Inspection on 17/10/06 for Magnolia Court

This inspection was carried out on 17th October 2006.

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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Magnolia Court 20/12/05

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 Magnolia Court 62 Leigham Court Road Streatham London SW16 2EL Lead Inspector Ms Rehema Russell Unannounced Inspection 17 October & 2 November 2006 12:30 th nd Magnolia Court DS0000065823.V299030.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 Magnolia Court DS0000065823.V299030.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. Magnolia Court DS0000065823.V299030.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Magnolia Court Address 62 Leigham Court Road Streatham London SW16 2EL TBA TBA 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) Magnolia Court Ltd Care Home 2 Category(ies) of Learning disability (2) registration, with number of places Magnolia Court DS0000065823.V299030.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th December 2005 Brief Description of the Service: 62 Leigham Court Road has been converted from an ordinary family home. It is semi-detached to the registered care home at 64 Leigham Court Road. 62 Leigham Court Road has been converted into two self-contained flats, each for one service user, with a common front door and hallway entrance. Apart from one of the self-contained flats, the ground floor also has an office, a toilet and the laundry room. There is a medium sized back garden for the sole use of the occupant of the ground floor flat and access is only available via this flat. There are two steps to the front door so the home is not wheelchair accessible, but the ground floor flat has a mobility access shower/bathroom. The home is within walking distance of a large shopping area with full community facilities and rail and bus transport. The forecourt of the home has space for 2 cars to park and there is on street parking in nearby streets. Potential service users would be given the Service User Guide and verbal information about the home. A copy of the most recent CSCI inspection report is available in the reception/hallway area of the home. The range of fees charged at the home is £2,500 - £7,000 per week and there are no additional charges. Magnolia Court DS0000065823.V299030.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over two half-days, on 20th October and 2nd November 2006. The home was full, with two service users. The first had been there for nearly one year and is non–verbal and with severe challenging behaviours. The second service user had been at the home for one week and was able to speak briefly with the inspector. The inspector also spoke with the manager and two members of staff, and looked at documentation, records and the environment. Subsequent to the inspection, feedback about the home was received from the care manager of the service user who has been at the home since it opened. What the service does well: • • • • • • • • • The home is comfortable, spacious and has good quality furniture and fittings There is a skilled and stable staff group who provide consistent care in a pleasant and friendly atmosphere The manager is open and supportive and committed to high quality service provision Assessments and care plans are appropriate and thorough Service users are supported to access the community and to maintain family relationships Staff provide varied, nutritious and culturally appropriate meals suited to service users’ individual preferences and choices Service users’ physical, emotional and psychological healthcare needs are met Staff ensure that risks are thoroughly assessed and suitable precautions taken to safeguard service users. The home’s recruitment and care practices ensure that service users are protected from harm and abuse. The service user who is verbal said that he liked the home and staff, that he could get up when he liked and liked the meals provided. A care manager spoken with was very happy with the care being provided at the home and the professional relationship established with staff. What has improved since the last inspection? There have been very positive changes to the behaviours of the service user who has been at the home for nearly one year. The one requirement and one recommendation arising from the last inspection were implemented. Magnolia Court DS0000065823.V299030.R01.S.doc Version 5.2 Page 6 What they could do better: • The Registered Provider must ensure that there is a system in place that ensures that maintenance problems are responded to and fixed in a timely manner. On the first day of inspection 2 immediate requirements were left in regard to the washing machine and a malfunctioning kitchen tap. These requirements were implemented. On the second day of inspection a serious problems were found with the central heating in regard to 2 non-functioning radiators and lack of access to all radiator thermostats. A further immediate requirement was not issued because the Finance Director undertook immediate action to get the problem fixed. The Registered Provider must review and update the medication policy, complaints procedure and abuse policy and procedure, so that it meets the required standard and accurately reflects the practice carried out at the home. The Registered Provider must ensure that registration documents for the manager are re-sent to CSCI and that the manager is registered. The Registered Provider must ensure that induction and foundation training meets required standards and training targets. The Registered Provider must ensure there is an adequately funded annual training and development plan for the home. • • • • 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. Magnolia Court DS0000065823.V299030.