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Inspection on 04/10/07 for MI CASA

Also see our care home review for MI CASA for more information

This inspection was carried out on 4th October 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 14 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Staff get on well with the people who live at the home and treat them with kindness. Staff plan activities and trips out for people and show interest in them. The home is clean, well decorated and tidy. It provides a choice of spaces for people to spend time as a group or alone.

What has improved since the last inspection?

This is the second inspection of the home since it was registered. The home has gone through a period of instability with several changes of manager in the last six months as well as changes of area manager. There has been a drop in standards. However I met with Mr Dhanak and saw that he is aware of the areas which need to be improved and has written an action plan to improve the care at the home for the benefit of residents.

What the care home could do better:

CARE HOME ADULTS 18-65 MI CASA 15 Duckett Road London N4 1BJ Lead Inspector Jackie Izzard Key Unannounced Inspection 4th October 2007 09:00 MI CASA DS0000067230.V349372.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 MI CASA DS0000067230.V349372.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. MI CASA DS0000067230.V349372.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service MI CASA Address 15 Duckett Road London N4 1BJ 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) 020 8340 2447 020 8967 3021 Precious Homes Ltd no registered manager Care Home 5 Category(ies) of Learning disability (5) registration, with number of places MI CASA DS0000067230.V349372.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th October 2006 Brief Description of the Service: Mi Casa is owned by Precious Homes Ltd and is registered to provide residential care for five adults who have a learning disability. The home is situated next to another registered care home owned by Precious Homes Ltd. Both homes are self-contained and have their own separate staff groups. The homes share one manager. Mi Casa is a large three storey terraced house that has been converted for use as a residential care home. The communal space is accommodated on the ground and lower ground floors. The lower ground floor consists of: kitchen/ dining room, laundry room, staff/ duty office, an activities/ quiet room and a storeroom; there is a small rear garden accessible from this floor. The ground floor consists of; the main entrance hall, lounge and manager’s office that also contains the medication storage cupboard and a separate toilet with wash hand basin. The five residents bedrooms all have full en-suite facilities and are spread across four sub landings along with additional toilet and shower room. The home is within easy access to local shops, restaurants, pubs, and public transport and near to Wood Green shopping city, Finsbury Park and Alexandra Park. Depending on the service users’ assessed needs, the fees for the current three residents range from £1700 to £1750 per week. Inspection reports are available from Precious Homes Ltd or the manager at the home. The stated objectives of the home include to promote: the service users right to social inclusion; their needs, aspirations and cultural values; their right to autonomy and self determination and their rights relating to leading their own life safely, positively and with dignity. At the time of this inspection, there were three people living at the home and there were two vacancies. MI CASA DS0000067230.V349372.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced. I arrived without telling the home and stayed for eight hours. To inspect the home, I did the following: • • • • • • • • • • • • • • • • Looked in all the rooms and in the garden Read two residents’ files Read four staff files Looked at records and policies in the office Talked privately with the manager Talked to three members of staff Met all three people living at the home Spent time with two of the people living at the home Talked privately with one person who lives there Watched how staff got on with the people living there Looked at the food and the menus Found out what activities people like and if they are helped to do the things they like Asked for the views of parents of people living at Mi Casa by giving them a survey about the home Read a survey written by one resident Asked staff to fill out surveys to see what they think of the home Read a form all about the home completed by Mr Dhanak and the new manager, Tristan Weedon (the form is called an AQAA) which says what they think of the care provided by the home. All this information was used to write this inspection report. What the service does well: Staff get on well with the people who live at the home and treat them with kindness. Staff plan activities and trips out for people and show interest in them. The home is clean, well decorated and tidy. It provides a choice of spaces for people to spend time as a group or alone. MI CASA DS0000067230.V349372.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: At the back of this report is a table of thirteen requirements. These are actions that Precious Homes Ltd and the manager of Mi Casa need to take to make sure the home meets the standards expected of all care homes in this country. These requirements are also actions that will improve the lives of people living at Mi Casa. The requirements are • • To make sure every resident has a care plan and risk assessment so that staff know their needs and how to support them To make sure these records are up to date; statement of purpose, residents’ contracts, complaints made To make sure there are enough staff on duty to support residents with their activities To make sure staff know residents’ health needs and look after their health by keeping good records of their health appointments To check one staff reference To improve staff training so that they understand their job and the needs of the residents better • • • • MI CASA DS0000067230.V349372.R01.S.doc Version 5.2 Page 7 • • To make sure staff are properly supervised to make sure they know what to do and to give them support and advice To get rid of broken furniture in the activity room so that people cannot hurt themselves I will come back to Mi Casa to make sure that all these improvements have been made. 