Inspection on 05/06/06 for Params The (18)

This inspection was carried out on 5th June 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Params The (18) 23/07/07

Params The (18) 27/01/06

Params The (18) 06/09/05

Params The (18) 04/02/05

Params The (18) 28/09/04

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 Params The (18) 18 Foxley Lane Purley Surrey CR8 3ED Lead Inspector Lee Willis Key Unannounced Inspection 5th June 2006 09:35 Params The (18) DS0000025853.V297175.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 Params The (18) DS0000025853.V297175.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. Params The (18) DS0000025853.V297175.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Params The (18) Address 18 Foxley Lane Purley Surrey CR8 3ED 020 8660 7747 020 8763 8615 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) Mr Siva Kandaswami Parameswaran Mrs Isabel Parameswaran Mrs Isabel Parameswaran Care Home 13 Category(ies) of Learning disability (13) registration, with number of places Params The (18) DS0000025853.V297175.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A variation has been granted to allow two specified service user over the age of 65 to be accommodated until such time as the needs of the service users can no longer be met or until such time as the placements cease. 27th January 2006 Date of last inspection Brief Description of the Service: The Params is a privately run service that is registered with the CSCI to provide personal care and support for up to 13 younger adults (18-65) with moderate learning disabilities. All 13 service users are currently aged forty and over. Mrs Isabel Parameswaran, who also co-owns the servcie with her husband Siva, continues to be the registered manager of the home, although the deputy manager, Cosmos Kapondeni, tends to be left in charge of its dayto-day operation. This detached Victorian property is perched on a hill in a residential suburb of Purley and is approach by climbing a steep set of winding steps. The home is within ten minutes walk of the centre of town, which is well served by a wide variety of local shops, cafes, resturants, take-aways, pubs, and banks. The home is also on a main line bus route and less than fifteen minutes walk away from a local train station with good links to central Croydon and London. The home comprises of thirteen single occupancy bedrooms, a large entrance hall, main lounge, separate dinning room, conservatory, kitchen, laundry room, office, first floor smoking room, and top floor games room. The sloping gardens at both the front and rear of the property are well maintained. Service users have all been offered copies of the homes Statement Of Purpose, new Residents Guide, and occupancy Agreements. These documents specify information about services and facilities provided and the fees charged, which currently stands between £2,597.04 - £4,494.40 a month. Params The (18) DS0000025853.V297175.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. From all the available evidence gathered the Commission for Social Care Inspection (CSCI) considers this service to have substantially more strengths than weaknesses and no significant shortfalls in areas relating to the health and safety of service users were identified. Nevertheless there remains areas of particular concern that require improvement through a mandatory action plan, despite most key National Minimum Standards being judged to be almost met. The Commission is confident the home will acknowledge all the weaknesses identified in this report and will have little difficulty resolving them in a timely fashion. An unannounced site visit to the home was carried out on Monday 5th June 2006 between 9.45am and 2.45pm. During the course of the five-hour inspection four service users; the homes Registered and Deputy managers; two support workers, and a nurse who was visiting at the time, were all spoken with at length. Furthermore, at least four other service users and three members of staff were also met, albeit briefly, during a tour of the premises. In addition, prior to this site visit being carried two service users relatives were contacted at random by telephone and twenty six comments cards were returned to our offices, of which thirteen had been completed by the service users (with some assistance from staff), nine by their relatives, two by reviewing offices representing two separate placing authorities, and two from GP’s. The deputy manager with assistance from various staff members also completed a pre-inspection questionnaire and an equalities survey. Finally, during the actual site visit four service users volunteered to take an active part in the inspection process by helping complete our ‘Have your say…’ surveys regarding their experiences of life at the Params. The remainder of the site visit was spent examining the homes records and touring the premises. What the service does well: The written and verbal feedback received from service users, their relatives’ and professional representatives was extremely favourable about the home. One service user wrote ‘I like all the staff and the food’, and one of their relatives spoken with said ’staff looked after their loved one extremely well, and they had nothing but praise for the home’. All four service users spoken with at length tended to agree that one of the ‘best things’ about living at the Params was having the freedom to come and go as you pleased and to do what you wanted when you liked. Similarly, most service users met said the quality of the meals and the attitude of staff was what they liked about the Params. One service user went onto say what they particularly liked about living at the Params was it enabled them to enjoy the company of others. Params The (18) DS0000025853.V297175.R01.S.doc Version 5.2 Page 6 