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 Magnolia Court DS0000065823.V299030.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Prospective service users have the information they need to make an informed choice about where to live in a suitable format. Prospective users’ individual aspirations and needs are thoroughly assessed prior to admission, and they have an opportunity to visit and “test drive” the home. EVIDENCE: There is a very comprehensive Service User Guide which is written in clear and simple language, in large font and with pictorial images throughout. It is therefore suited to the cognitive disabilities of service users. It covers all aspects of life at the home and is written with humour, making it a friendly and welcoming document. The Service User Guide doubles as the Statement of Purpose. There is a separate service user complaints procedure available with the service user guide, which is also clearly and simply written with pictorial images throughout, and includes all of the information required by regulation. The case files of both service users were seen and evidenced that thorough assessments were undertaken prior to placement. Guidelines and reports from the previous placement are obtained and initial risk assessments devised. The assessment undertaken by the home is comprehensive, covering areas such as psychological support and mental health needs, managing emotions, communication skills, daily living skills, relationships and sexual needs, Magnolia Court DS0000065823.V299030.R01.S.doc Version 5.2 Page 9 community presence and participation, recreation and relaxation and cultural and spiritual needs. Prospective service users are given the opportunity to visit the home prior to placement, with the most recently admitted service user having visited the home with three carers, and his care manager also having visited the home. Magnolia Court DS0000065823.V299030.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ assessed and changing needs and personal goals are reflected in their individual care plan. Service users are supported and enabled to make as many decisions and choices about their daily life as possible. Thorough risk assessments and behavioural guidelines have been devised which support service users to be as independent as possible. EVIDENCE: The most recently placed service user had been at the home for just one week and therefore the care plan was in the initial stages only. However the induction programme evidenced that staff had already organised keyworker assignment, a parent from the Relatives Group named to establish contact with the client’s family, a thorough internal assessment and registration with a local general practitioner. There are also guidelines in place in regard to the behavioural characteristics of the service user. The care plan of the service user who has been resident at the home for nearly one year was examined. Each component of the care plan cited individual strengths and needs/wants and these related to the needs/wants that had arisen from the assessment. Each component was signed and dated by the manager and keyworker. The Magnolia Court DS0000065823.V299030.R01.S.doc Version 5.2 Page 11 service user is unable to use a signature. Areas covered included emotional needs, house skills, communications, aggression management, speech and language therapy, gradual community presence and hygiene. There was a matrix of goal plans that had immediate, medium term and long term goals and an action plan review record of each goal. Thorough guidelines were present, with a record of staff signatures to show that all staff had read and understood each guideline. Care plans had been regularly reviewed and the Care Manager confirmed that there are six weekly reviews of incidences and progress by the care manager, South London & Maudsley team and the home, and regular Care Programme Approach reviews. The service user who is verbal makes his own choices and decisions, supported by staff and subject to any restrictions in his agreed behavioural guidelines. He has already decided upon his menus and was observed during the inspection to choose where he spent his time in his flat and whether he wanted to go out or not. The service user who is non-verbal expresses her preferences via her behaviours, which can be obvious such as pushing things away or throwing food to the ground, or less obvious and interpreted by staff who are now experienced with her moods and behaviours. However, the service user has made a lot of progress over the year and can now make sounds that are recognisable as some staffs’ names and some foods and drink. The challenging behaviours of the service users are severe and so risk assessments and guidelines have been written for most aspects of service users’ behaviours. Risk assessments from previous placements were obtained before placement at the home and new risk assessments and guidelines have been written in conjunction with external experts such as the South London & Maudsley team. This team includes a general practitioner, consultant psychiatrist, behavioural support practitioner, care manager and community psychiatric nurse. All risk assessments and guidelines have been signed by staff as having been read, and risk assessments have been reviewed as necessary. Magnolia Court DS0000065823.V299030.