Inspection on 18/01/07 for Outlook Care 80 Doyle Gardens

This inspection was carried out on 18th January 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 no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Outlook Care 80 Doyle Gardens 20/01/09

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 Outlook Care 80 Doyle Gardens 80 Doyle Gardens London NW10 3NS Lead Inspector Clive Heidrich Key Unannounced Inspection 18th January 2007 8:15 Outlook Care 80 Doyle Gardens DS0000065922.V325620.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 Outlook Care 80 Doyle Gardens DS0000065922.V325620.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. Outlook Care 80 Doyle Gardens DS0000065922.V325620.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Outlook Care 80 Doyle Gardens Address 80 Doyle Gardens London NW10 3NS Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8961 9762 020 8961 9762 Outlook Care Ms Estella Taguiam Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Outlook Care 80 Doyle Gardens DS0000065922.V325620.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27/9/2005 Brief Description of the Service: 80 Doyle Gardens is registered to provide accommodation and care support to three adults with learning disabilities. At the time of this inspection, there were no vacancies. The home is a three-storey terraced house owned by New Era Housing Association. Outlook Care provides the care support. Service users’ accommodation is provided on the ground and first floors. All bedrooms are single occupancy. Office space and the staff quarter are on the top floor. The home is located opposite a large public park. It is close to public bus routes. It is within easy reach of Harlesden and Willesden town centres, shops, leisure, and health & social care services and facilities. There is parking space for one car at the front of the house, in addition to unrestricted street parking. There is also a well-maintained garden to the back of the house. Care costs, and the Service User Guide, are available on request from the home. Outlook Care 80 Doyle Gardens DS0000065922.V325620.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Since the last inspection of this home, the only regulatory activity undertaken by the CSCI in respect of the home has been the registration of the manager. This inspection took place across one weekday in mid-January. It lasted just over eight hours in total. The focus was on inspecting all of the key standards, and with checking on compliance with requirements from the last inspection report. The inspector attempted to speak with all three service users during the visit. However, due to communication difficulties between the inspector and some service users, only one service user was able to provide clear feedback. This came mainly through looking at many photos with the service user of them undertaking activities. The inspection process also involved observations of how staff provide support to service users, discussions with staff, checks of the environment, and the viewing of a number of records. The manager was present throughout, and was provided with overall feedback at the end of the visit. CSCI service user surveys were sent to a number of homes in advance of this inspection. One such survey for this home was returned. Its contents have been noted, and have been used to influence the inspection. However, to protect the confidentiality of responses, the survey has not been directly referred to within this report. The inspector thanks all involved in the home for the patience and helpfulness before, during, and after the inspection. What the service does well: The home provides a caring and stable environment for the service users. The staff and service users have developed positive relationships with each other, which were observed by the inspector during the course of the inspection, and as confirmed through feedback including from external professionals. Staff showed good awareness of service users’ individual needs. The service users are supported as far as possible to make decisions and to lead independent lifestyles. They are encouraged and supported to participate in an excellent range of leisure activities within the local community. Good emphasis is put towards meeting service users’ health needs, including through professional consultations where needed. Detailed and appropriate medication support is also provided. Outlook Care 80 Doyle Gardens DS0000065922.V325620.R01.S.doc Version 5.2 Page 6 There are also excellent standards of recruitment checks made before people are entitled to work in the home with service users. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Outlook Care 80 Doyle Gardens DS0000065922.V325620.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 Outlook Care 80 Doyle Gardens DS0000065922.V325620.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Prospective service users can be provided with considerable and clear information about the home, to help with making an informed choice about whether to move in or not. EVIDENCE: No-one has moved into the home since the last inspection. The home has had full service user occupancy during that time. The previous inspection reports excellent standards of assessment, visiting opportunities, and contracts. The documentation about the home was briefly checked through. The Service User Guide was found to have been updated in November 2006, the Statement of Purpose in April 2006. Both contained considerable detail about the home and the services provided. Both included many pictures and photos, to help with people’s understanding of the services, including of the current staff team and of the house. The documents are available to service users and visitors within the dining area of the home. The standard consequently remains exceeded. Outlook Care 80 Doyle Gardens DS0000065922.V325620.R01.S.doc Version 5.2 Page 9 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 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a detailed care plan in place for each