It was clear from the comments made by staff and records sampled at random that service users are actively encouraged to maintain and develop their independent living skills (e.g. based on assessments of risk any service user who is wiling and capable of self-administering their medication is actively encouraged and supported to do so. Furthermore, it was noted that staff also actively encourage service users to get involved in the homes day-to-day running and be responsible for certain household chores, such as helping prepare lunch or hanging out their washing to dry. All the staff who were on duty at various times throughout the course of this site visit were observed interacting with service users in an extremely friendly and respectful manner at all times. Furthermore, because the home has experienced relatively low levels of staff turnover in the past year the service users continue to be supported by experienced individuals who are familiar with their unique needs and preferences. Finally, the manager’s approach to planning the staff duty rosters is a very flexible one and it was positively noted that staff on a morning shift much start much earlier in the summer months to meet the needs of those service users who tend to get up at sun rise. What has improved since the last inspection? Where weaknesses have emerged in the past the providers have generally acknowledged them and managed them well. The Commission accepts the registered manager and her deputy’s comments that the service has improved since its last inspection. In March 2006 the providers finally established a Residents Guide that stood alone from the homes Statement of purpose and which contained the vast majority of information service users and their representatives needed to know about the facilities and services they could expect to receive from the providers. Furthermore, each service user is now supplied with a written contract that sets out the terms and condition of their occupancy, including the fees to be charged for facilities and services provided, as agreed between themselves/their representatives and the home. At the time of this site visit it was positively noted that the providers maintenance person was in the process of replacing both the rather threadbare carpets there were laid in the dinning room and main lounge with new floor coverings. The providers continue to actively encourage their staff to attend relevant training courses and as a result over 50 of all the homes support workers have recently achieved an National Vocational Qualifications (NVQ) - Level 2 or above in care, in accordance with the National Minimum Standards. Finally, it was noted during a tour of the premises that no fire resistant doors were being inappropriately wedged open, contrary to fire safety Regulations. Params The (18) DS0000025853.V297175.R01.S.doc Version 5.2 Page 7 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. Params The (18) DS0000025853.V297175.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 Params The (18) DS0000025853.V297175.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 at least once during a 12 month period. 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 all the available evidence, including a site visit to this service. The home has produced an up to date Residents Guide that ensures prospective service users and their representatives have the vast majority of information they need to know about the service, although further amendments are needed to ensure it contains more information its latest inspection report and service users views about the home. Sufficiently robust arrangements are in place to ensure no prospective service users are admitted without their unique aspirations and needs being thoroughly assessed to determine whether or not the placement is capable of meeting their needs. Each service user and their representatives are provided with a written contract that clearly states what services and facilities they can expect to receive and how much they will be charged for them. EVIDENCE: The home helps prospective residents to understand the service by providing them with a Statement of Purpose and Residents guide which sets out clearly what the homes objectives and philosophy of care are, along with the services and facilities it offers. Params The (18) DS0000025853.V297175.R01.S.doc Version 5.2 Page 10 The recently established Residents Guide is very precise and sets out exactly what prospective service users and their representatives can expect in terms of the quality of their accommodation, the qualifications and experience of staff, and how they can make a complaint if they wish. The guide’s format is relatively service user ‘friendly’ and is illustrated with a number of coloured photographs and symbols to ensure it is more accessible for the people for whom the service is intended. The minutes of a service users meeting held in April 2006 revealed that all thirteen service users currently residing at the home were offered copies of the new Residents Guide, although only three took up the offer to keep a copy in their bedrooms. One service user spoken with said they were happy for the deputy manager to keep a copy of their Guide in the office on their behalf. The Commission has been supplied with the new Guide and the Deputy manager was aware that this document would need to be reviewed on an annual basis and up dated accordingly to reflect any changes in provision. These positive comments notwithstanding the Guide does not make reference to the availability of the homes most recent CSCI’s report and nor does it contain any of the services users views about their experiences of life at the Params. The Guide needs to be amended to contain this information. The home has not accepted any new referrals in the past six months as it continues to operate at full capacity. The deputy manager was fully aware of the provider’s admissions procedures and the homes criteria for accepting new referrals. Three service users files sampled at random all contained two signed and dated contracts that each contained detailed information about individual’s terms and conditions of occupancy, agreed between themselves, their placing authority, and the providers. These documents also included information about the fees each service user and their placing authorities (where applicable) would be charged for services and facilities provided, and how much they would be expected to pay for so called ‘extra’ services not covered by the basis cost of their placement. Params The (18) DS0000025853.V297175.