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. MI CASA DS0000067230.V349372.R01.S.doc Version 5.2 Page 8 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 MI CASA DS0000067230.V349372.R01.S.doc Version 5.2 Page 9 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, 5 People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives have access to written information about the home before deciding to move there but this information needs updating. Residents’ needs are assessed prior to being offered a place but they are not provided with copies of their contracts specifying the service they will receive which could lead to confused expectations. EVIDENCE: At the time for this inspection, there were three people living at Mi Casa. I was informed that eight people had lived at the home since it opened in June 2006 but the others had moved out, either to more specialist provision or in one case to supported living accommodation. The files of two of the three residents were examined in detail and it was evident that their needs had been assessed before they were offered a place at this home. Both had been assessed by a previous manager of Mi Casa prior to being offered a place. MI CASA DS0000067230.V349372.R01.S.doc Version 5.2 Page 10 The contracts for these two people were also requested from head office as these were not available for inspection on their files. One contract was seen but this did not specify details of the service to be provided. Signed contracts including the fees were not available for inspection. There was some confusion as to whether a resident received funding for one to one staffing for specific times and this information could not be located in written form. The statement of purpose for the home was dated May 2006 and some information needed to be updated; specifically the staff information and description of a snoezelen room which does not exist. A requirement is made to update the statement of purpose and to ensure contracts are signed and in place on residents’ files. MI CASA DS0000067230.V349372.R01.S.doc Version 5.2 Page 11 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, 9 People using the service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. A lack of up to date individual care plans means residents are at risk of their needs not being fully understood nor consistently met. They are benefiting from staff who, despite a lack of guidance, are doing their best to meet residents’ needs and have formed good relationships with them. Residents are supported in their interests and encouraged to make decisions for themselves. EVIDENCE: To assess these standards, the files for two residents were examined in detail to look for a care plan, reviews of the care plan, risk assessments and daily records to see whether planned risk management strategies and planned care was taking place. The home’s self assessment completed prior to the inspection stated that each resident had a care plan and person centred plan. This was found to be MI CASA DS0000067230.V349372.R01.S.doc Version 5.2 Page 12 inaccurate. Neither of the two residents had a care plan recording their needs and how these needs will be met at the home. Both had lived in the home for six months. The manager was in the process of preparing one care plan during the inspection. This is a serious failing on the part of the registered provider. A series of changes in manager may be responsible for this failure but it is essential to the wellbeing of any resident that their needs are set out in a plan of care for staff to follow. A requirement is made to ensure care plans are completed as soon as possible. I was informed that the third resident did have a care plan but I did not request to see this. For one resident, the home was using a care plan from a previous placement as guidance. This was dated 2005. It was clear from talking to staff and observing staff-resident interaction, that staff worked hard to understand the individual needs of residents and to support them. However, it is essential that staff have guidance in the form of a current care plan to ensure they are providing the right care and consistent support for the residents. During periods of observation during the inspection I saw instances where staff respected the decisions of residents ( eg, what activity to do, where to eat, etc) and this was confirmed by talking with one resident who said that s/he received good support from staff with daily routines, leisure interests and future plans. Both residents had a risk assessment in place in their files. One was dated 23 April 2007 and had been reviewed in June 2007. The other risk assessment was dated 9 April 2007 and had not been reviewed since then. From my observation of one resident over a period of time during the inspection, it was apparent that some of the information in the risk assessment was not appropriate as it did not relate to this resident. The assessment appeared to be a standard format and not tailored to the individual and was carried out by somebody not familiar with the resident. A requirement is therefore made that risk assessments are carried out and risk management plans specific to the individual are made for staff to follow. MI CASA DS0000067230.V349372.