service user. Improvements are needed for the plans to be kept up-to-date including with reference to personal goals, and with making them more easily accessible. Service users are provided with support where needed, to make decisions about their lives. Support is also suitably provided to service users, to enable their independence within a risk-management framework. EVIDENCE: Checks were made of two service users’ files. One was found to have a mixture of care-planning documentation dating across the last few years, within which it was hard to find specific information easily. A clear and up-todate plan is needed, to easily inform relevant people about the support needs and personal goals of the service user. The other file had a care plan that was clearly documented and easily accessible, but was slightly out-of-date insofar as it had not been reviewed and updated following a formal review meeting in Outlook Care 80 Doyle Gardens DS0000065922.V325620.R01.S.doc Version 5.2 Page 10 September 2006. The manager must ensure that the care plan includes only current guidance and goals, to ensure that support is consistent and up-todate. Both files showed formal review meeting minutes dating from within the last six months, which is appropriately timely. The meetings involved the service user, their representatives, their keyworker in the home, the home’s manager, and representatives from their day service. There were also review meetings between the manager and the funding authority, within which it was clear that the home is generally supporting the service users to achieve goals, such as with greater community involvement, and medication reviews with the GP. Furthermore, there were records of in-house reviews. All of this shows very good standards of consideration of service users’ individual needs and goals. Risk assessments were in place from 2006 across both files, for a suitable range of individual scenarios. These included, where applicable, about diet, bathing, fire, epilepsy, holidays and community activities. There was also a suitable assessment about a recent incident in the community. Staff and the manager could explain how specific risks are managed in practice in the home. For instance, community excursions in a variety of scenarios are provided to service users, but assessments of possible risks are first considered. Staff responded in practice to risk scenarios, for instance with managing the late arrival of transport for the day service and service users’ consequent expressions of need around this. There was an overall sense of encouraging the independence of service users within a risk management framework. Observations during the inspection found that service users generally had freedom of movement downstairs, and that staff responded positively to service users making decisions and interacting with them. For instance, support was provided to a service user who wanted to make a drink, and the decision of a service user to refuse their cereal was responded to by offering scrambled eggs on toast, which the service user consequently ate. Feedback from staff showed good awareness about providing service users with choices, about the limitations of this due to communication inequalities between service users and themselves, and about how to try to enable better communication. There has been Speech & Language therapy input for this, which has included the production of communication books for each service user using photos and pictures, to try help with expressions. There are also laminated icons, and objects of reference. This overall suggests suitable attention with supporting service users to make decisions about their lives. Outlook Care 80 Doyle Gardens DS0000065922.V325620.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are provided with excellent opportunities to be part of the local community. They are supported by staff to attend day services, college, clubs, church, and individual activities. There is also excellent support with going on holidays during the year. Consequently, service users are provided with opportunities to also have appropriate personal and family relationships. Service users are provided with reasonably health diets that recognise individual choices and needs. There are good standards overall of recognising service users’ rights within the home. EVIDENCE: One service user kindly and enthusiastically showed the inspector a range of photos about themselves at the start of the inspection. From this the inspector understood for instance that the service user enjoyed a range of holidays in Outlook Care 80 Doyle Gardens DS0000065922.V325620.R01.S.doc Version 5.2 Page 12 2006, attended classes in art, computing and drama, went on the London Eye, and was involved in a large project to tidy the garden. A recent report to the funding authority included noting about the individual progress made by each service user. It included about such things as a service user starting a trampoline class through their day service, regular walks in the local park being implemented, speech & language therapy developments, and attending the Notting Hill Carnival. Staff and service users provided positive feedback about the day service that service users attend. The home provides one service user with support at the day service as part of a development program for the service user, which shows good flexibility from the service. It was also apparent that service users attend local community facilities through the day service. Some service users also attend local college courses, and have personal development days at home, during the week. Feedback and records showed that service users attended a group holiday in Cornwall during the previous summer. Individual service users also attended individual holidays with staff support, including one person at an activity holiday based around boating. Pictures from the holidays were pleasantly displayed around the home. There was also feedback about attending the provider organisation’s Christmas party, and of staff and service