Inspection on 16/06/06 for Mountearl House

This inspection was carried out on 16th June 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mountearl House 19/03/09

Mountearl House 29/12/07

Mountearl House 03/01/06

Mountearl House 04/08/05

Mountearl House 06/12/04

Mountearl House 09/08/04

Mountearl House 02/02/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Mountearl House 73 Leigham Court Road Streatham London SW16 2NR Lead Inspector Mary Magee Unannounced Inspection 16th June 2006 10:00 Mountearl House DS0000022744.V299882.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 Mountearl House DS0000022744.V299882.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. Mountearl House DS0000022744.V299882.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mountearl House Address 73 Leigham Court Road Streatham London SW16 2NR 0208-769-0322 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) The Robinia Group PLC Miss Aida Seferovic Care Home 10 Category(ies) of Learning disability (10), Mental disorder, registration, with number excluding learning disability or dementia (10) of places Mountearl House DS0000022744.V299882.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd January 2006 Brief Description of the Service: Mountearl House is home to ten people with learning disabilities. Some have additional mental health needs. It is located in a large listed building close to the main shopping area of Streatham. It is owned and managed by Robinia Care who manage several care homes for people with Learning Disabilities. Local amenities are located within a short walking distance away as is local public transport. The house is divided into four main areas - ground floor, first floor, bed-sit and annexe. There is no lift to the first floor and the home does not have CCTV cameras. There is a lounge on the ground floor of the main area of the building. The dining room is located on the first floor with the main kitchen alongside. The annexe area is detached from the main premises. It has two bedits as well as a separate lounge and kitchen. The home has a large garden to the rear of the property. Parking facilities are good with a large parking area available to the front of the home. Fees range from £2000 to £3000 per week. Mountearl House DS0000022744.V299882.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 16th June 06. The home manager and five members of staff were present. Seven of the current service users met with the inspector. Four relatives and two care managers were spoken to by telephone. A tour of the home was conducted All the communal areas and five bedrooms were viewed. The views of those spoken with are incorporated into the inspection report. What the service does well: What has improved since the last inspection? The home has made great improvements to the environment. The premises are well maintained and pleasantly presented. A number of areas have been refurbished. As a result service user find the environment comfortable and relaxing. Mountearl House DS0000022744.V299882.R01.S.doc Version 5.2 Page 6 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. Mountearl House DS0000022744.V299882.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 Mountearl House DS0000022744.V299882.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): 23 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to the home. Service users live in a home where their needs are fully met by a consistent and stable staff team that they are familiar with. The home makes referrals as appropriate to external professionals when necessary so that any additional needs that arise may be considered. EVIDENCE: Service users have all lived at the home for a number of years. Staff are familiar with their needs and their individual personalities. A good relationship has been established between service users and staff. Relatives also find that staff are responsive and that they address promptly any issues raised. The interaction observed between staff and service users was good, support workers sat with service users and engaged with them. Service users were relaxed and at ease expressing their feelings. A service user’s mother spoken to finds that her son experiences an excellent quality of life since moving there to live, he previously had resided at a long stay hospital. She finds that staff know his personality and are good in how they manage her son’s moods and challenges. Each service user has a care plan developed from a needs assessment, the care plans also detail restrictions necessary to safeguard individuals. Professionals such as behaviour specialists and psychologist are involved in working alongside staff and making recommendations on rehabilitation and therapeutic programmes. Mountearl House DS0000022744.V299882.R01.S.doc Version 5.2 Page 9 The needs of service users are understood by staff. This was demonstrated throughout the inspection, particularly effective is the way staff communicate with service users. For one service user that is non-verbal a support worker showed her competence in communicating with him and explained to the inspector the indicators, these were how staff understood what he was expressing. A support worker spoke to another service user that displayed challenging behaviour calmly but firmly. The response from the service user was positive with him recognising the boundaries while receiving reassurance from staff. A behaviour specialist from the multidisciplinary team is working with staff to ensure that the best outcome is achieved for the service user. The staff team have worked with service users for some time with not much change experienced in staffing personnel. Relatives