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff support service users to take part in activities appropriate to their interests and behavioural guidelines, and to be part of the local community. Staff also support and encourage service users to maintain family contact and to exercise their choices and rights. Service users are offered healthy, nutritious and culturally appropriate meals in congenial settings. EVIDENCE: Service users cognitive disabilities and challenging behaviours prevent them from being able to work or attend educational classes but staff support service users to access the local community. Both service users go out shopping, visit the park and enjoy drives out in the home’s minibus. They also go out to cafes or the pub for meals. The service user who was at the home during the summer was taken on long drives and day trips, such as to the coast. Staff maintain good relationships with the local community but there has been a noise issue with neighbours this summer (see Standard 22). Magnolia Court DS0000065823.V299030.R01.S.doc Version 5.2 Page 13 Staff support service users to maintain family relationships. One service user’s family attend review meetings and keep in telephone contact and the other service user visits their family monthly and stays for the weekend. Daily routines are flexible where this suits the service user’s needs. For example, one service user is autistic and so it is very important for staff to keep activities to a set routine. This is done and the routine can only be changed very occasionally as otherwise challenging behaviours are triggered. Staff have obviously been very successful with maintaining the necessary routine and support as the service user’s behaviours have improved to the extent that the behaviour support practitioner is considering ending his support at the home. The service user’s care manager said that there has been a “dramatic improvement” in the service user’s behaviour since her placement at the home and that she was “absolutely pleased with the service user’s progress and the staffs’ response to her needs”. The service user who is nonautistic is able to practice flexibility in daily routines and is supported to have as much independence as possible. This was evidenced on the day of inspection when the service user changed his mind about what he wished to do and whether he wanted to go out. He told the inspector he is able to go to bed and get up when he likes. Staff said they are trying to establish a routine for him during the week, as is normal, and then for him to be freer to lie in or go for day trips at the weekend. Service users have completely individual menus. These were seen and were varied and nutritious. The menus for each service user were completely different, reflecting the service users’ individual tastes, choices and ethnic backgrounds. Staff were observed to take a great deal of care in preparing the meals and in making them tasty and culturally suitable for service users. The service user who was capable was supported to assist staff in making the meal. Fridges were full, with a variety of foods so that alternatives can always be offered, and fresh fruit was available. The inspector sampled the culturally specific evening meal cooked for one service user and it was very tasty. Magnolia Court DS0000065823.V299030.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are given personal support in a way that ensures their privacy and dignity, and their physical and emotional health needs are met. The home’s procedures and practices for handling medication are thorough and protect service users. The medication policy should be reviewed to ensure it is specific to the home and the actual practice there. EVIDENCE: Observation and verbal evidence indicated that staff provide sensitive and flexible personal support in a way that promotes service users’ privacy, dignity and independence. Service users were age appropriately dressed with good personal grooming and hygiene. Because service users have very challenging behaviours there are many detailed behavioural guidelines, which staff were familiar with and understood. Staff understand the importance of consistent care for this client group and were observed to implement the behavioural guidelines with kindness and patience. Care files and daily records showed that staff ensure that service users access the full range of healthcare facilities, including the general practitioner, district nurse, chiropodist and optician. They are also supported to access a range of specialist health professionals as appropriate such as the psychologist, Magnolia Court DS0000065823.V299030.R01.S.doc Version 5.2 Page 15 continence advisor, behavioural practitioner, psychiatrist and community psychiatric nurse. The storage, administration and recording of medication was checked and found to be in very good order, including the controlled drugs. A tablet count is undertaken at each shift changeover, which is very good practice, and there are detailed guidelines for the administration of controlled drugs. The medication folder has full instructions and details of side effects for each of the medications administered, which is also good practice. Records of returned controlled drugs, signed by the pharmacist, were seen. Although the practices of medication administration at the home were thorough and no problems were found, the medication policy refers to “carrying boxes”, taking medication “to the resident’s bedside” and has an example of a drugs and medicines disposal record that is out of date and does not reflect practice at the home. The Registered Provider must therefore update the medication policy so that it is relevant and suitable to the home. See Requirement 1. Magnolia Court DS0000065823.V299030.