Inspection on 29/12/07 for Mountearl House

This inspection was carried out on 29th December 2007.

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

The inspector 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 1 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 16/06/06

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 29 December 2007&11 January 2008 10:00 th th Mountearl House DS0000022744.V345107.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.V345107.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.V345107.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 0208 769 0859 mountearl@robinia.co.uk www.robinia.co.uk The Robinia Group PLC 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) Sorin Ciociu 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.V345107.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th January 2007 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 managed by Robinia Care who manage several care homes for people with Learning Disabilities. The property is owned by the local authority, but Robinia take responsibility for the upkeep of the premises. 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 £1500 to £2000 per week. Mountearl House DS0000022744.V345107.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was unannounced and carried out over two days, in late December 2007 and early January 2008. The inspection methods included observation of care practice, discussion with residents, relatives and staff, inspection of residents’ files, as well as a range of other records. All seven residents were spoken to. Relatives were sent survey forms so that they could contribute to the inspection process. Written feedback was received from three relatives, three other relatives were spoken to by telephone. The inspector is grateful for their contributions. The CSCI also used information gathered through notifications from the home. An Annual Quality Assurance Self Assessment was completed by the service and returned to the CSCI. All of this information has been taken into account in compiling this report. The registered manager and the deputy manager, together with support staff were helpful and courteous throughout the process, and facilitated the inspection visits. What the service does well: The staff team structure consists of a registered manager, a deputy manager senior/team leaders and support workers. With managemnt support and guidance this structure is effective. It makes sure that practices are monitored and that the appropriate support is given to each resident. Residents are valued as individuals. and influence how the service is run, together as a group they meet regularly to put forward their views and suggestions to shape the future of the home. The staff team are motivated, they are skilled and competent and ensure that residents receive the necessary personal and health care support either within the home or in the community. One of the relatives spoken to remarked on the skills and expertise of staff, she said, “I have seen how competent staff are at managing some challenging episodes that residents display”. Staff actively respond to changes in mood/behaviour to ensure that the mental health conditions receive the appropriate treatment from healthcare professionals. One parent spoke of the ‘can do attitude” that has helped empower her son; he lives more independently in the annexe area now and enjoys more independence. Independence is promoted and risks are managed positively to help people using the service lead the life they want. Any limitations on freedom, choice or facilities are always in the resident’s best interests. Mountearl House DS0000022744.V345107.R01.S.doc Version 5.2 Page 6 Staff ensure that care and support is person led, personal support is flexible, consistent, and is able to meet the changing needs of the residents. One of the relatives spoken to said “ If I have any worries I can always speak to staff about my son’s needs and know that they will respond promptly”. Staff respect people’s preferences, they are experienced with the client group and have expert knowledge about individual personal needs when providing support. The service has a highly developed recruitment procedure that has the needs of people who use the service at its core. The employment and retention of good quality carers that are trained and skilled has contributed to the consistency in the service. What has improved since the last inspection? What they could do better: The home needs to continue with monitoring and evaluating the service and drive further improvements though the service. The service needs to make sure that the systems in place to monitor residents living in the annexe area are more effective and do continue to promote independence without compromising safety and welfare. Please contact the provider for advice of actions taken in response to this Mountearl House DS0000022744.V345107.R01.S.doc Version 5.2 Page 7 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. Mountearl House DS0000022744.V345107.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 Mountearl House DS0000022744.V345107.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 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a home with an experienced and stable staff team. Individual needs are assessed and appropriate support arrangements are in place to meet these assessed needs. EVIDENCE: A selection of records was viewed relating to the support required and provided to two residents. A copy of the service user’s guide was seen on the two files examined. Contracts with terms and conditions are in place. The home has not admitted any new residents for some years. Evidence was available indicating the improvements made by the service in meeting the needs of residents. The home is managing to meet the needs of current residents well. Earlier in 2007 some difficulties were experienced due to the changing need and challenges displayed by a resident. This had impacted on the environment. The resident was referred to mental health team for further assessments. A hospital admission took place, resulting in the decision that the resident’s needs could no longer be met in the home. Residents appear more relaxed since these changes occurred. This was the view of a parent spoken to during the inspection. Mountearl House DS0000022744.V345107.R01.S.doc Version 5.2 Page 10 Recorded care needs assessments are in place for all residents, these detail all areas where support and care is required, also too recorded are personal profiles and histories and reports from mental health and behaviour psychologists. Professionals such as behaviour specialists and psychologist are involved in working alongside staff and making recommendations on rehabilitation and therapeutic programmes. There is a stable staff team at the home. Staff are familiar with individual needs and understand the mode of communication. This is essential as a number of residents are unable to verbalise. Mountearl House DS0000022744.V345107.