users going out themselves for a Christmas meal. Records showed that service users are provided with support for physiotherapy and exercise such as leg exercises, and with home-living skills such as hoovering, when at home. Service users attend a local catholic church weekly, as per their chosen denominations, and may attend a local recreational club on some weekday evenings. Photos of gym use were also seen. It is consequently judged overall that service users receive excellent community opportunities. One service user was able to use photos to show that they keep in good touch with their family. Beyond family, the manager noted that service users can maintain and develop personal relationships with people through the many community activities that they are involved in, for instance the day services, the recreational clubs, and through the church. She noted also about maintaining relationships with the neighbours, such as with inviting them to any parties at the home. Minutes of monthly service user meetings were seen for the month of the inspection. They included planning for holidays, and noting that service users wanted collectively to go to the cinema more. There was documentation about infringements of rights in place on service users’ files. These concerned for instance actions to take on medication Outlook Care 80 Doyle Gardens DS0000065922.V325620.R01.S.doc Version 5.2 Page 13 refusal, which were judged as reasonable, and which had been signed off by a representative of the service user where possible. Each service user has a picture/photo board by the front door to help them plan for the week ahead. The boards were partially filled in, and photos were too big for the components of the boards. Their use was discussed with the manager. Consideration should be given to how well these meet the individual needs of each service user, with adjustments made as necessary. Staff stated that menus are planned in advance, except for breakfasts when service users may choose from a range of options at the time. This was seen in practice at breakfast (see also standard 9), where staff were seen to provide support where needed, and within which the meal was at a relaxed pace based on when the service user got up. Menus for the previous three weeks showed that service users receive a reasonably varied and healthy diet that matches the cultures of the service users. The home has a range of laminated menu cards from which service users can help to communicate their choices. Checks of the kitchen found a suitable supply of food available to service users, including healthy options such as fruit. Outlook Care 80 Doyle Gardens DS0000065922.V325620.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive good standards of personal and health support. Good consultation with external health professionals is acquired where needed. Service users are also suitably protected by the home’s detailed medication systems. EVIDENCE: Service users were seen to be wearing well-fitting, clean, and individual clothing from the start of the inspection. There were no concerns about nail and hair care. It was evident that staff had provided appropriate support in these respects where needed. Additionally, checks of service users’ rooms raised no concerns about how personal care is provided. Rooms were suitably tidy, there were no offensive odours, and continence support items were discretely stored. Records showed that staff rosters are organised so that there is usually a mixed-gender staffing group to support this mixed-gender serviceuser group. Records showed that service users are being regularly supported by a dentist, an optician, and a GP. Specialist input from such services as a physiotherapist, a speech & language therapist, and a psychiatrist is acquired Outlook Care 80 Doyle Gardens DS0000065922.V325620.R01.S.doc Version 5.2 Page 15 where needed. It was encouraging to see that service users are taken to the GP for check-ups if looking unwell. One service user’s file was found to have up-to-date plans in respect of managing their seizures, and in respect of physiotherapy exercises. See standard 41 in respect of the few missing health records that were identified. Records of regular weight checks were present, and Health Action Plans were in place as is good practice. The plans were suitably individual and relevant. A recent report to the funding authority included noting about the input of a professional masseur and how the service user has consequently become more active and alert. There were also records of compliments about the health care provided in the home, from two health professionals, dating from 2006. During the inspection, staff paid appropriate attention to the mild health symptoms that one service user was displaying. In respect of the windy day, staff also supported service users to be appropriately dressed to go out. None of the service users are able to self-medicate. A pharmacist supplies the home with weekly NOMAD pre-packed dispensing containers for each service user. These were securely stored in the home’s medication cabinet. The cabinet was found to be clean and tidy. There were no concerns with medication records. Administration records were up-to-date and suitably detailed. There were detailed records of medications arriving in the home, and of those returned to the pharmacist. Each service user has a medication profile, including for as-needed (PRN) medicines, and for homely remedies that the GP had signed approval of. Allergy lists for each service user were in place. All service users had had a medication review with their GP within the last six months. This included for the reduction of medication in one case. The only concern with medication was about finding a prescribed gel in the fridge. The manager promptly placed it in a locked container labelled ‘medication’, and returned it to the fridge. This provided appropriate security. The manager explained that, in addition to the organisation’s medication training day, staff must pass an internal audit of their ability to appropriately provide service users with medication. All permanent employees are assessed as capable of administering medicines. Records of an organisational audit of medication in the home, from October 2006, were seen. Most of the small amount of action points from this report, including about medication reviews and individual refusal guidelines, had since been addressed. A Primary Care Trust pharmacist’s review of medication in November 2006 raised no concerns. Outlook Care 80 Doyle Gardens DS0000065922.V325620.