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is adequate. This judgement has been made using all the available evidence. The home has developed and agreed with each service user an individual care plan, which ensures they each receive the personal and health care support they require to meet their unique needs. However, plans still need to be reviewed on a more frequent basis and up dated accordingly to ensure they continually reflect service users changing needs. Sufficiently robust arrangements are in place to ensure service users have every opportunity to be consulted on, and participate in, all aspects of life in the home, including its day-to-day running. EVIDENCE: The deputy manager has recently introduced a new care plan format and all four plans sampled at random had been revised to incorporate the new style. The new format is very detailed and includes information about each service users unique personal, social, and health care needs and preferences. The Params The (18) DS0000025853.V297175.R01.S.doc Version 5.2 Page 12 plans also set out clearly what support each service user would require in order to achieve their personal goals. It was evident from the minutes of review meetings held in respect of the four plans inspected at random that they are being ‘formally’ reviewed on an annual basis with the service user, and where applicable their families, advocates and care managers all invited to attend. A service users relative spoken with on the telephone prior to the site visit confirmed that they had been invited to attend their loved ones last care plan review meeting. However, as identified in the homes last inspection report, in order for the service to fully comply with this standard, care plans must be reviewed at least every six months and updated accordingly to reflect any changes in need. It is acceptable for these reviews can be less formal and possibly only involve the service user, their next of kin and/or advocates, and keyworker, but they must be held and the minutes recorded. The deputy manager appeared acutely aware of this shortfall and it was positively noted that they had already drawn up a time specific action plan to commence resolving this on going matter. The minutes of residents meetings revealed that four had been held at monthly intervals since the beginning of 2006. These frequently held meetings had all been well attended by the service users and had covered a wide range of topics, including household chores, holiday destinations, and Birthday celebrations. One service user met said an agenda sheet is always pinned to the notice board for people to write down what they want to discuss at the next house meeting. Copies of the agenda are kept in the service users meeting book. The deputy manager said three service users have advocates who regularly visit the home and play active roles in their ‘clients’ life’s e.g. Attend care plan review meetings. Service users met all said one of the best things about living at the Params was having the freedom to go out and do what you liked when you liked. It was also evident from comments made by service users and staff that people are actively encouraged to take ‘responsible’ risks as part of a structured programme to promote independent living, providing any identified risks could be minimised so far as reasonably practicable. Risk management strategies to minimise the likelihood of service users being harmed while taking a shower/bath or going out unaccompanied in the wider community were all available from care plans on request. Params The (18) DS0000025853.V297175.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using all the available evidence. The social, leisure and recreational opportunities the service users have to engage in, both at home and in the wider community, are well managed, ‘age’ appropriate, and provide daily variety and stimulation. Suitable arrangements are in place to enable service users to maintain good links with their families and friends, and daily routines ensure service users rights’ and responsibilities are recognised and respected as a means of promoting independence. In the main dietary needs and preferences are well catered for and the meals nutritionally well balanced, providing daily variation and interest for the service users, although more could be done to meet the culturally diverse needs of all the residents. Params The (18) DS0000025853.V297175.R01.S.doc Version 5.2 Page 14 EVIDENCE: It was evident from the comments made by one service user met that the registered manager continues to accompany them to church every Sunday for Mass. This particular individuals wish to continue attending Services at the local church they had been a member of for many years was clearly noted in their care plan. Furthermore, five other service users who were also practising Christians either walked or were driven by other members of their respective congregations to various local churches that met their particular Christian denomination. Service users appear to lead very active lives both at home and in the