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 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Care and support requirements are agreed and written in person centred formats. Risks are identified and appropriate risk management arrangements are in place to support residents and enable them lead as independent a lifestyle as possible. EVIDENCE: Case tracking was used to evaluate the care arrangements and determine how Individual needs and aspirations are responded to. All the residents have lived at the home for many years. The personnel files for two residents were selected for case tracking. The provider organisation Robinia has introduced a new format with a more person centred approach. This format is being implemented for all residents Each resident has a care plan developed from a needs assessment, the care plans also detail any risks that are presented, also any restrictions or actions necessary to safeguard the individuals. The information recorded in support plans for both residents is good. The support plans are based on the needs assessments and the information Mountearl House DS0000022744.V345107.R01.S.doc Version 5.2 Page 12 supplied from other healthcare professionals ands from personal profiles. The risks associated with conditions such as swallowing or drinks are recorded, also guidance on how to manage safely these risks. Residents present challenging episodes, the management of challenging behaviour is recorded. From speaking to staff it was evident that staff have a clear understanding of best practice in managing challenging behaviour. As a result of recent changes it is noticeable that the more calming environment now experienced has resulted in residents displaying fewer challenging behaviour episodes. Individual key workers are allocated and work with residents. They take responsibility for developing and reviewing with residents the support plans. Improvements are seen in care and support arrangements, also in the reviewing process. Each resident has a review of support plans and risk management at least every six months. Evidence was present that indicated that members of the family were present for the reviews. Letters were sent to social workers notifying them of planned reviews. Daily and monthly records are held for each resident. The monthly records maintained are too brief and need more information to indicate not only residents’ progress but also participation in activities of daily living, leisure and educational opportunities engaged in. A recommendation is made. The majority of the staff team have worked with residents for some time. This has enabled the development of effective working relationships between staff and residents. Relatives spoken to have found this to be very beneficial and has given stability and security to individuals. Staff are more consistent in their approach, they demonstrate more professionalism and know the importance of in providing stability and support In achieving positive outcomes for residents. There is an improvement in communication between staff at handovers. Confidentiality is maintained with all handovers taking place in the office. Individual records are stored securely in the office. This is locked when staff are not present. All areas concerning the welfare of residents 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 residents are recognised and met. Examples of these seen were the presence of staff that share similar cultural backgrounds. The home is proactively recruiting to a vacant post. It recognises that an additional male member of staff is required to redress some imbalance Mountearl House DS0000022744.V345107.R01.S.doc Version 5.2 Page 13 as all current residents are now male. The needs of residents are understood by staff. Staff communicate well with residents, especially those that are non-verbal. This was demonstrated throughout the inspection on both days. Four support workers were spoken to individually. All appeared interested in the welfare of residents and are keen to develop further more exciting and suitable opportunities for residents to develop more independence. . Mountearl House DS0000022744.V345107.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11 12 13 14 15 16 17 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Residents enjoy living at Mountearl. The lifestyle offered to residents makes provision for individual need preference and culture. The routines and activities are resident focused with plans in place to develop more individualised opportunities for leisure and stimulation to those that are not engaging in many community facilities. Meals are healthy and balanced and take into account individual cultural, religious and health needs. EVIDENCE: Consideration is given to supporting individuals to participate and access age, peer and culturally appropriate activities. Each resident has a weekly activity plan in place that they have been supported to develop. The activity programmes for two residents demonstrated that staff recognised the need for a structured routine to reduce incidents of anxiety or challenging behaviour. Progress has been made in enabling residents access more stimulating activities but this should be developed further. Two parents