Inspection on 01/07/08 for Ronak Home

This inspection was carried out on 1st July 2008.

CSCI found this care home to be providing an Adequate service.

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

Ronak Home 14/01/09

Ronak Home 17/07/07

Ronak Home 10/04/06

Ronak Home 11/08/05

Ronak Home 14/04/05

Ronak Home 15/10/04

Ronak Home 10/05/04

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 28/09/2008.

CARE HOME ADULTS 18-65 Ronak Home 120 Alderman`s Hill London N13 4PT Lead Inspector Jane Ray Unannounced Inspection 1st July 2008 9:30 Ronak Home DS0000010634.V366721.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 Ronak Home DS0000010634.V366721.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. Ronak Home DS0000010634.V366721.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ronak Home Address 120 Alderman`s Hill London N13 4PT 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 8882 3586 020 8447 9105 MHJ Crausaz Ltd Manager post vacant Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Ronak Home DS0000010634.V366721.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are the following categories: 2. within Learning disability - Code LD The maximum number of service users who can be accommodated is: 10 17th July 2007 Date of last inspection Brief Description of the Service: Ronak Home is operated by MHJ Crausaz Ltd. This company has other homes locally. This home is registered for ten adults, aged between 18 and 65 years, who have a learning disability. The majority of current service users are non-verbal and a number have a diagnosis of autism. The home is a semi-detached three-storey house with a garden. There are ten single bedrooms, of which eight are en-suite. The home is situated close to the facilities of Palmers Green and is opposite a large park. There are good public transport services locally. High staffing levels and some day services are provided by the company in line with the service users individual needs. The homes stated aims are to provide care and support to ten younger adults who have learning disabilities. At the time of the inspection the range of fees at Ronak were £1612 - £3334 a week. A copy of this report can be obtained direct from the provider or via the CSCI website (web address can be found at page two of this report). Ronak Home DS0000010634.V366721.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The inspection took place on the 1 July 2008 and was unannounced. The inspection lasted for seven hours and was the key annual inspection. The inspection looked at how the home was performing in terms of the key National Minimum Standards for Younger Adults and the associated regulations. The inspector was able to observe the support given to the current residents and to talk individually to one of the residents. The inspector was also able to spend time talking to the manager as well as the two care staff who were working. The inspector did a tour of the premises and also looked at a range of records including resident records, staff files and health and safety documentation. The home had provided the inspector with a completed self-assessment questionnaire (AQAA) prior to the inspection. The inspector also received two completed surveys from relatives. What the service does well: The home provides a good standard of care and support to a group of residents with a range of very complex and challenging needs. The staff team are very stable and demonstrate a good knowledge of the residents and are able to recognise their individual needs, particularly in relation to their autism. The staff are also kind and patient and work hard to support the residents to express their choices. The house is comfortable and offers access to a choice of communal areas as well as being very near to a park and local shops. This contributes to the residents making good use of a wide range of community activities. The people who live in the home are supported to maintain positive contact with their relatives and they are able to visit the home whenever they wish to do so. One relative said, “I am happy that Ronak is providing a service to my relative”. Ronak Home DS0000010634.V366721.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: A few areas for improvement were identified for the service. The most significant of these is that the manager who has been in post for ten months needs to apply to be registered. This is important to ensure stable and consistent management in the home with clear accountability. In terms of the care and support to the residents it was required that they each have a correctly completed contract between themselves and the home that includes any specific staffing levels that have been agreed with placing authorities. The residents also need to be supported to access dental and optical checks if these are due. The implementation of person centred planning in the home should be completed. Ronak Home DS0000010634.V366721.R01.S.doc Version 5.2 Page 7 The staff team need to ensure they make use of the complaints procedure so concerns can be appropriately addressed. The manager should also use the regulation 26 reports as a way of completing work that needs to be addressed in the home. The manager should ensure all the records are appropriately organised so they can be accessed as needed. Ongoing maintenance issues need to be addressed to enable the environment is kept in a good state of repair. Some staff need to have their epilepsy training updated to enable them to support the residents with this condition. Staff also need training to ensure they use appropriate language when communicating with the residents when they are displaying complex and challenging behaviours. 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. Ronak Home DS0000010634.V366721.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 Ronak Home DS0000010634.V366721.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,2,3,4 and 5 were inspected. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home can be assured that they will be assessed and that the service can meet their needs. The contracts between the home and the resident are not always in place and may not reflect the agreed level of service. EVIDENCE: We looked at the statement of purpose and service user guide. The statement of purpose contains all the appropriate information and had been updated to reflect changes that had taken place in the home. The service user guide is in a user-friendly format and clearly explains what the home will provide. The case notes for four residents were inspected and three included a contract between the home and the resident and these had been signed as needed by the resident or an appropriate representative. The final person who had most recently moved to the service did not have a contract available. It was also noted that whilst some of the residents have specific agreements with their Ronak Home DS0000010634.V366721.R01.S.doc Version 5.2 Page 10 placing authorities about one to one staffing, this is not reflected in their contracts. The four case notes we inspected all had comprehensive assessments prepared by the staff in the home. These provided a good summary of the needs of each person and linked with the care plans. The AQAA completed by the home stated that since the last inspection four new residents have moved into the home for a respite service. At the time of the inspection two of these residents were staying at the home and they had both had an assessment prepared by a care manager and other care professionals prior to their admission. The staff explained that one of the new residents had visited the home prior to their admission with relatives and then again with a care manager. The other resident had lived at the home previously and was familiar with the service before moving back into the home. The admissions process is reflected in the statement of purpose. We discussed the current needs of the people who live in the home with the manager and care staff. They have very specific individual needs linked to their learning disability, complex behaviours, autism and epilepsy. The staff spoken to had a very good understanding of the individual needs of the residents. In addition it was observed that the staff were supporting the residents with great skill and sensitivity. The staff spoken to said they had received training on meeting the needs of the people living in the home. This was reflected in the training records. It was however noted that whilst eight staff had their epilepsy training updated since the last inspection, the rest of the staff team needed this training. It is recommended that this is arranged with the learning disability team. There was also a discussion with the manager about makaton training as this is used as a method of communication with several of the residents. This training was required at the last inspection, but the manager said they are finding it hard to identify a suitable trainer. Ronak Home DS0000010634.V366721.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6,7,8 and 9 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home can be confident that they will be supported to have an individual care plan and risk assessments. This will facilitate the residents to make choices in their daily lives. EVIDENCE: We inspected care plans for four people currently living in the home. We also spoke to the manager and care staff about the care plans. All of the people whose records were inspected had comprehensive care plans in place. These were clearly laid out and covered all aspects of each persons needs and were written using appropriate language. The care plans had all been reviewed on a monthly basis by the key-worker. The residents had been supported to have Ronak Home DS0000010634.V366721.R01.S.doc Version 5.2 Page 12 an annual care plan review meeting with their care manager and where the meeting was overdue it was seen that the home had written to the care manager to arrange the meeting. One resident was asked about his care plan and said he “looked at it sometimes” and was “happy” the contents of the plan. Each resident had a named key worker and co-key worker. The staff were asked about their role as a key-worker and this showed that the support they provided was very comprehensive including helping with personal shopping, attending healthcare appointments, ensuring all the residents personal care needs were met, organising leisure activities and updating care plans. The staff spoken to said, that they felt they were well matched as key-workers and had a positive relationship and good communication with the residents they keyworked. One resident was able to talk about his key-worker and how they are helping him to “plan my college course, talk about healthy eating and discuss holidays”. The staff also showed a good understanding of each resident’s individual care plan goals. Since the last inspection the manager and deputy manager have attended training on person centred care planning and have introduced a new format for the care plans that are gradually being completed. The four residents whose case notes were inspected all included individual risk assessments covering all areas of potential risk and these identified what action the home would take in response to the identified risks whilst at the same time promoting each persons independence. These had been reviewed and were up to date. Each person living in the home had individual behavioural guidelines as part of their individual profile, assessment and care plan and these were clearly written and gave appropriate guidance to the staff. The four residents assessments and care plans clearly stated what arrangements were in place to support them to manage their personal finances including who acts as their appointee and how they can access their monies. We observed the people living in the home and their interaction with the staff. It was positive to note that they were being facilitated to make choices including when they wished to get up or move around the home, when they were ready to eat and in some cases what they wanted to eat or drink. The staff were observed to be very aware of both verbal and non-verbal communication. They were also able to describe how they facilitate choices by for example offering a choice and observing the residents response. One resident was also able to describe how they have a monthly residents meeting and how he is able to contribute ideas. Ronak Home DS0000010634.V366721.