local community. Throughout the course of this site visit staff were continually observed actively encouraging and supporting service users to attend all manner of social, vocational, and educational activities in the wider community. By the end of the site visit the vast majority of service users had either been out to work, attended classes/sessions at various local colleges and/or day centres, or been participating in domestic tasks around the house. One service users spoken with at length said they were looking forward to attending their Art therapy classes held at a local day centre that afternoon, while two others were observed peeling potatoes for lunch and hanging out their washing to dry in the garden. In the afternoon several service users and staff were observed getting ready to go out bowling at a local alley. Several service users met said they had spent last week on holiday on the Isle of Wight, which they had enjoyed. The deputy also said two others had just got back from Cornwall and arrangements were currently being made for another service user to visit their family in the north of England next week. As previously mentioned service users are consulted about holiday destinations and who pays for them is clearly reflected in each of their terms and conditions of occupancy. The home operates an open visitors policy and all the service users spoken with said they were not aware of any restrictions on visiting times. Several service users said they could entertain their guests in the privacy of their bedrooms or any number of the homes communal areas. The homes visitors book, which was being appropriately maintained, is kept in the entrance hall for all to see. As previously mentioned there is an expectation that service users should be encouraged to take greater responsibility for the day-to-day running of the home. During the site visit one service user was observed helping staff prepare lunch by peeling potatoes and another was seen hanging out their washing out to dry in the back garden. Staff were observed knocking on bedrooms doors and asking the occupants permission to enter before doing so on several occasion during the visit. One service user who had been out food shopping with staff locked their bedroom door from within while their put the items of Params The (18) DS0000025853.V297175.R01.S.doc Version 5.2 Page 15 food they had bought away in their fridge and later said they had a set of keys for both their bedroom and the front door. Two other service users met said they could spend as much time as they liked in their bedrooms, but often spent a lot of time in the main lounge as they also enjoyed the company of others. The manager said only one service user now smokes and they are aware they may only do so in the designated smoking room on the first floor or outside. All the service users met said they liked the choice of main meals they were offered three times a day, although no one spoken to at length was aware that turkey burgers were being prepared for lunch at the time of this site visit. Nevertheless, all the service users met said they thought the meals they were served at the home were on the whole very good and if they did not like what was on offer they could always choose an alternative meal from the ingredients stored in the kitchen. A member of staff who was interviewed said an alternative meal was always prepared for one service user when chicken was on the menu as this particularly individual did not like white meat. This preference was noted in the individuals care plan and the homes record of food actually consumed revealed that when roast chicken was last served for a Sunday lunch an alternative meal had been prepared for this person. Similarly, it was clear from the published menus that one service user who liked cooked breakfasts was now offered it twice a week, as opposed to just Sunday mornings. However, one service user spoken with at length, who said they were generally satisfied with the food, did say they were disappointed about the lack of Asian style cuisine on the menus. The record of food actually consumed by the service user revealed that chicken tikka masala had been the only Asian dish served by the home in the past three months, although several meals from the Far East had been consumed in this time. A far greater choice of Asian style cuisine should be offered on a more regular basis to meet the diverse ethnic tastes and food preferences of all the service users. Params The (18) DS0000025853.V297175.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using all the available evidence. The home has sufficiently robust arrangements in place to ensure the health care needs of the service users are recognised and met. Sufficiently robust arrangements are in place to enable service users to retain control of their own medication where appropriate and the homes policies and procedures for dealing with medicines ensure the service users are protected from avoidable harm. EVIDENCE: On arrival all the service users met were appropriately dressed for the warm weather and were wearing all manner of summer clothing, including shorts, tshirts, light trousers and dresses. Several service users spoken with at length said they were looking forward to the World cup and had decided to put on their replica England football shirts that morning in anticipation. As previously mentioned all the service users spoken with said the best thing about living at the Params was having the freedom to get up, got out, have a bath and generally do what you wanted, when you liked. Params The (18) DS0000025853.V297175.R01.S.doc Version 5.2 Page 17 The four care plans inspected at random all contained comprehensive overviews of each service users general health care needs. The home appropriately maintains up to date records of all the