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ views are listened to and they are protected from abuse, neglect and self-harm. However both the complaints procedure and the abuse policy need to be updated to meet required standards and reflect the actual practice at the home. EVIDENCE: The home has received no specific formal complaints but there has been one complaint involving this and the adjacent registered home, also owned by the Registered Provider. This complaint is from a neighbour regarding noise nuisance. It was investigated and progressed by the Group Operations Manager and a satisfactory solution found. Although the service users’ complaints procedure compiled by the manager contains all relevant details and is in a suitable format, the Registered Provider’s complaints procedure in the policy file is incomplete. It does not include recourse to line management above the Registered Manager, nor does it give details of the Commission, or how to contact the Ombudsman. See Requirement 2. The manager and staff at the home are fully aware of the different types of abuse and how service users can be protected. The manager has obtained copies of the local authorities’ adult protection procedure and given a copy to each member of staff, which is good practice. All staff have had training in adult abuse prevention. However the Registered Providers’ adult abuse policy does not meet required standards. Information contained in it is out of date, does not refer to adult protection procedures and does not specify when the police should be involved in the process. See Requirement 3. Magnolia Court DS0000065823.V299030.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users live in a homely, comfortable and safe environment, but repairs and maintenance needs must be carried out in a timely fashion. Service users’ bedrooms suit their needs and disabilities and promote their independence. Toilets and bathrooms provide full privacy and meet individual needs. The home is clean and hygienic throughout. EVIDENCE: The home’s premises are suitable for its stated purpose and are accessible and safe. The two flats have been designed, fitted and furnished to a high standard. Both flats are personalised according to the individual service user’s needs and preferences and both lounges have good quality furnishings and television, video and music facilities. One service user cannot have paintings or pictures on the walls due to their very challenging behaviours and the home had arranged for attractive murals to be painted so that the bedroom and lounge walls are not bare but attractive and homely. Bathroom, toilet and kitchen facilities are of good standard and the home is well decorated, clean and hygienic throughout. Magnolia Court DS0000065823.V299030.R01.S.doc Version 5.2 Page 18 There were however problems with maintenance and repair. On the first day of inspection it was noted that the washing machine was an ordinary domestic machine which did not have the required foul laundry temperature facility nor the on-going serviceability to meet the care needs of service users. The machine was due for replacement but the Registered Provider intended to replace it with another ordinary domestic machine. An immediate requirement was issued for the washing machine to be replaced by an industrial strength machine with the required foul laundry facilities. On the same day it was also found that the hot water tap in the upstairs flat kitchen was not functioning at the required temperature. The water temperature was too low and staff were having to boil kettles to prevent the risk of unhygienic conditions. A second immediate requirement was issued for the problem to be resolved. The Registered Provider implemented both of these immediate requirements within the timescales set. However on the second day of inspection, two weeks later, further maintenance problems were found. Areas of the home, such as the office, the ground floor bedroom and the first floor lounge were uncomfortably cold. This was because the radiator in the office and one of the two radiators in the very large ground floor flat bedroom were not working. In addition, the radiator covers that had been installed all service users’ radiators had very minimal openings for the radiator heat to come out from, and also did not give access to the radiator thermostats. The weather temperature had dropped considerably since the first day of inspection and it was obvious that the ground floor service user would be very cold at night in her bedroom. The service user in the first floor flat told the inspector that he found his lounge cold to sit in. Due to the urgency of the situation the inspector spoke directly with the Registered Provider’s Finance Director, one the home’s two partners, by telephone. The Finance Director arranged for the heating engineer to visit the home the following morning. The inspector was subsequently informed that all radiator cover openings had been increased the following day and that access to all thermostats had been provided. Later in the inspection, whilst looking at the monthly Regulation 26 reports by the Group Operations Manager, it was found that the thermostatic valve issue had been raised since April 2006. It was also noted that the Group Operation Manager had also recommended non-slip flooring to be put in the downstairs flat bathroom since April 2006 but both of these recommendations had remained outstanding at October 2006. See Requirement 4. The inspector was told that the non-slip flooring has recently been ordered and is awaiting installation. Magnolia Court DS0000065823.V299030.