of worthiness including electrical and gas systems were available for inspection and up to date. There was some general information that electrical portable appliances had each been recently checked/serviced, the registered person should ensure that there is evidence that each electrical appliance has been serviced. Following the inspection the manager reported that she had contacted the electrical servicing company and that they confirmed that they had checked the portable appliances, and would supply the home with the required appropriate documentation. The employers liability insurance was up to date. Integrated Care Services Limited DS0000056792.V337151.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 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 2 2 3 3 X 2 X X 2 X Integrated Care Services Limited DS0000056792.V337151.R01.S.doc Version 5.2 Page 27 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 YA9 Regulation 13(4), 14(1) Requirement Timescale for action 01/08/07 2 YA20 13(2) 3 YA22 22(3) 4 YA24 23(2) To ensure that people living in the home are safe. Risk assessments including falls, bathing, use of the stairs, moving and handling assessments, and health and safety risk assessments (other risk assessments may be appropriate) all need to be completed, with involvement from people living in the care home, and be recorded There needs to be recorded 01/08/07 evidence that an assessment has been carried out to ensure each member of staff (who administers medication) is competent to handle, record and administer medication, and that staff competence and compliance is monitored by management. There needs to be evidence that 01/07/07 any complaint made under the complaints procedure is fully investigated. • The vinyl flooring in the 01/07/07 kitchen near the sink was loose. This needs repair due to possibly being a DS0000056792.V337151.R01.S.doc Version 5.2 Integrated Care Services Limited Page 28 5 YA33 6 YA39 7 YA42 trip hazard. • A toilet seat in the upstairs bathroom was not secure and needs repair or replacing. 17(2) The registered manager needs 01/06/07 to ensure that there is a record of all the shifts/hours of every staff member staff who work in the home. This to ensure that there is evidence that there are sufficient numbers of staff on duty at all times. 24(1)(2)(3) The manager needs to ensure 01/07/07 that an up to date annual development plan, which includes the views of all stakeholders (service users, family members, staff etc.), and is based on a systematic cycle of planning, action, and review, which reflects aims and outcomes for people living in the care home. 23(4) • There needs to be 01/07/07 evidence that the fire fighting equipment (fire extinguishers etc) has been recently serviced. • If doors are needing to be left open during the day the registered person needs to consult with the local fire service and seek their advice as to which systems need to be put in place to enable doors to be left open safely. 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 Good Practice Recommendations DS0000056792.V337151.R01.S.doc Version 5.2 Page 29 Integrated Care Services Limited 1 Standard YA1 2 YA6 3 YA19 4 YA22 5 YA23 6 YA24 7 YA24 8 9 YA39 YA42 The service user guide information could be further developed to ensure that the address and contact number of the Commission for Social Care Inspection is accessible in the service user guide. • All the care plans should be person centred so be evident that the people living in the care home are fully involved in their plan of care. • There should be evidence that the care plans are working documents, and that they consistently reflect the care being delivered, and the changing needs of the people living in the care home. It is recommended that assessment of the environment be carried out by an occupational therapist, particularly in regard to the varied mobility needs of the people living in the care home. • The complaints procedure should be further developed in the service user guide, and statement of purpose to ensure that all residents and significant others know the process for communicating a complaint or concern. • The format should include pictures to ensure that the procedure is accessible to people who have difficulty reading. There should be evidence that people using the service and/or their representatives have been made aware of what abuse is and of the safeguards in place for their protection should they need them. The registered manager should review the cleaning programme in the care home to ensure that all areas including light switches and bathroom extractor fans are regularly cleaned. In regard to the mobility needs of people living in the care home it is recommended that the registered manager consider putting a handrail on the wall opposite the banister of the stairs. The manager should develop ways of ensuring that policies/procedures (that are particularly relevant to residents) are accessible to people living in the home. The registered person should ensure that there is evidence that each electrical appliance has been serviced. Integrated Care Services Limited DS0000056792.V337151.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Integrated Care Services Limited DS0000056792.V337151.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!