spoken to have found this to be very beneficial and has given stability and security to service users. Staff are consistent in their approach and know the importance of this to service users. Good communication is evident at handovers, all areas concerning the welfare of service users is written and discussed at handover periods throughout the day. Examples were seen of records made at handovers when areas of concern were identified and highlighted so that staff pay particular attention to these changes and access additional help promptly. The specific cultural needs of service users are recognised and met. Examples of these seen were the presence of staff that share similar cultural backgrounds, records showed evidence of staff regularly supporting a service user to develop his cooking skills and prepare Caribbean dishes that he likes. A service user has developed additional support needs demonstrated at periods by his inappropriate behaviour in the community. Staff at the home work with the probation officer and support the service user in the community. A referral was made to the learning disability team and mental health team. A review took place. The outcome of the review was that the service user’s needs have changed dramatically and that he requires a placement in a more secure unit. The inspector spoke to the placement officer about the future plans. A specialist unit had been identified as a suitable placement. The manager discussed with the inspector the role of staff in assisting the service user with the transfer. She said that together with support staff the move would be coordinated with the service user and relevant authorities. Mountearl House DS0000022744.V299882.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): 679 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to the home. The arrangements in place for delivering care and support safeguard service users and take into account individuals’ changing needs and the achievement of personal goals. EVIDENCE: Care and support plans for two service users were examined. For one of the service users a copy of a recent statutory review was also present. The outcome of the review was that the home was meeting his needs successfully. An internal review had also taken place. Three parents were spoken to. All of them are satisfied that the services provided are good and find that their sons/daughters are well cared for and safe. Two parents described the progress that their sons had made and find that the placements are very suitable. Both service users’ plans were examined. They had all the essential details on their support needs. They also contained plans on how to manage the risks identified. The input of the psychologist was also evident and included in the guidance. Evidence was present on records seen that staff follow the recommendations made. Mountearl House DS0000022744.V299882.R01.S.doc Version 5.2 Page 11 Behaviour charts as recommended by the behaviour specialist are maintained for a service user. These gave a full picture of the pattern of the particular challenges displayed by service users; they are used at internal and statutory reviews. Staff demonstrated their knowledge when spoken to about how they manage particular risks and the reason for the absence of unsuitable items such as pictures and mirrors and ornaments. In a service user’s bedroom staff had identified items that could be a danger. Glass protectors were in place on the window to prevent a service user from injury from glass. Other rooms had plastic mirrors. Another service user that has frequent outbursts of challenging behaviour and is prone to damaging the contents of the room, to respond to this need he has sturdy furniture in place. The service is clear when incidents need external input and who to refer the incident to. Examples were seen and quoted of appropriate referrals made to other professionals. Mountearl House DS0000022744.V299882.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): 11 12 13 14 15 16 17 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to the home. Service users receive the support to lead meaningful and fulfilling lifestyles outside the home. More consideration and options need to be explored to consider the needs of the small number of service users that choose not to engage in activities. Meals are healthy and balanced and take into account individual cultural, religious and health needs. EVIDENCE: Feedback from service users’ parents and from service users was that the home provided an environment where service users live ordinary and meaningful lives. Service users have plenty of opportunity to develop and grow as individuals and feedback from three relatives was that great progress has been made in this area. Service users receive support and counselling including therapy as necessary and in accordance with plans of support. The capacities and abilities of service users are considered. The registered manager quoted examples of the response by service users to support received to maintain and develop emotional and independent living skills. Mountearl House DS0000022744.V299882.R01.S.doc Version 5.2 Page 13 A small number of service users attend regular college courses. Other service users attend day centre activities. Two of these returned from daycentres during the inspection. One service user in the older age group enjoys walks to the local shops as well as day trips. A member of staff is always present to support him with these leisure interests. Annual holidays are planned with service users. The home has successfully supported a service user to enjoy a holiday last year. This was a great achievement by staff as the