spoken to value Mountearl House DS0000022744.V345107.R01.S.doc Version 5.2 Page 15 the support given but feel there should be more opportunities. A recommendation is made. Staff encourage residents to access as many activities in the community as possible and to choose themselves their favourite leisure activities. While case tracking it was observed that one resident has a varied programme, he attends college four times weekly, also other day centre and advice centres. Residents attend college and have educational opportunities. Some require the presence of support workers while at college. This is under review for one resident currently. Residents are valued and recognised as individuals. Contributions that include art work are displayed in the home. Within the guidelines of risk assessements and the law staff encourage all residents to live their life as they see fit and to treat Mountearl as their home. For some residents some relapses are experienced from time to time, on occasions these have resulted in legal restrictions,including access to community facilities with escort only. With the support and encouragement of staff residents have managed these situations well. Examples were seen of staff working with probationary service to support a resident through a difficult period. Residents access all areas of the home without restrictions unless there is a particular risk identified. There are two to three residents that choose not to engage in many regular external activities. They frequent local shops on a one basis with the support worker. The home has it’s own transport facility. Residents were seen going out for a day trip to a large park in South London. When they returned they indicated their pleasure with the trip. They participate in regular outings Holidays are arranged for residents which are appropriate to age and interests. Some residents have weekends at the family home. Staff at the home assist and support residents with travel arrangements. Visitors are welcome at the home, also invited to internal reviews. Relatives too are informed on any changes that take place within management structure. A resident was preparing to go on a long weeked to France with his relatives. He chooses not to engage in regular social and recreational activities but was looking forward to enjoying this short break. According to management and staff residents are visiting many more places and enjoying this. It is not always recorded in monthly reports of progress. Another resident that chooses not to engage with activities in the community was working on a jigsaw puzzle with his support worker. Mountearl House DS0000022744.V345107.R01.S.doc Version 5.2 Page 16 The AQQA supplied information that makes provision for future development plans including a focus on developing more opportunities for recreation and stimulation. The dining room is conveniently located to the kitchen. It is comfortable and homely and conducive to a relaxed environment. Dining facilities are also provided in the annexe area of the home. Culturally appropriate menus are available, individual health and dietary requirements are also considered in the planning of meals. Dieticians are consulted as necessary and recommendations followed. One resident where care and support arrangements were case tracked is awaiting consultation from the dietician following referral from the home. From feedback from relatives the information supplied suggested that the choice of meals should be more individualised, comments received include the following “not all residents like dishes that they are unfamiliar with or that are not reflecting their preferences”. Picture format menus are now available that enable residents participate in meal planning and choose food of their liking. The manager informed the inspector that individually tastes are catered for and if a resident chooses to have a different dish then this is provided. A recommendation is made. Staff demonstrated a good knowledge of individuals’ health needs and dietary requirements. They spoke of the medical condition experienced by a resident, he is restricted to the amount of fluids he takes otherwise he is at risk due to his medical condition. Another resident has slight swallowing concerns; these are managed appropriately through risk management guidelines. Residents were seen to enjoy meals during the inspection, all indicated that they enjoy mealtimes and that the food is to their liking. Appropriate measures are in place to monitor the temperature of hot food, also appropriate storage of perishable food. Records are maintained of meals taken in the home. On many occasions residents take meals in restaurants or cafes. Records of food intake for these periods are absent. It is recommended that records be maintained of all food eaten. Mountearl House DS0000022744.V345107.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. The staff team are good at supporting service users with personal care. The physical and emotional needs of residents are monitored, when any issues or concerns are observed in individual conditions these are responded to promptly and referred to relevant professionals. Medication procedures are safe with effective systems in place to monitor the effectiveness of these procedures. The annexe area of the home accommodates residents, effective systems are needed to monitor residents ate nightime. EVIDENCE: Residents are encouraged and supported to maintain good personal hygiene with attention to good grooming and the promotion of self-esteem. Residents appeared well groomed and were dressed in clothing that reflected their individual personalities and personal taste. One resident showed the inspector his wardrobe of clothes; the clothes were age appropriate and reflected his individual taste. His key worker had assisted him with shopping. Individuals receive one to one support from family relatives or support staff to buy clothing and toiletries. Mountearl House DS0000022744.V345107.R01.S.doc Version 5.2 Page 18 The service consistently promotes equality and diversity. The staff team comprises of persons from similar ethnic and cultural backgrounds as residents. 