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Both of them. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are a number of systems in place in the home to help ensure that service users are protected from abuse. The home has a sufficient complaints system in place. EVIDENCE: The CSCI has received no complaints about the home since the last inspection. The home’s bound complaints book recorded the last complaint as being from December 2004. It also recorded compliments. A pictorial complaints policy was on display in the home. There was evidence that service users could be supported to make a complaint if needed. Staff demonstrated suitable knowledge of abuse whistle-blowing during discussions. Some staff had been on the funding authority’s abuse-awareness training earlier in the month. All three staff files randomly chosen by the inspector found that the staff member had had this training. The home’s accident & incident file was checked. Carbonated and numbered forms are used, so that records can be copied easily to the organisations head office and can be easily tracked. A copy is then returned to the home with any further necessary action recorded about. This system protects service users very well. Checks of individual records within this file found records about, for instance, missing service user clothing, concerning behaviour from a service user, a Outlook Care 80 Doyle Gardens DS0000065922.V325620.R01.S.doc Version 5.2 Page 17 minor accident to a hired van, a service user having a seizure, and staff reporting about a few scratches being found on a service user. The manager had signed off each form. None of the records raised concerns, as appropriate responses had been documented about. Risk assessments included about the behaviours of service users that challenge. Guidance from this was suitably positive and respectful, looking at trigger removal and avoiding restraint and sanctions. The three randomlychosen staff files found records of detailed training on positive behaviour management in two cases. Staff and the manager reported about general reductions in the behaviours of service users that challenge. The evidence overall shows suitable actions being taken to protect service users from abuse. Outlook Care 80 Doyle Gardens DS0000065922.V325620.R01.S.doc Version 5.2 Page 18 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): All of them. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are provided with a home environment that is kept suitably clean, tidy, homely and comfortable. This includes bedrooms, within which service users can individualise as they wish. The home has physical adaptations to meet current service users’ minor mobility needs. Improvements are only needed with ensuring that soap is always available in the downstairs toilet, and with keeping the dining room carpet sufficiently clean and free of ingrained stains. EVIDENCE: The inspection findings indicated that the home was clean and tidy from the start of the visit. The home was warm and well-maintained. The communal areas contained many framed photos of the service users and of their artwork, which added to the homely feeling. Staff and the manager reported that much of the home has been repainted since the last inspection, including a repainting of the kitchen just the day before the inspection. Outlook Care 80 Doyle Gardens DS0000065922.V325620.R01.S.doc Version 5.2 Page 19 The few items identified for repair at the previous inspection were found to have been addressed. There are adequate bath and toilet facilities, with appropriate safety grab-rails to aid independence and promote safety. This includes a downstairs toilet. The toilet was during the inspection found to lack any form of soap. The manager explained it is removed by a service user. This however can lead to poor hygiene for people using the toilet. The manager must arrange for soap to always be available in the toilet area, for instance through the installation of a small, fixed dispenser. The carpet in the dining area was found to have ingrained black stains within its deep-red colouring. This is not sufficiently homely and clean. The manager agreed to have the carpet promptly deep-cleaned, as required. She noted that this was last undertaken in November. Consideration should be given to fitting flooring in the dining areas that is suitably homely but more easily cleanable. Each service user’s room was decorated and furnished in style that reflected their personality and preferences. Each room also had washbasins, adequate natural light and ventilation, and sufficient storage space. Additional safety measures are in place around the home. This includes railings on the stairs, entrance to the garden, and bathrooms. There are ramp entrances to the front and back of the house. All radiators have suitablyprotective covers. Due to unusually high winds, three fence panels were blown over in the garden during the inspection. The manager began arranging to ensure that these are fixed, before the inspection was completed. The home has an industrial washer and separate dryer within an accessible and small laundry area. The area was suitably clean during the inspection. Outlook Care 80 Doyle Gardens DS0000065922.V325620.