service user displays extremes of challenging behaviour and chooses not to engage in any activities externally. A service user’s mother spoke of the caring spirit fostered at the home, she said, “ staff are kind, helpful making sure that it feel like a family unit”. Her son she said leads a full life, the activities range from two hours of swimming to football and attending college. She spoke of his experience at a previous placement where care was institutionalised. He has progressed very well since moving to Mountearl. Another mother spoke of how responsive staff are at the home to her son’s needs. Another area she is reassured by is the quality of life all other service users experience. She visits her son regularly. While present at the home she is interested in the welfare of all service users. The practices she observes are that each service user is treated as an individual and well cared for. Programmes of activities have been developed with service users, copies are displayed in the office. The majority of these involve participation in external activities in the community. It was acknowledge that services are flexible and are tailored to recognise that a service user may choose to participate in activities other than those on the planned programme. The inspector observed a key worker sitting with a service user and discussing what activities he would like to explore further that day. Service users demonstrated that they are supported to pursue particular interests or hobbies. The inspector found evidence that for a small number of service users there was a shortfall in the activities available at the home. The inspector recognises the difficulties encountered in engaging these service users. The home needs to explore further options and seek to introduce more activities in the home for service users that do not engage in activities in the community. This shortfall was also raised by a care management team with the inspector. It is detailed as a requirement. Service users have unrestricted access to the home and grounds except in certain circumstances and in accordance with agreed restrictions. For a number of service users risks have been identified. As a result they are not permitted to leave the home unless supported by a support worker. Consultation has taken place with a dietician following a requirement set at the previous inspection. This related to the promotion of health eating at the home. Mountearl House DS0000022744.V299882.R01.S.doc Version 5.2 Page 14 Menus are planned with service users in advance. Menus are available in picture formats so that service users may choose exactly the meals that they enjoy. This practice was observed by the inspector. Service users have the option of choosing alternative menus if they do not wish to select from the main menu. The dining room is conveniently located to the kitchen. It is comfortable and homely and conducive to a relaxed environment. Culturally appropriate menus are available, individual health and dietary requirements are also considered in the planning of meals. Staff demonstrated a good knowledge of individuals’ health needs and dietary requirements. They spoke of the medical condition experienced by a service user, he is restricted to the amount of fluids he takes otherwise he is at risk due to his medical condition. They spoke of how this was managed and monitored effectively. Service users spoken with indicated how much they enjoyed their meals. This view was also supported by the comments received from relatives. Progress has been achieved by service users with the capacity to develop cooking skills. On diary notes there was evidence of a service user regularly receiving the support he requires to cook his meals. Another service user benefits from the support of the behaviour specialist and a support worker as she participates in some light cooking duties. Contents of the fridge and freezer included a supply of fresh and wholesome ingredients. Mountearl House DS0000022744.V299882.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 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. The judgement has been made using available evidence including a visit to the home. The support and encouragement from staff ensure that service users receive the assistance they require and in a way that they prefer. The healthcare conditions of service users are monitored carefully with prompt action taken to address any concerns or problems identified. Medication polices are put into practice and ensure that service users are protected. EVIDENCE: Support workers encourage and support service users to take pride in their appearance. Guidance and personal support is given in private, service users have the option of having showers or a bath. Service users appeared well groomed and were dressed in clothing that that reflected their individual personalities and personal taste. One service user showed the inspector new trainers that he had bought recently. A female service user, although seldom accesses the community, was pleased with latest fashion she had chosen. Service users receive individual support from staff to shop for clothing and toiletries. Magazines were present in the lounge, one service user that is nonverbal was busy viewing and selecting items that he liked. His support worker was attentive and encouraged him. Mountearl House DS0000022744.V299882.R01.S.doc Version 5.2 Page 16 The service consistently promotes equality and diversity. The staff team comprises of persons from similar ethnic and cultural backgrounds as service users. They are able to translate their understanding into positive outcomes for people who use the service in the areas