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. The organisation recognises some imbalance in the staff team and is actively recruiting to the vacant post for a staff member that is male. There are no female residents at the home now but the majority of the staff team are female. Record keeping has improved, there is an improvement too in communication between staff. Handovers are more thorough with staff giving more accurate details and the state of well being of each resident during handover. Health action plans are in place for all residents. Records are maintained up to date and gave an accurate picture of the present situation. All residents are regisitered with a GP, and she speciaise in learning disabilities. The practice nurse visits the home annualy to do a health check on each resident. On occasions when a resident becomes anxious about attending a GP for minor conditions the district nurse assists by visiting the resident at the home. . All medical appointments are recorded in the diary and residents are supported by staff to ensure that the necessery information is handed over and any changes in the support plan are implemented. Frequent consultations take place with psychology, psychiatry and other health professionals. The health care needs of residents are monitored, any changes or concerns are responded to promptly and referred to relevant professionals for advice. The feedback from all five relatives consulted was overall positive on communication between staff and relatives, especially if there are health concerns. One relative finds that staff are not always informing her when appointments with psychiatry are taking place. A recommendation is made that Relatives are kept informed of all appointments made for residents with healthcare professionals. The annexe area is detached from the home. Two residents live there, one on the ground floor and one on the first floor. One is monitored every forty five minutes during the night in accordance with risk assessment. There are no systems in place to monitor and record the well being of the other resident. A requirement made at the previous inspection is restated regarding the monitoring of residents living in the annexe area. The home has relocated the medication cabinet from the first floor to the office on the ground floor. Senior trained members of staff administer medication, the list of these staff plus signatures are maintained. Medication is dispensed in a monitored dosset system, it and delivered by a large pharmacy. The pharmacist has provided training to support staff in the medication procedures. Mountearl House DS0000022744.V345107.R01.S.doc Version 5.2 Page 19 Observations were made of medication prescribed and how it is administered to two residents. No errors or omission of signatures on MAR sheets were identified. A recommendation is made in regard to the MAR sheet and to how dates are recorded. Medication reviews take place, these are with either the GP or the psychiatrist. There is evidence that when any changes are made to prescribed medication that residents are monitored closely to observe any changes that take place. Also that any changes are recognised and reported to relevant professionals. In addition a weekly audit is undertaken of medication and any anomalies including errors are identified and addressed appropriately. Notifications are made to relevant bodies. Any shortfalls in staff following the medication procedures are responded to as part of training and supervision, or by using the disciplinary procedures of the home. The medication is stored securely in a cabinet in the office. A controlled drug cabinet has also been supplied in recent months. Senior support staff that are trained and competent administer medication. None of the current residents have been assessed as competent in administering their own medication. . Mountearl House DS0000022744.V345107.R01.S.doc Version 5.2 Page 20 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 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Residents’ interests are promoted with regular resident in house meetings. They are encouraged to shape the service, they have autonomy and are encouraged to be part of larger service user forums within the organisation. Procedures that safeguard vulnerable adults are robust within the service. EVIDENCE: The home has a more inclusive approach. Independence is promoted with a focus on empowering residents. The evidence of this was seen in the accommodation arrangements for a resident. Since moving to the detached area in the annexe he has become more confident as an individual. Monitoring takes place less frequently as the risk has reduced. Continual discussions take place between the resident/parent and members of staff on how safety is maintained without compromising too much of his independence. The resident’s mother is pleased that the move for her son has resulted in more positive outcomes. Residents’ meetings are held every other month so that residents can put forward any suggestions or ideas. The organisation has developed a national provider’s forum with representation from numerous service user groups. Two of the residents now sit on the provider’s forum and attend these. One of the residents spoken to feels that this gives him the opportunity to express views on behalf of other residents. Mountearl House DS0000022744.V345107.R01.S.doc Version 5.2 Page 21 The home records and investigates complaints in line with policies and procedures. The complaints procedure for the home has been developed in a more user friendly format. A copy of this is displayed on the notice board. Records seen on AQQA and within the complaints book indicate that a small number of complaints are received. No complaints about the service were received at CSCI. Comments received from relatives via comment cards and directly in person or by telephone are that issues are dealt with and resolved satisfactorily. Vulnerable adults are safeguarded as a result of the policies and procedures in place. All staff have a full CRB/POVA check before commencing employement and for