health care appointments service users attend, which revealed in the last month several service users had received input from a psychologist, an occupational therapist, a dietician, chiropodist, and dentist. During this unannounced site visit a registered nurse arrived to give the manager advice about dealing with incontinence issues. A service user who had injured their arm whilst on holiday said staff had taken them to the local hospital and made an appointment for them to see their GP on their return. Staff responded well to the incident and maintained appropriate records. The homes accident book revealed that no other accidents involving service users had occurred since January 2006, although several significant incidents had occurred in this time, which staff had kept an appropriate record of. Appropriate records are maintained of all medicines received and administered in the home with no recording errors noted on three service users Medication Administration sheets sampled at random. These records accurately reflected the current medication stocks held by the home on these service users behalves. It was positively noted that based on assessments of risk three service users who are willing and able are supported to self-administer their own medication. To minimise the risks associated with this activity each of the service users are provided with a lockable space in their bedrooms where they store their medication, a record of all the medication they keep is appropriately maintained by staff, who also discreetly monitor its handling at regular intervals. The deputy manager said the home does not currently handle any Controlled Drugs and protocols for the safe use of ‘as required’ (PRN) medication were available on request, which clearly identified when and how staff should administer this type medication. Params The (18) DS0000025853.V297175.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using all the available evidence. The homes arrangements for dealing with complaints and allegations of abuse appear to be sufficiently robust to ensure the service users feel confident that any concerns they may have will be listened and that they are, so far a reasonably practicable, protect from avoidable harm and/or abuse. EVIDENCE: All the service users met during the course of this site visit said they felt staff always listened to their point of view and they knew they could speak to their keyworker or the manager if they were unhappy with anything. As previously mentioned it was positively noted that a copy of the homes complaints procedure, which had been illustrated with symbols, was contained in the newly established Residents Guide. The homes complaints log revealed that no formal complaints or informal concerns had been made about the homes operation in the past four months. In response to one service users changing needs it was positively noted that the individuals care plan contained specific guidelines to enable staff to deal more effectively with the occurrence of significant incidents that challenged the service. The deputy manager stated that no allegation of abuse have been made within the home in the past twelve months. Two service users financial records sheets examined at random revealed that all the transactions taken on their behalves by staff had been recorded and receipts obtained where applicable. The balances recorded on these finance Params The (18) DS0000025853.V297175.R01.S.doc Version 5.2 Page 19 records matched the amounts being stored in the jars for these two service users and receipts sampled at random tallied with the amounts spent on specific items. All the receipts sampled had been marked with a folio number to make auditing easier. All monies looked after by the home on service users behalves is individually stored in glass jars, which are kept secure in a locked cabinet in the office. Params The (18) DS0000025853.V297175.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using all the available evidence. Overall the physical design and layout, which is currently maintained to a reasonably high standard, ensures service users are able to live in a relatively clean, comfortable, and safe environment. However, the home has not ensured that specialist equipment is always available to meet the individually assessed sensory needs of all the service users. The environment must be suitably adapted to ensure that so far a reasonably practicable the safety of people with sensory problems are protected. EVIDENCE: The home appeared to be very clean, felt pleasantly warm, and was free from any offensive odours throughout the course of this site visit. The interior décor of the premises is also maintained to a reasonable standard and a handyman was in the process of laying new flooring in the dining room and the main lounge at the time of this site visit. Params The (18) DS0000025853.V297175.R01.S.doc Version 5.2 Page 21 The temperature of hot water emanating from the first floor bath nearest the stairs was noted to be a safe 40 degrees Celsius at 12.20. Staff appropriately maintain up to date records of hot water checks carried out on a weekly basis on all the homes water outlets. Staff spoken with were all aware that hot water used in baths must never exceed 43 degrees Celsius. Having discussed the needs of the homes sensory impaired service users with the deputy manager it was evident that specialist equipment they required to maximise their independence and ensure their safety was protected had not being provided. Advice must be sought from the homes local fire authority as a matter of urgency about installing flashing light alarms in certain bedrooms to meet the sensory needs of both the homes hearing impaired service users. The homes washing machine is capable of washing clothes at appropriate temperatures and also has a sluice programme for dealing with foul laundry. The laundry room is located on the top floor of the house and therefore there is never any need to take dirty washing through areas where food is stored, prepared, and/or eaten. Adequate supplies of latex gloves and plastic aprons are kept in the home. As previously mentioned, a specialist nurse who had been asked to give advice on managing incontinence was also met during this site visit to the home. Params The (18) DS0000025853.V297175.