of race, ethnicity, age, sexuality, gender, disability and belief. Personal support is provided at the home by same gender carers where possible. The registered manager spoke of the further training planned for the team to further develop staff’s understanding of equality and diversity. Records were seen of appointments attended with healthcare professionals. Service users receive the support of staff to access these appointments. The physical and emotional health care needs of service users are monitored closely. There was evidence on daily records and on review notes that prompt action is taken when issues of concern or notable changes are identified. A former service user experienced frequent relapses in his mental state. This was reviewed on an ongoing basis. He was supported to attend appointments with psychiatric services. Despite all the support he received it was unable to prevent readmission to hospital for treatment. Health action plans are in place for all service users. Records are maintained up to date and gave an accurate picture of the present situation. These provide valuable information at internal and statutory reviews. Medication reviews for service users are undertaken regularly by the GP. Senior trained members of staff administer medication, the list of these staff plus signatures are maintained. Medication is delivered in blister packs. No errors or admissions of signatures were identified. In addition a daily audit is undertaken of medication administered PRN and of that not held in blister packs. Mountearl House DS0000022744.V299882.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 23 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to the home. Service users are better protected since adult protection procedures have become more robust. Service users and relatives feel confident in raising any issues of concern or if they are unhappy with any aspect of the service. EVIDENCE: Adult protection issues that include any allegations are reported to the local authority, with the home responding and investigating as recommended by the lead person in the local authority. Previously Adult Protection investigations were undertaken by personnel that were sometimes unfamiliar with correct procedures. This on occasions resulted in investigations that were not always thorough. Recently five senior managers within the organisation have been trained to investigate thoroughly any allegations under the Vulnerable Adults Policy. At the regular staff meetings the topic of protecting vulnerable adults is always included on the agenda and discussed with staff. One allegation was recorded since the last inspection. This was not substantiated following investigations. Physical and verbal aggression by service users are understood by staff and dealt with appropriately. Response to these behaviours by staff was observed directly during the day of the inspection. The communication between service users and staff is good with staff familiar with individuals’ method of communication and understanding the signals when a service user is unhappy or displeased. Mountearl House DS0000022744.V299882.R01.S.doc Version 5.2 Page 18 Five service users have their own bank accounts. The organisation holds a corporate account for the remaining three service users, Robinia is also the appointee by DWP. The policies and practices regarding service users’ monies and financial affairs are good. Copies of individual statement show clearly all transactions in the accounts. The recording system observed for monies held demonstrated that all expenses were backed by appropriate receipts and signed for on each transaction. The area manager completes monthly audits of the management of funds and expenses. Money is held in individual purses that are labelled and stored in a locked cabinet. This was accurate and corresponded with written records when checked by the inspector. From speaking to relatives and service users evidence supplied indicated that complaints were dealt with satisfactorily at the home. No complaints have been logged since the previous inspection. Service users appeared comfortable with expressing their views to staff. Parents spoken to have found staff to be responsive and helpful when any issues are raised. All those spoken to have raised the issues verbally and did not feel it necessary to record these as complaints. The complaint procedure should be developed further. A format should be introduced to record pattern of complaints or issues raised. All issues raised by service users or relatives need to be logged in writing. Mountearl House DS0000022744.V299882.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 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 good. The judgement has been made using available evidence including a visit to the home. Service users benefit from living in a pleasant safe clean well-maintained environment. Garden furniture is needed so that service users may utilise the spacious garden to the rear. EVIDENCE: The home was well presented on the day of this unannounced inspection. This included both internally and externally. It is a period residence and efforts have been made to retain the character and features of the premises. All communal areas were toured. These were bright and pleasantly decorated and contributed to the overall ambience of the home. Pictures are displayed that enhance the colour scheme and give it a homely touch. The annexe area at the side of the home currently has one service user. The building is detached from the main home. The inspector found that access from this area to the main building relies on the use of a keypad or a doorbell. Although the