good practice at least every three years after that we apply for another. Adult protection training is given as part of CWPLD and then again as further training. Staff at the home received training in Safeguarding Vulnerable Adults from the local authority coordinator in the past eighteen months. Staff spoke to (four) demonstrated a good knowledge on indicators of abuse or neglect; they also demonstrated that they are familiar with relevant procedures. Previously there was some confusion about internal investigations procedures. There are now trained staff within the organisation who can conduct the investigations including coordinate adult protection, subject to referral back by the local authority. One allegation in relation to Safeguarding Adults Procedures was received in 2007. Following full investigations it was not substantiated. The improvements made within the organisation by providing trained staff that are responsible for advising on staff suspension has addressed the recommendations made. All incidents are recorded and relevant notifications made in accordance with regulation. Mountearl House DS0000022744.V345107.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 25 26 27 30Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. The environment is pleasant and well maintained. It offers comfortable, spacious and suitably furnished accommodation for residents to relax and enjoy the lifestyle afforded. EVIDENCE: The home is attractive and homely and spacious. Numerous improvements have taken place. Maintenance is now attended to promptly worth a continuous rolling programme of refurbishment. Furniture damage is a regular feature due to the challenging needs of residents, this is replaced accordingly. The new furniture supplied to individual residents for the bedrooms looks more homely. The annexe area has three bedrooms, two of which are currently occupied. It has also a separate kitchen and lounge area. The home is planning to redecorate all bedrooms in the next phase of refurbishment. Five bedrooms were viewed, all are suitably furnished, and they are tastefully decorated with many displaying personal affects. The communal areas are comfortable with large couches in the lounge area. Mountearl House DS0000022744.V345107.R01.S.doc Version 5.2 Page 23 A separate dining room is located off the kitchen. Residents were observed taking meals together. The mealtime was relaxed and jovial, staff were present to assist and support as necessary. Repairs are responded to more promptly with a permanent maintenance person employed, no outstanding repairs were recorded. Appropriate numbers of bathrooms and toilets are located at convenient places The interior of the home is clean and fresh. An improvement has taken place in the garden. The pond area is now fenced off for safety, additional shrubs and plants compliment the garden. A large outdoor trampoline is now available in the garden for residents to use in finer weather. One resident was excited about having the opportunity to use it and said how much he enjoyed the trampoline. Mountearl House DS0000022744.V345107.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 32 34 35 36 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Residents feel comfortable because they benefit from a consistent and stable staff team that relate well to their needs. Recruitment procedures are robust. Ongoing training and development equips staff with all the necessary knowledge and skills required for their role. Staff are effectively supervised and supported to ensure that working practice reflect best practice. EVIDENCE: Staff retention is good. Support workers are clear about roles and responsibilities. Appropriate staffing levels are maintained that enable and support residents to maintain an independent a lifestyle as possible. Support staff know what is expected of them and show a good understanding of the actions they need to take to meet and promote equality and diversity. Staff have valuable experience of working with residents. This has provided stability and security to a very challenging service user group. At previous inspections it was observed that support and supervision for staff could be inconsistent. It is evident that this has been addressed. Staff are responding well to the recent increases in management commitment with the emphasis on performance management and best practice. This has resulted in Mountearl House DS0000022744.V345107.R01.S.doc Version 5.2 Page 25 a more optimistic approach by staff. Regular staff meetings are now held. Staff are effectively supervised and supported. The structure of the team is good. There are senior/team leaders on every shift that guide and direct support staff and take on more senior tasks. There are tangible signs that this has significantly improved working practice, morale and attitude among staff is good. “Staff are helpful and friendly” was the comment from a resident. Observations made over both days were that staff are patient and work at the pace that suits the individual. Communication is good with staff understanding residents behaviour patterns, body language and responding appropriately. There are signs from observations made and from records of reviews and progress that staff engage more positively with residents and focus on supporting and empowering individuals. A comment received from a parent indicated too that staff are good at engaging with residents. Recruitment procedures are robust. No new staff were recruited since the last inspection. Personnel files (five) were examined. All files have appropriate documentation, new Enhanced disclosures were present for all staff that are employed at the home for over three years. According to the area manager to support best practice in the service new CRB checks with POVA clearance are completed every three years for staff. Over 80 of support staff have NVQ Level 3 in care. The organisation has a new induction programme called CWPLD that ensures staff are given the right information and training to be able to do their job well. All new staff are enrolled on the programme. According to information received on AQQA