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): 12, 13, 14, 15, 16, 17 People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents enjoy good food and good relationships with staff and their families. Their community and leisure preferences are known by staff but they would benefit from further access to activities outside the home, and the staffing necessary to support them in the community. EVIDENCE: One of the three residents attends a day service five days a week. Another is currently being supported to find employment opportunities. The third resident has a planned activity programme for staff to support him/her with during the day. Two staff said that one resident went out to parks, swimming and trampoline sessions with the support of two staff. Activity programmes were displayed in the staff office and I saw that the planned activity for the day of the inspection MI CASA DS0000067230.V349372.R01.S.doc Version 5.2 Page 14 was swimming. This could not take place as one of the two staff on duty had to take another resident to an appointment. The swimming was postponed until the afternoon, but also could not happen then as there were not enough staff on duty. I looked at the activity programme for one resident and compared the planned activities with the daily records over a period of 23 days as evidence as to whether the activities were taking place. On nine of the twenty-three days the planned activity did not take place which was more than a third of the time. Records showed good use was made of a local park for exercise and there were trips to local shops and cafes. Planned trips to parks further afield and to swimming pools and trampolining were not taking place as often as planned due to the need for three staff to be on duty and the home not adhering to this staffing level when these activities were planned. Staff spend time in the home with residents; talking and sharing their interests. It was evident from observation and from discussion with two staff and one resident that staff have formed good relationships with residents who feel comfortable with them. Residents have regular contact with their families. Relatives are welcome in the home and records showed that families took the residents out or to stay with them when they wished to. I was able to speak privately with one resident to find out his/her views about the lifestyle s/he is living at this home. The other two residents were unable to give their views verbally. A survey was given to the manager for these residents’ families to complete giving their views on the service provided at the home. No response was received by CSCI from the families. The resident who was able to give an opinion, said that s/he was very happy at this home, was supported by staff and was able to follow his/her interests and career aspirations with help from staff. The home provides television, DVD and music facilities for residents. There is a room in the basement which is intended to be developed as a sensory room. Currently some activities do take place in this room but it is also used for storing old and broken items. A requirement is made to improve this room to meet the residents’ needs as it is advertised in the home’s guide as a sensory room. Staff said that residents will be supported to go on holiday which the company will pay for. Staff knew the activity preferences of the residents and spent time with them in a positive way, including them in domestic tasks and interacting with them in positive and respectful way. MI CASA DS0000067230.V349372.R01.S.doc Version 5.2 Page 15 Despite the lack of care plans to guide staff in their day to day work with residents, I observed that staff knew the wishes of residents and respected their choices even when this was a choice to not cooperate with what staff had asked of them. Staff spoke calmly and respectfully to residents when asking them to carry out requests. Staff on duty were also able to tell me about residents’ challenging behaviour and how to respond if this behaviour happened. I observed that residents could choose whether to be alone or with staff and that staff supervised them from respectful distance when needed. Residents also showed they had unrestricted access to the rooms in home by leading me where they wished to fo. These examples showed that staff respected residents’ rights to make choices and decisions for themselves in their daily routines. One resident was able to explain how staff support him/her with whatever s/he asks for support with and do not impose their own ideas. The menu was seen as well as the current supply of food in the home. On Saturdays, the residents have a takeaway meal which the company pays for. One resident takes part in cooking meals. The menu was satisfactory in terms of nutrition. Menus showed that staff provide cooked meals twice a day and a choice of breakfast. MI CASA DS0000067230.V349372.R01.S.doc Version 5.2 Page 16 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 People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents receive the personal care they need but their health needs are not recorded sufficiently to show that that their health needs are fully met. EVIDENCE: Although two residents had no care plan outlining their personal care needs, staff had gained information (from previous plans from other placements/assessments/information provided by parents) on their personal care needs and wishes. Staff had changed the personal care routine for one resident at the request of his/her parent. One resident was independent in this area of care but the other two needed help with bathing, teeth care, dressing etc. It was noted that all residents were dressed in well fitting clothes and appeared to have a good level of personal care on the day of the inspection. MI CASA DS0000067230.V349372.R01.S.doc Version 5.2 Page 17 Two residents’ files were inspected for evidence of their health care needs being known and met and clear records of appointments to medical professionals. One resident had no record in his file that he was registered with a GP though the manager said that he was. There was