current service user is familiar with the routines of the home it could pose a problem during busy periods if staff are engaged with other service users. The registered person should ensure that better provision is made for service users living in the annexe area to access the home. Mountearl House DS0000022744.V299882.R01.S.doc Version 5.2 Page 20 A number of improvements have been made. New comfortable couches have been provided in the lounge. The dining room has also been furnished with new dining tables and chairs. Four bedrooms were viewed. These were clean and comfortable. Bed linen and furnishings were colourful and clean. All bedrooms viewed were spacious and well maintained. A number were personalised, one room was without many items of personalisation. This was due to the individual needs of the service user and the personal history in relation to effects. One service user’s room had a wardrobe that required repair. The service user experiences spells of challenging behaviour and misuses the furniture. The necessary repair had been recorded and was placed in the maintenance book for attention. Repairs at the home are responded to more swiftly with regular maintenance persons employed to carry out these duties. Carpets have been replaced in some communal areas with wooden flooring, a service user commented on how much he liked the new floor. Requirements stated at the previous inspection relating to cracked glass on the landing, stained carpets and bathrooms needing refurbishment have all been addressed. The garden looked very pleasant with well maintained shrubs and flowers at the front. The rear garden is flat, easily accessible and spacious. There is little shade and not many service users make use of it. There is no garden furniture available to enable them use the garden. The registered person should ensure that provision is made for service users to make use of the garden by the provision of suitable outdoor furniture. Mountearl House DS0000022744.V299882.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 32 34 35 36 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to the home. Service users have confidence and trust in the staff team that care for them. The team is stable and reliable. The organisation provides a wide range of training so that staff have the skills and knowledge. Areas of weakness regarding individual supervision and lack of attendance at training the inspector feels confident the home is addressing. EVIDENCE: All staff have a current job description. From discussions with three staff members all of them demonstrated a clear knowledge of their roles and responsibilities. They enjoy their roles and are familiar with service users’ needs. The majority have worked at the home for a number of years which gives service users and their families reassurance. Relatives spoken find that this has given great stability to service users. Staff spoken have participated in regular training to keep their skills and knowledge updated. Observations were made of staff interacting with service users. Records viewed had evidence of frequent episodes of challenging behaviour by some service users. On the inspection day it was observed that staff demonstrated great competence and ability to understand and respond appropriately to individual needs and manage these challenges. Service users expressed verbally and by body language how secure they felt with the staff team. The team is stable and has not experienced many changes to staffing overall. Mountearl House DS0000022744.V299882.R01.S.doc Version 5.2 Page 22 A large number of staff have worked at the home for four to five years. For one of these staff members two written references had not been filed at the time of appointment. The registered manager spoke of the difficulties acquiring a second written reference for a member of staff after this period of time. She also reported that the member of staff referred to above has been found to be satisfactory since commencing employment. Annual appraisals are completed with staff. Not all had been completed at the time of inspection. Regular team meetings are held which staff said they find valuable. One to one supervision is provided. Improvements were found in how frequently staff receive supervision, some receive it at least every two months. However it needs to be at least six times a year for all staff. This was the subject of a requirement at the previous inspection. It is restated as a new requirement. No new members of staff have been recruited since the last inspection. One new member of staff has been interviewed. She had not commenced work as all the necessary information had not been received. Staff files viewed were for three staff that have worked there for some years. Enhanced disclosures by the Criminal Records Bureau were available on staff files. The organisation takes prompt action to address any irregularities in staffing records. A member of staff had his contract terminated recently when it was discovered that there were some anomalies when completing his application for a new CRB. The organisation recognises the importance of training for staff and delivers a training programme that is comprehensive. The registered manager confirmed that of the seventeen staff employed nine have completed NVQ Level 3 in care. The training profile for staff was supplied to the inspector. The programme included future training planned for 2006. The inspector examined the records of training delivered. This showed that the majority number of staff participated in mandatory and other additional training and development. Areas of shortfalls were identified in the training provision to a small number of staff including a bank staff member. The following areas where training was overdue included First Aid, Fire Training, challenging behaviour and mental health. It is essential that management address this problem where individual staff members have become complacent about training. The registered manager was spoken to about these shortfalls. She is confident that these training needs will be discussed at supervision sessions and that they will be addressed promptly. Mountearl House DS0000022744.V299882.