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have the competencies and qualities to meet service users’ needs and are in the process of meeting the NVQ Level 2 training target. There is an effective staff team in sufficient numbers to meet service users’ needs. Service users are supported and protected by the home’s recruitment policy and procedures, and benefit from well supported and supervised staff team. Staff have received induction and some relevant training but these do not meet Sector Skills Council specification or Learning Disability Award Framework accreditation. EVIDENCE: Observation and verbal evidence showed that staff have the competencies and qualities to meet service users’ needs. Staff are very familiar with service users’ challenging behaviours and needs and have developed strategies to manage them. They were observed to be patient and good humoured with service users, and to understand how to deal with difficult and aggressive behaviours. Documentary evidence showed that staff work positively with suitable specialist teams and professionals to ensure that the service users’ needs are met. A care manager spoken with said that she was “absolutely pleased and very happy with the care given at the home” and that staff “always respond to needs, are very compliant and flexible, and keep us updated”. The service user who has been at the home for nearly one year and has very challenging behaviours has already shown an improvement in these Magnolia Court DS0000065823.V299030.R01.S.doc Version 5.2 Page 20 behaviours. For example, small furnishings have been successfully introduced into the bedroom, the service user has been taken out into the community successfully, and the service user no longer wets themselves but goes to the toilet and also flushes it. The commitment of the staff team to observing guidelines and providing consistent care, as well as the stability of the team over the year, has all contributed to this improvement. The home has not met the recommended 2005 NVQ Level 2 training target but will have achieved it within the next six months. Two support workers have NVQ Level 2, all other support workers are studying for it and all of the seniors are undertaken NVQ Level 3. Rotas were seen and evidenced that staffing ratios meet the assessed and agreed needs of service users. One service user has 3:1 staffing during the day and the other has 1:1 staffing. There are 3 waking staff at night. As noted above, the staff team is stable, with low rates of sickness and no agency staff use. The staff team is mixed in terms of race and gender, and monthly minuted staff meetings take place. Evidence of two monthly supervision was also seen. Three staff recruitment files were checked, including the most recently appointed member of staff, and all required documentation was present, correct and in good order. This included application forms, identification, photographs, references, Criminal Record Bureau checks, medical declarations and training certificates. All staff receive induction training within 6 weeks of joining the home, which covers all basic areas necessary, with evidence seen on staff files. The National Minimum Standards requires that all staff receive structured induction training and foundation training to Sector Skills Council specification and the Registered Provider must ensure that this is the case. See Requirement 5. In addition, it is recommended that all training received by staff prior to commencement of NVQ Level 2/3 is Learning Disability Award Framework-accredited training (LDAF), as cited in National Minimum Standards 35.8. See Recommendation 1. The training record for the year beginning January 2006 showed that staff had also received training in relevant areas such as adult abuse, autism and physical intervention. However the Registered Provider does not have a training and development plan in place for the home, underpinned by funding. See Requirement 6. Magnolia Court DS0000065823.V299030.