a record that this resident would be attending an appointment with a dentist on 22 October. The other resident’s file showed that s/he had visited their GP in August and a follow up appointment was arranged. The resident did not attend the follow up appointment but the reason for this, although known by the manager, had not been recorded. This resident has a new health action plan recently written which is positive. A requirement is made that residents’ health needs are recorded and met. A sample of medication records and the medication stogre cupboards were also inspected. These were satisfactory. One staff member raised a concern that medication training was not sufficient. Some staff were awaiting training in medication before they are able to support residents with their medication. This was to take place the day after the inspection. MI CASA DS0000067230.V349372.R01.S.doc Version 5.2 Page 18 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, 23 People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The company have provided a clear complaints procedure but have not kept a record in the home of complaints made. This is required so that residents and their representatives can be assured that their views are listened to. Residents will be better protected from risk of abuse when staff receive the planned training in this area, which is due to take place in the near future. EVIDENCE: The home has a complaints procedure and this is available in a pictorial form to make it easier for some of the residents to understand. Others are not able to understand the procedure in any form but a copy of the service user guide which contains this procedure has been given to their parents. The home did not have a record of complaints available for inspection. I was aware that one relative of a resident had made a formal complaint to Precious Homes Ltd about the care but no record of this complaint was in the home. A requirement is made to ensure this complaint along with the action taken and outcome is recorded, plus any other complaints received, in the home in a central complaints file. There have been no adult protection investigations about any of the current residents whilst living in this home. The company, Precious Homes Ltd, MI CASA DS0000067230.V349372.R01.S.doc Version 5.2 Page 19 provides staff with training on the protection of vulnerable adults which is undertaken by a manager within the company. The new manager said he was not aware of any allegations of abuse being made regarding anyone in this home. The Business Development Manager for Precious Homes Ltd was due to train staff in the protection of vulnerable adults procedures shortly after this inspection. At present, some staff are not trained in this area. I looked at the financial records for one resident. Staff were recording expenditure and keeping receipts of purchases. Residents’ financial records were being checked daily by staff so that any errors could be addressed and rectified without delay. This is good practice. I had been made aware prior to the inspection that residents had paid for staff meals when staff were out with them. This contravenes company policy and I was informed that residents had been reimbursed and staff informed of the correct procedures. There was an occasion where a resident had bought a meal in a café. The registered provider was asked what the company policy was regarding residents paying for meals out and he said that residents are expected to cover the cost of their own meal when they eat out. A recommendation is made that this is recorded in the policy on residents’ finances so that the residents (and their representatives in the case of those who cannot understand) are aware of this policy. MI CASA DS0000067230.V349372.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 30 People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefit from a home which is comfortable, well decorated and offers a range of spaces to spend their time in. The standard of cleanliness is good. EVIDENCE: A tour of all rooms in the building was carried out. It was noted that the standard of cleanliness and tidiness on the day of the inspection was very good. Each resident has a bedroom with ensuite bathroom and there are extra toilets and shower room. Residents can spend time in the lounge, dining room, their own room or in the activity room in the basement. This room is described as a sensory room in the guide to the home but has not yet been developed into a sensory room. Residents spent some time in this room during the inspection MI CASA DS0000067230.V349372.R01.S.doc Version 5.2 Page 21 and showed enjoyment. The manager said he is keen to develop this room to better meet the needs of the residents. The rooms were well decorated and bedrooms are personalised with pictures and personal items. There are suitable laundry facilities. One resident was asked for his/her views on the building and said that s/he liked it and was pleased with his/her bedroom facilities. The manager said he is considering how to develop and improve the garden to make it more homely and inviting for residents. MI CASA DS0000067230.V349372.