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 39 40 41 42 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to the home. Service users benefit from living in a home that is well managed and where service users are placed at the heart of the service. The health safety and welfare of service users are promoted and protected. EVIDENCE: The home is run by a manager that is keen and motivated. She leads by example and demonstrates a clear commitment to achieving the best outcome for service users. The inspector found service users to feel reassured and secure by her presence and guidance. She has completed NVQ Level 4 in care; she hopes to have completed the Registered Manager’s Award by the Autumn 2006. There is a strong ethos of being open and transparent in all areas of running of the home. The manager is regarded highly by other professionals involved with service users care. She is person centred in her approach, and leads and supports a strong staff team. The home also benefits from an experienced deputy manager who assists with delegation of tasks and the supervision of staff. Mountearl House DS0000022744.V299882.R01.S.doc Version 5.2 Page 24 Staff have been recruited and trained to a standard that ensures that they are fit for their role. The manager is aware however of the need for all staff to continue with training and development and assured the inspector that she will pursue this objective. The organisation uses a number of methods to monitor and evaluate the quality of the service and measure how effective the home is at meeting it’s aims and objectives. These range from regular service user reviews to Regulation 26 visits. The organisation has appointed a quality assurance system manager with responsibility for further developing the quality assurance system. It is recommended that the report on the outcome of the first full quality audit be forwarded to the inspector for evaluation. The registered manager is aware of the need to plan the business activity of the home. Due to her training commitment she has not yet completed the business and development plan. She proposes to complete this plan within the next two months. This is restated as a requirement. Checks of a variety of documentation show that record keeping is good with few gaps in information written. Staff when spoken to demonstrated their knowledge on maintaining confidentiality and not sharing information of a confidential nature. Policies and procedures are reviewed regularly by the organisation to comply with current legislation. Areas identified at inspections requiring attention are responded to positively. Following recent training senior staff personnel have put into practice more robust methods of investigating under Vulnerable Adults procedures. Mountearl House DS0000022744.V299882.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 2 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 x 34 3 35 2 36 2 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 3 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 2 3 3 3 x Mountearl House DS0000022744.V299882.R01.S.doc Version 5.2 Page 26 yes 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 YA14 Regulation 16 (2) m, n Requirement Timescale for action 30/09/06 2 YA35 18 (1) c 3 YA36 18 (2) The registered person must ensure that service users not engaging in external activities have access and support, and can choose from a variety of stimulating activities in the home. The registered person must 30/11/06 ensure that all the staff team receive relevant training that is targeted and focused on improving outcomes for service users. The registered person must 30/09/06 ensure that staff are supervised and supported regularly and consistently. One to one supervision must be provided to each staff member staff at least six times a year. (Previous timescale of 31/03/06 Not met) The registered person must 30/10/06 ensure that a copy of the business and development plan for the home reflects the aims and outcomes for service users. (Previous timescale of 28/02/06 not met) A copy must be forwarded to the inspector for DS0000022744.V299882.R01.S.doc Version 5.2 4 YA39 24 (2) 25 Mountearl House Page 27 evaluation. 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 YA22 Good Practice Recommendations The registered person should ensure that the complaint procedure is developed further so that service users and relatives’ feel confident that all issues raised are logged in writing. The registered person should ensure that better provision is made for service users living in the annexe area to access the home. The registered person should ensure that provision is made for service users to make use of the garden by the provision of suitable outdoor furniture. The registered person should ensure that a copy of the quality assurance audit is forwarded to the inspector 2 YA24 3 4 YA28 YA39 Mountearl House DS0000022744.V299882.R01.S.doc Version 5.2 Page 28 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 Mountearl House DS0000022744.V299882.R01.S.doc Version 5.2 Page 29 - 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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