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users benefit from excellent standards of recruitment checks for prospective new staff, and from excellent standards of staff support and supervision. Service users are supported by a knowledgeable and consistent staff team who have generally been provided with good levels of training. Suitable staffing levels are also provided. EVIDENCE: Staff were generally seen to respond to service users in a friendly and supportive manner during the inspection. Discussions with staff showed that they have good knowledge of the service users as individuals. One recent record within the home, from an external professional, noted that staff had done a ‘great job’ with implementing their guidance. Records and feedback showed that, of the five staff employed at the home, three have NVQ qualifications in care, two at level 2 and one at level 3. Other Outlook Care 80 Doyle Gardens DS0000065922.V325620.R01.S.doc Version 5.2 Page 21 staff are currently being provided with training on the Learning Disability Awards Framework (LDAF). Checks of the training records of three staff members, and feedback from staff and the manager, established that suitable training is provided to staff. This includes for statutory training courses such as manual handling, emergency first aid, food hygiene, and abuse prevention. All staff had also received the organisation’s medication training, and a course on epilepsy, and most had attended a positive behaviour management course. There were suitable records of induction training in place for one newer staff member. These spanned a training period of six months, and included a reasonable range of appropriate topics. Rosters for two weeks of January were checked on. They showed that there were always two staff members working at all times of the day and evening, with one staff member sleeping-over. The majority of this is undertaken between the five permanent staff members, including through three extrahours shifts. The manager occasionally worked shifts including one sleep-over. Eleven other shifts were covered, one by a bank-employee of the provider organisation, and ten by an established agency staff member. This all provides for a good standard of consistency with staffing. Recruitment records were in place for the two staff members checked on. These included application forms with employment records, identification checks, and suitable Criminal Record Bureau disclosures. Two written references are undertaken, including from the last care employer. The records include follow-up phone checks of the referees. The manager also noted that service users meet applicants as part of the recruitment process. The standard of recruitment is consequently considered to remain exceeded. Supervisions records were in place for the two staff members checked on. These showed a monthly frequency, and included discussion of training and development needs. Appraisals were also in place for these two staff members from within the last few months. Feedback from staff about supervisions was positive. A summary supervision grid showed that the regular agency staff member receives supervision, as is good practice, and that most staff had received a supervision session already in 2007. There was additionally feedback and records about regular team meetings being held. Consequently, the standard on staff support and supervision is judged as exceeded. Outlook Care 80 Doyle Gardens DS0000065922.V325620.R01.S.doc Version 5.2 Page 22 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 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a well-run and suitably managed home. There is an excellent standard of quality monitoring within the home. This includes acquiring the views of service users and their representatives. Minor improvements are needed with keeping specific records in the home up-todate. The health & safety systems in the home generally protect everyone using the home. Improvements are needed in a few areas to help prevent accidents, including with preventing the water from the bath hot-tap from being too hot, and with installing fire-safety devices on fire doors that are otherwise wedged open. EVIDENCE: Outlook Care 80 Doyle Gardens DS0000065922.V325620.R01.S.doc Version 5.2 Page 23 The current manager has been in charge of the home since the summer of 2005. She was registered in that role by the CSCI late in 2005. The manager stated that she retains her registration as a nurse, and that she has completed the Registered Managers’ Award since the last inspection. She has around fifteen years’ experience overall in the care home environment. The overall standards of care found in the home during this inspection, and the positive feedback received about the manager, show that she is running the home appropriately and to service users’ benefit. This includes through written praise of the services at the home from the contracting authority. It was recommended, from the CSCI registration process, that the manager undertake a course on the investigator’s role for when dealing with an abuse allegation. She noted that she is trying to pursue this, but that an appropriate course with the local authority had fallen through. There was certification to show that the provider organisation is registered under the ISO9001:2000 scheme. This scheme shows that good standards of policy and procedures are in place at an organisational level. The manager noted that there are three-monthly meetings with the funding authority. She provides a report for these. The meetings focus on outcomes for service users, and include the setting of developmental goals. An annual development plan for the home for the 2006/07 period was seen. It includes focus on the development of areas such as the environment, health & safety, person-centred planning, and individual needs & wishes of service users. The evidence gained from the inspection suggested that most areas of the plan had been addressed. The manager provided evidence of the recent formal auditing of the views of service users and their representatives. These will be used to assist with the next developmental plan for the home. There were records of monthly visits undertaken on behalf of the provider organisation at the home, as per legislative requirements. The manager confirmed that these are unannounced