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33, 34, 35, 36 People using the service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. Although there is evidence that Precious Homes Ltd are working on positive improvements which will benefit residents, at the time of this inspection staff were inadequately trained and supervised and staffing levels did not always meet residents’ needs. EVIDENCE: It was not possible to fully assess standard 32 regarding the qualities and competence of staff due to the lack of records of their induction training. NVQ training was not assessed at this inspection. It was noted that some staff were inexperienced and had little knowledge of disability. A requirement to provide induction training will improve staff skills. The qualities of individual staff on duty were assessed by observing them in their duties and those seen did show interest and motivation towards residents who in turn showed they felt comfortable with staff. MI CASA DS0000067230.V349372.R01.S.doc Version 5.2 Page 23 I looked at staffing levels to see if they were sufficient for meeting the residents’ needs. This was done by discussing staffing levels with the registered provider, manager, two staff and one resident plus reading views of three staff in the surveys they completed. In addition, I looked at the staff rotas, activity programmes for residents and daily records to see if the activities had been carried out and how many staff were on duty on these days. One staff member wrote in their survey that there were usually enough staff on duty, another said there were sometimes enough staff to meet individual needs. A third said there were never enough staff. Examination of staff rotas showed that there were at times not enough staff on duty for residents to be able to go out and take part in their planned activities. A requirement is made to ensure staffing levels are sufficient to meet residents’ needs. Although it is not recorded in writing I was informed that the current staffing requirements are two staff in the morning and three in the afternoon/evening. The rotas inspected showed that 50 of the time this staffing level was not provided and only two staff were on duty. If all residents want to go out on a planned activity staff said that two staff is sufficient, however one resident needs two staff when out so if another resident does not want to go out on the planned activity then staff cannot take the resident who does want to go. A more flexible rota with sufficient staff provided for planned community activities would benefit all the residents. The files of staff were examined to look for evidence of a thorough vetting process before employment and of adequate training and supervision being provided to ensure staff are carrying out their duties properly. Staff members had completed an application form before employment and had references. There was a discrepancy with one reference which was raised to the manager and a requirement made to check this reference was accurate. Precious Homes Ltd had taken out Criminal Records Bureau checks on staff before employing them. These were not kept in the home but were sent to the home for inspection by head office staff when requested. These showed evidence that the company had vetted staff before allowing them to start work. The home’s self assessment sent to the Commission for Social Care Inspection a few days prior to the inspection (called an AQAA) stated that the company plans to involve residents in the future recruitment and appraisal of staff. Of the three files inspected, none had a written record of induction training which is essential for understanding company policies and procedures and the needs of the residents. I was informed that induction training takes place at head office but that no record is made there. There was therefore no evidence that these staff had any induction before starting work in this home. There was also no written record of the manger having a formal induction. MI CASA DS0000067230.V349372.R01.S.doc Version 5.2 Page 24 Training records show a lack of training being provided for staff in the required topics needed to undertake the duties of the post. The registered provider had taken action to address this and has produced a training programme. Staff did not have an individual training needs analysis on their files and this is needed when planning training. Staff were to attend medication training the day after this inspection. Supervision records were unsatisfactory. One staff had two supervision sessions in seven months and was therefore not up to date as the requirement is a minimum of six sessions a year. One staff member told me s/he had received one supervision session but had not been given a copy of the minutes of the session and there was no record on this person’s file of any supervision. The other had no records of any supervision taking place. The new manager was aware that supervision was not up to date and had started supervising staff since his employment. It was of concern that night staff work on their own and may not have been provided with induction training or supervision to ensure they are equipped to carry out their duties and meet the needs of residents. MI CASA DS0000067230.V349372.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Although since the last inspection, this home has not been well managed due to changes of manager, and has experienced a time of difficulty, the provider is aware of the home’s shortcomings and has plans to improve standards, which residents will benefit from. Residents can be assured that the home will be monitored to ensure standards improve. EVIDENCE: There have been five different managers this home in the last six months. This has resulted in some deterioration in standards. Records in the home MI CASA DS0000067230.V349372.R01.S.doc Version 5.2 Page 26 showed there have also been four changes of Area Manager in the same time. The provider said that the area manager post had been advertised and that the current area manager was temporary in the post. I met with the registered provider in respect of Precious Homes Ltd, Mr Mitesh Dhanak, two weeks prior to the inspection to discuss the issues and concerns. Mr Dhanak was able to demonstrate that he was aware of the areas which need improvement and has produced an action plan for raising standards in the home. He had also provided objectives for the new manager to achieve with timescales. The area manager is conducting monthly unannounced inspections for the home and sending copies of these reports to the manager and to Mr Dhanak. These reports are also being sent to CSCI so that progress can be monitored. The current manager had only been in post for a few weeks at