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager runs the home well and for the benefit of service users but is not yet registered. Service users’ views are sought verbally or through their behaviours, as appropriate. The health, safety and welfare of residents is promoted and protected. EVIDENCE: The manager has previous experience in managing a home for people with learning disabilities and challenging behaviour. She has obtained NVQ Level 4 and the Registered Manager’s Award, and the documentation and practices in place at the home demonstrate that she has the skills, abilities and knowledge to run the home in a way that achieves it stated purpose, aims and objectives. She demonstrated a thorough and sensitive knowledge of service users’ needs, characteristics and behaviours and a strong commitment to their rights, choice, dignity and independence. The manager sent her application for registration papers to the Registered Provider’s head office in July 2006 and the head office sent the application to CSCI that same month. However, CSCI Magnolia Court DS0000065823.V299030.R01.S.doc Version 5.2 Page 22 did not receive the papers and the Registered Provider’s head office personnel did not follow up on the situation. Hence, the manager is still not registered. See Requirement 7. The manager’s style is open, positive and inclusive with a strong commitment to service users’ rights and a well supported and trained staff team. As evidence of this, comments from an anonymous internal staff survey included “good support through supervision”, “communication is very good between the manager and the staff team”, “the home manager is very professional and highly supportive in building the staff team” and “we get a chance to voice our opinion”. A care manager spoken with said that they “were very impressed with the manager” and “very pleased with the dramatic improvement” of the service user’s behaviours and quality of life. Currently the Registered Provider monitors quality assurance at the home via the monthly Regulation 26 reports undertaken by the Group Operational Manager. However, there was evidence that the Registered Provider was either not considering these reports or was failing to act on their recommendations (see Standard 24 above). See Recommendation 2. The home had been opened for just under one year at the time of this inspection and for the majority of that time there had been only one service user, who is unable to express a view other than through challenging behaviours. It has therefore not been possible for the home to conduct a survey of service users’ views to date. However, the views of the service users family has been sought at review meetings, and the Registered Provider has conducted an anonymous staff survey. As the home was registered within the last year, it was not necessary to check health and safety documentation such as electricity and gas certificates, environmental health and London Fire & Emergency Planning Authority clearance, and small electrical appliances certificates as these would have been checked at registration. All staff have been trained in moving and handling, fire safety, first aid, food hygiene and infection control and the following documentation was up to date and in good order: • • • • • • • • • Fire alarm certificates Emergency lighting checks Fire drills Call points Control of Substances Hazardous to Health storage Weekly water temperature checks Risk assessments Daily fridge and freezer temperatures Staff rotas A problem was found with the window restrictors in use at the home, which are flimsy and not fit for purpose. They consisted of a short piece of chain at the Magnolia Court DS0000065823.V299030.R01.S.doc Version 5.2 Page 23 bottom of the window fastened between the window and window ledge by nails. If risk assessments indicate that window restrictors are needed, then the current chains must be replaced by window restrictors that are robust and fit for purpose. See Requirement 8. Magnolia Court DS0000065823.V299030.R01.S.doc Version 5.2 Page 24 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 4 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 3 3 X X 2 X Magnolia Court DS0000065823.V299030.R01.S.doc Version 5.2 Page 25 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 YA20 Regulation 13(2) Requirement The Registered Provider must ensure that its medication policy is relevant and suitable for the home. The Registered Provider must ensure that the complaints procedure contains all of the required information. The Registered Provider must ensure that the abuse policy and procedure contains all of the required information. The Registered Provider must ensure that maintenance and repairs that affect the well being and/or health and safety of service users are always carried out in good time. The Registered Provider must ensure that there is structured induction and foundation training to Sector Skills Council specifications and workforce training targets. The Registered Provider must ensure there is an adequately funded training and development plan in place for the home. The Registered Provider must ensure that the manager is DS0000065823.V299030.R01.S.doc Timescale for action 01/02/07 2 YA22 22(1) & (7) 12(1)(a) & 13(6) 12(1)(a) 13 (3) 23(2)(p) 01/02/07 3 YA23 01/02/07 4 YA24 YA30 02/11/06 5 YA35 18(1)(c) 01/04/07 6 YA35 18(1)(c) 01/04/07 7 YA37 CSA 01/03/07 Magnolia Court Version 5.2 Page 26 registered. 8 YA26 13(4)(a) The Registered Person must ensure that window restrictors necessary as part of a risk management strategy are robust and fit for purpose. 01/02/07 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 Refer to Standard YA32 Good Practice Recommendations The Registered Person should ensure that staff receive Learning Disability Award Framework-accredited training (LDAF) prior to undertaking NVQ 2/3. The Registered Person should ensure that Regulation 26/quality assurance surveys are considered and recommendations implemented. YA39 Magnolia Court DS0000065823.V299030.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Magnolia Court DS0000065823.V299030.R01.S.doc Version 5.2 Page 28 - 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. 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