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 Quality in this outcome area is good. This judgement has been made using all the available evidence. In the main sufficient numbers of suitably competent and experienced staff are employed on a daily basis to ensure the individual needs of the service users are met, although there are still some areas of practice that staff need further training in. EVIDENCE: Staff were observed taking there time to deal with service users questions and the two support workers informally interviewed at length demonstrated an extremely good understanding of the basic principles of care, and frequently referred to service users rights to make informed choices and decisions for themselves. Staff training records revealed that in accordance with National Minimum training targets for support workers over 50 of the homes current staff team have now achieved a National Vocational Qualification in care (Level 2 or above). Furthermore, at least one other member is currently enrolled on a suitable NVQ course. Params The (18) DS0000025853.V297175.R01.S.doc Version 5.2 Page 23 Three support workers, the homes manager and deputy, a cook, cleaner, and handyman were all noted to be on duty at the time of arrival. This corresponded with the information displayed on that mornings staff duty roster and the deputy manager said having at least three support workers on duty at al times during the day remained adequate to meet the assessed needs of the service users. At night the homes continues to employ one waking night staff while the homes manager remains on call in her won home which is located in the rear garden. If the owners are ever away the duty rosters identified that a member of staff must sleep-in on the premises to offer support as and when required to the waking night staff. It was positively noted that the managers have a very flexible approach to planning the rotas and have found a creative way of ensuring staff on the morning shift start an hour earlier to meet the needs of those service users who tend to get up much earlier in the summer months. The home continues to have a full compliment of staff and because no one has left since the beginning of the year the home has not needed to recruit any new members of staff. The service continues to recognise the importance of training and in the main delivers a programme that meets the service users needs. The manager said that sufficient numbers of his current staff team had received training in moving and handling, including specialist training in the use of the homes ‘Baronmead’ chairlift; basic food hygiene; medication, and fire safety. Documentary evidence of attendance of these courses was made available on request from staff files inspected at random. The deputy manager was aware that not all the homes current staff team have received suitable training in vulnerable adult protection and infection control courses, although he was confident both these training shortfalls would have been addressed by December 2006. Furthermore, although the deputy manager has recently attended equal opportunities, understanding racial, and disability equality training, this knowledge has yet to be formally cascaded down to the rest of his staff team, either through staff meetings or one to one supervision sessions. The homes staff team is ethnically extremely diverse and comprises of individuals from Indian, South East Asian, and black Caribbean/African and Eastern European backgrounds. The deputy manager acknowledged that while the culturally diverse mix of his current staff was quite reflective of Croydon as a whole, it did not match the ethnic origins of most of the service users, the majority of whom are white British. The manager has agreed to be mindful of this ethnic and cultural imbalance when he next recruits. Params The (18) DS0000025853.V297175.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42 Quality in this outcome area is adequate. This judgement has been made using all the available evidence. The service users benefit from living in a reasonably well run home which continues to be managed by two relatively experienced and competent individuals who currently job share, although neither are suitably qualified to manage a residential care home. The results of any quality assurance surveys undertaken by the providers must be assessed and their findings published on an annual basis. Without these results service users, their representatives, and other interested parties, including the CSCI, are unable to determine how successfully or not the service has been at achieving its stated aims and objectives. Sufficiently robust arrangements are in place to ensure, so far as is reasonably practicable, the health, safety and welfare of service users, their guests and staff are promoted and protected. Params The (18) DS0000025853.V297175.R01.S.doc Version 5.2 Page 25 EVIDENCE: Mrs Isabel Parameswaran, as the registered manager and co-owner of the Params, continues to be the named individual who is ultimatley responsible for this service, although it was clear from comnets made by the owners themsleves, staff and servcie users that Cosmo Kapondeni, the Depty manager, continues to be responsible for the homes day-to-day operation and espically the paparerwork. Neither Mrs Parameswaran nor Mr Kapondeni have