the time of this inspection and was working hard to improve the areas which had fallen below standard. He said he has been receiving good support from senior managers within Precious Homes Ltd which is very positive. It is not yet possible to assess the manager’s competence as he has not yet applied for registration with the Commission for Social Care Inspection, which he is in the process of doing. The manager said he intends to stay in the job and, although not qualified, is registering on the registered manager’s award to qualify him for the registered manager post. The last two monthly reports on the conduct of the home by the area manager were read. These show that the home is being monitored on behalf of the registered provider. The annual Quality assurance surveys which consult residents and their representatives for their views has not yet taken place this year. This will take place when the current action plan to raise standards has been completed. The fact that an action plan has been produced shows evidence that the provider is aware of the shortfalls in the service and intends to improve them. A sample of health and safety records were chosen for inspection on this occasion. These included fire safety checks and electrical checks. An electrical inspection took place in May 2006. The fire alarm system was inspected and found to be working properly in March 2007. Staff are expected to check the fire alarm is working every week and keep records of these checks as required. Records showed that this had been taking place except for one week before the inspection. The manager said he would ensure this was undertaken straightaway. A tour of the home was undertaken and no health and safety hazards were noted. The level of hygiene in the kitchen was very good. MI CASA DS0000067230.V349372.R01.S.doc Version 5.2 Page 27 It was not clear from records whether staff have been provided with training in the required health and safety topics of first aid, food hygiene, infection control and fire safety so a requirement is made to ensure this takes place. Window restrictors were in place to reduce risk of accidents and the home was well maintained. A requirement is made to remove broken items in the activity room as these could be a danger to residents and staff. MI CASA DS0000067230.V349372.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 2 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 3 25 3 26 X 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 2 34 2 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 2 x LIFESTYLES Standard No Score 11 x 12 2 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 x 3 X 3 X X 2 X MI CASA DS0000067230.V349372.R01.S.doc Version 5.2 Page 29 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 2 Standard YA1 YA5 Regulation 4(1)(c) sched 1 5(3) Requirement The registered persons must ensure the home’s statement of purpose is updated and accurate. The registered persons must ensure signed contracts are in place for each resident in the home. The registered persons must ensure that each resident has an individual care plan in place which all staff are familiar with. The registered persons must ensure that each resident has an individual risk assessment and risk management plan which all staff are familiar with. The registered persons must ensure that staffing levels are adhered to so as to ensure that residents can take part in their planned activity programmes. Agreed staffing levels for the home must be recorded in writing so that staff, residents and their representatives are aware of what to expect. Timescale for action 07/11/07 31/12/07 3 YA6 15(1)(2) 07/11/07 4 YA9 13(4)(c) 07/11/07 5 YA12 YA33 18(1)(a) 07/11/07 MI CASA DS0000067230.V349372.R01.S.doc Version 5.2 Page 30 6 YA19 13(1)(b) 7 YA22 17(2) sched 4(11) 8 YA34 19(1)(c) 9 YA35 18(1)(c) 10 YA36 18(2) 11 YA35 18(1)(c) The registered persons must ensure that residents’ health needs are known, recorded and met. Records must be kept of the outcome of medical appointments to ensure that residents’ health can be closely monitored. The registered persons must keep a record of all issues raised and complaints made including details of the investigation, action taken and outcome in the home. The registered persons must clarify the discrepancy on one staff member’s reference to be satisfied that the reference is authentic. The registered persons must ensure that the manager and all staff working at this home have structured induction training which is recorded and placed in their files as evidence that it has taken place. The registered persons must ensure that all staff working in this home receive individual supervision at least six times a year with records kept of each session and placed on their files. The registered persons must ensure that the training needs of each staff member are analysed and recorded in an individual training profile. The registered persons must remove old and broken items from the activity room which could prove a danger to residents and staff. 07/11/07 04/11/07 04/11/07 09/11/07 01/10/08 09/11/07 12 YA42 13(4)(a) 07/11/07 MI CASA DS0000067230.V349372.R01.S.doc Version 5.2 Page 31 13 YA42 18(1)(c) The registered persons must ensure all staff have been trained in safe working practice topics as detailed in standard 42 of the national minimum standards for care homes for younger adults. 31/01/08 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 Refer to Standard YA23 Good Practice Recommendations The company policy regarding residents paying for meals taken outside the home should be included in the policy and procedures regarding residents’ finances so that residents and their representatives are aware of it. MI CASA DS0000067230.V349372.R01.S.doc Version 5.2 Page 32 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 MI CASA DS0000067230.V349372.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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