to everyone in the home, as is good practice. The records include areas of shortfalls, which are consequently generally addressed. The high standard of quality auditing within the home, including through the gaining of service users’ views where possible, shows that the standard is exceeded. Whilst there was overall a great deal of recording about service users, there were some areas where records had not been kept to a sufficient standard. This included with consistently making records about health professional input, Outlook Care 80 Doyle Gardens DS0000065922.V325620.R01.S.doc Version 5.2 Page 24 for which the manager was able to explain that the input had been acquired and addressed but for which the paperwork was not present. The manager was also open that records about individual staff members’ completed training was not up-to-date. The up-to-date records are a legislative requirement, and being up-to-date helps with planning for further training. The manager must ensure that all records required under legislation are kept up-to-date. Professional safety-check records were suitably in place for the gas systems, the portable electrical appliances, all the fire systems and equipment, and against legionella within the water systems. An appropriately up-to-date certificate of electrical wiring for the structure of the home could not be found. The most recent certificate expired in 2006. The manager agreed to address this, to help minimise risks of accidents. Records showed that fire-system checks are undertaken weekly by staff. Emergency lighting and fire extinguishers are checked monthly. Suitable fire drills are also undertaken, involving assessment of service users’ abilities and willingness to evacuate the building. A professional assessment of fire safety in the home had been documented from November 2006. It included about not wedging fire doors open. Lounge and dining area doors were wedged open during the inspection. This could compromise people’s safety should a fire occur, albeit that the manager noted that the doors are always shut at night. As it was also stated that shut doors could cause some service users accidents through limited mobility, fire-safety devices must be fitted to the fire doors if any such doors need to be held open. An organizational environmental assessment of the home was undertaken August 2006. The action plan from this mainly involved garden improvements, and such things as replacing the fridge/freezer. The evidence suggested that most points had been addressed. Internal health & safety assessments are also recorded about on a monthly basis, with checks of key items such as fridge temperatures undertaken suitably frequently. The hot water from the wash-basin in the bathroom was found to be of a suitable temperature. The hot water from the bath was found to be too hot to hold a hand in. This could lead to a scalding accident, especially as one service user has a written assessment in case of running a bath for themselves. Records of temperature checks found no concerns with the hot water at the last test, hence the issue is newly-arisen. The manager must ensure that appropriate measures are taken to have the water from the bath hot-tap always come out at a safe temperature (43ºC or less), to prevent possible scalding accidents. Outlook Care 80 Doyle Gardens DS0000065922.V325620.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 4 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 3 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 4 35 3 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 4 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 4 3 2 2 X Outlook Care 80 Doyle Gardens DS0000065922.V325620.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement The manager must ensure that each service user’s care plan includes only current guidance and goals, to ensure that support is consistent and up-todate. The carpet in the dining area, that has ingrained black stains within its deep-red colouring, must be promptly deep-cleaned to restore it to a suitably clean and homely appearance. The manager must arrange for soap to always be available in the downstairs toilet area, for instance through the installation of a small, fixed dispenser. This is to help uphold suitable standards of hygiene for everybody in the home. The manager must ensure that all records required under legislation are kept up-to-date. Shortfalls were identified with service users’ individual health records and with staff training records. The manager must ensure that appropriate measures are taken to have the water from the bath DS0000065922.V325620.R01.S.doc Timescale for action 1 YA6 15(2) 01/04/07 2 YA24 23(2)(d) 01/03/07 3 YA30 16(2)(j) 01/03/07 4 YA41 17(3)(a) 01/04/07 5 YA42 13(4) 01/04/07 Outlook Care 80 Doyle Gardens Version 5.2 Page 27 6 YA42 13(4) 7 YA42 13(4), 23(4A) hot-tap always come out at a safe temperature (43ºC or less), to prevent possible scalding accidents. An appropriately up-to-date certificate of electrical wiring for the structure of the home must 01/05/07 be acquired, to help minimise the risk of electrical accidents. Fire-safety devices must be fitted to the fire doors where any such doors need to be held open. 01/05/07 The wedging open of such doors is not acceptable, as this is a potential fire hazard. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard YA16 Good Practice Recommendations Consideration should be given to how well the picture/photo boards at the front door meet the individual needs of each service user, with adjustments to be made as necessary. Consideration should be given to fitting flooring in the dining area that is suitably homely but more easily cleanable. It is recommended for the manager to undertake a course on the investigator’s role for when dealing with an abuse allegation. 1 2 3 YA24 YA37 Outlook Care 80 Doyle Gardens DS0000065922.V325620.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Outlook Care 80 Doyle Gardens DS0000065922.V325620.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!