achieved an National Vocational Qualification Level 4 or an equivilent in Management, despite this being made a recommendation in the homes last four inspection reports. This on going matter was raised with the homes co-owner/manager and deputy who both said they had recently dropped out of the NVQ courses they were enrolled on. The providers are reminded that while it is acceptable to the Commission for two suitably competent and experienced individuals to job share the responsibility of managing a care establishment it has never been permissible for this to be carried out by unqualified persons. Anyone who is either designated as in sole or joint charge of a residential care home must have achieved an NVQ Level 4 in management and care or at least be studying for it. The proprietors position on this matter needs to be clarified as a matter of urgency and a descion taken regaridng the manager and her deputy’s future roles. Minutes of staff meetings held in 2006 revealed that they continue to be arranged on a monthly basis and cover a wide variety of relevant topics including safe handling of medication practises, service users individual needs, and infection control issues. The home has Equal opportunities and Racial harassment policies in place that refer to the most up to date anti-discrimination legislation, (e.g. Race Relations, Sex, and Disability Discriminations Acts) and how staff should deal with racism between services users, staff and between these two groups. The providers have a quality assurance system in place and the deputy manager was able to locater service users and their respective satisfaction questioners on request. However, the deputy acknowledged that these surveys were now well over a year old and no attempt had been made to assess this feedback and publish their findings for all the relevant parties, including prospective new service users and the CSCI to view. Params The (18) DS0000025853.V297175.R01.S.doc Version 5.2 Page 26 The homes fire records indicated that its fire alarm system continues to be tested on a weekly basis and the last fire drill involving all the service users was carried out in May’06. All the service users met said they had participated in at least one fire drill in the last couple of months and knew they had to leave the building as quickly as possible and gather outside at the emergency assembly point if the fire alarm was sounded. Two fire resistant doors checked at random on the first floor landing and a bedroom on the ground floor both closed flush into their frames when released. It was also noted that no fire resistant doors were not being wedged open contrary to fire Regulations during a brief tour of the premises. Up to date Certificates of worthiness were in place to show that ‘suitably’ qualified engineers had tested all the homes fire extinguishers, ‘Baronmead’ chairlift, and water heating for compliance with Legionella in the past year. All the food kept in the ground floor kitchen fridge was correctly stored, along with all those items taken out of their original packaging which had all been correctly labelled and dated. Params The (18) DS0000025853.V297175.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 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 X 26 X 27 3 28 X 29 2 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 3 2 X X 3 X Params The (18) DS0000025853.V297175.R01.S.doc Version 5.2 Page 28 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 5(1)(d) Requirement Timescale for action 01/07/06 2. YA6 15(2)(b) (c) 3. YA29 12(4)(b), 13(4), 16(2)(c) & 23(4)(c)(ii) 4. YA35 13(3) (6) & 18.1, Sch 2.4 The Residents Guide must either include or make reference to the availability of the homes most recent CSCI Inspection report. Care plans must be reviewed 01/09/06 at least once every six months with each service user and/or their representatives and up dated accordingly to reflect any changes. Previous timescale for action of 1st March 2006 not met. Consult the local fire 01/09/06 authority about suitable arrangements that can be made to ensure all service users, including those with a hearing impaired, are given ample warning of fire. Sufficient numbers of staff 01/12/06 must receive training in infection control and vulnerable adult protection training. Documentary evidence of this training must be available for inspection on DS0000025853.V297175.R01.S.doc Version 5.2 Page 29 Params The (18) request. 5. YA37 9(2)(b)(i) The individual responsible for the full-time day-to-day management of the home must have achieved an NVQ Level 4 in Management and Care, or the equivalent. The results of any stakeholder surveys undertaken by the providers to ascertain service users, their relatives and professional representatives views about the quality of the service provided must be published on an annual basis. 01/01/07 6. YA39 24(2) 01/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA1 YA17 Good Practice Recommendations The Residents guide should contain the resident’s views about their experiences of life at the home. The culturally specific dietary preferences of all the service users, who come from a wide range of ethnically diverse backgrounds, should be taken into account when planning the weekly menus. The deputy manager should be mindful of the cultural and ethnic imbalance that currently exists between the homes staff team and the service when he next recruits. The knowledge obtained by the deputy manager who recently undertook equal opportunities training should be cascaded down to his staff through meetings or one to one supervisions. 3. 4. YA33 YA35 Params The (18) DS0000025853.V297175.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Params The (18) DS0000025853.V297175.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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