there are plans for all existing staff to complete this programme too. Staff receive a variety of training. The five personnel files viewed had evidence of training. Additional training has also been supplied but the records have not always been well maintained to record this. This shortfall has been identified within the managemnt team. Since the inspection the manager and the area manager have assured the inspector that the training matrix is being updated and that any gaps or identified need will be addressed. Individuals spoken to feel confident hat they receive appropriate training to develop the skills necessary to met the needs of the client group. The inspector is confident that improved managemnt structure will ensure that the training plan is delivered in accordnace with the training and development programme to all staff. A recommendation is made. The registered person should ensure that training and development records for staff are maintained up to date. Mountearl House DS0000022744.V345107.R01.S.doc Version 5.2 Page 26 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 40 41 42Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Residents live in a home that is resident focused. It is well run with effective management arrangements in place to recognise and address any shortfalls. Both the health and safety of residents and staff are promoted by premises that are well maintained where effective health and safety measures are implemented. EVIDENCE: Changes in the management structure have contributed to the improvements found in this service. Effective management means that the home is well run. Strong leadership gives clear direction to staff, there are action plans in place to continue with improvements. Management is consistent in the approach. Staff know the standards expected and are responding positively to these. Mountearl House DS0000022744.V345107.R01.S.doc Version 5.2 Page 27 Staff find that they are supervised and supported with a consistent supervision process through one to one supervisions and staff meetings. According to staff this has contributed to the staff approach and attitude. A new manager has been in post permanently since August 2007. He has together with the area manager worked hard to identify and respond to shortfalls within the service, this has secured all the improvements in the service. Improvements to the environment have also taken place. The AQAA contains excellent information that is fully supported by appropriate evidence. It as well as well as development and training plans includes a high level of understanding about the importance of equality and diversity and a wide range of evidence showing how they have listened to residents and families. From records examined of future plans and from speaking to management the home demonstrates a high level of self-awareness and recognises the areas that it still needs to improve, and has clearly detailed the innovative ways in which they are planning to do The manager has registered with CSCI since the inspection. He is experienced in working with the client group having worked for the organisation for three years. He needs to complete the RMA. A recommendation is made. Visits done in accordance with Regulation 26 visits by the area manager identify and address any shortfalls; action plans are developed and respond to any areas that need attention. Copies of these visit reports are submitted to CSCI every month. The home has an effective quality assurance system that is outcome based. A business plan has been developed for the service. The home has ensured that health and safety issues are managed appropriately. Procedures are more robust, a weekly health and safety audit takes place; this includes a check of the environment, hot water temperatures, and food management including the storage of perishable foods. Fire fighting equipment is serviced and maintained, regular fire drills are undertaken. A fire risk assessment is in place. Mountearl House DS0000022744.V345107.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 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X 3 3 3 3 X Mountearl House DS0000022744.V345107.R01.S.doc Version 5.2 Page 29 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. 7. Standard YA19 Regulation 12 (1) a, b Requirement The registered person must make proper provision for monitoring and observing residents that are accommodated in the annexe area of the home. Robust procedures must be in place and these to be validated by recording findings. (appropriate measures are in place for one resident) Timescale for action 28/02/08 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 YA6 Good Practice Recommendations The registered person should ensure that daily and monthly records held for residents contain more details of individual’s participation in leisure and activities of daily living. The registered person should ensure that residents not engaging in external activities have access support and DS0000022744.V345107.R01.S.doc Version 5.2 Page 30 2 YA14 Mountearl House encouragement to choose and participate in a greater variety of stimulating activities in the home. 2 3 4 YA17 YA17 YA19 The registered person should ensure that meals served consider and provide for individual personal preferences The registered person should ensure that a record is maintained of food consumed by residents when eating at venues outside the home. The registered person should ensure that where possible relatives are included, involved and kept informed of all appointments made for residents with healthcare professionals The registered person should ensure that all training records are maintained up to date to evidence that training needs are recognised and responded to accordingly. The registered person should ensure that the registered manager completes the Registered Manager’s Award 5 6 YA35 YA37 Mountearl House DS0000022744.V345107.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Sidcup Area Office River House 1 Maidstone Road Sidcup London DA14 5RH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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