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 11,12,13,14,15,16 and 17 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home are supported to develop their daily living skills and are also enabled to follow their own routine. The home has made progress in supporting the residents to enjoy a range of activities during the daytime based on their individual interests. Residents are offered a healthy and varied diet. EVIDENCE: The staff spoken to explained that the people living in the home were being supported by staff to develop their independent living skills in line with their individual needs. For example some residents are being supported to be more independent in terms of their personal care, others are learning to make use of public transport and others are being supported to assist with the shopping. Ronak Home DS0000010634.V366721.R01.S.doc Version 5.2 Page 14 The development of independent living skills was also reflected in the residents care plans. It was also observed during the inspection that residents were being supported to tidy their rooms. We spoke to the staff and looked at the resident’s activity programmes to get an understanding about the activities that are taking place. The manager explained that one of the residents goes to a specialist day centre five days a week. The other residents are supported by staff to participate in a range of activities. One of the residents since the last inspection has started attending a supported employment service where he does gardening. The activity records show that most of the residents go out every day and make good use of local leisure facilities such as parks, gyms and the library. On the day of the inspection most of the residents enjoyed a picnic in the park. The home has also arranged for an external fitness instructor to come once a week to the home to do an exercise session with the residents and an aromatherapy masseur. This activity also took place on the day of the inspection. In addition each weekend the home has access to a minibus and arrange day trips further away. The staff rota showed that additional staff are made available to facilitate these trips. There have also been some new leisure facilities provided in the home, including a range of fitness equipment, table football and pool, sensory equipment and some musical instruments. These all help to stimulate and provide entertainment for the residents. In terms of holidays one of the residents explained that they are all going to the Isle of Wight for a holiday at the end of August. The AQAA identified that the residents have different ethnic and cultural backgrounds. One person is Muslim and in line with her relatives’ wishes, does not eat pork, wears some traditional clothing and joins her relatives to celebrate some festivals. Other residents go to church and one of the residents explained how a volunteer comes to the home each Sunday to take him to church. The manager explained that the people living in the home have close contact with their relatives, who either come to visit them or they are supported to go home. One resident talked about his different friends. This included friends that he met through his family and the church as well as other people he knows through college and other activities. During the inspection one friend visited the home to go out with him for tea. We were able to observe during the inspection that the people living in the home were able to follow a routine of their choice and that people get up at different times according to their individual wishes and needs. It was very positive to note that the residents were supported in a very person centred and individual manner. Ronak Home DS0000010634.V366721.R01.S.doc Version 5.2 Page 15 We saw the record of food eaten in the home and this was a healthy and nutritious diet. The care plans provide the details of each persons specific nutritional needs and how these are met. The staff said they do the shopping at a local supermarket and then buy additional fresh food during the week. Ronak Home DS0000010634.V366721.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18,19 and 20 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home are supported in a manner that protects their privacy and dignity. Each person is supported to access professional healthcare input based on their individual needs although some healthcare checks need to be updated. Medication systems within the homes are well organised. EVIDENCE: We observed during the inspection that the people living in the home were given support with their personal care based on their individual needs. The residents were all well dressed and groomed and what they were wearing was very age appropriate. Most of the people living in the home have en-suite bathrooms and this helps to maintain their privacy. Ronak Home DS0000010634.V366721.R01.S.doc Version 5.2 Page 17 The healthcare records were inspected for the four people living in the home. They had all been supported to access the GP and psychiatrist but three had no record of an optical check and two no record of a dental check in the last 12 months. In addition the residents receive input for their specialist healthcare needs and it is also positive to note that a number of other services including psychology input had been accessed as required for specialist advice. All the people living in the home are supported to check their weight on a monthly basis. The recording of their weights was confusing as sometimes it was in kilograms and at other times in stones and pounds and so it is recommended the each persons weight is recorded consistently. The home uses a Lloyds blister pack medication system supplied by a local pharmacist. The medication administration records were inspected and are completed correctly. The medication entering the home is recorded appropriately on the medication administration record. There is a separate record for medication returned to the pharmacist. The medication available was correct. Some of the residents have PRN medication and guidelines are in place for when these should be administered. Each resident has a list of what medication they take and information about this medication including why it is used and possible side effects. Training records were inspected and fourteen of the twenty-one permanent staff had received medication training. The staff who administer the medication have completed the training. The medication storage cupboard is in the lounge and the deputy manager explained that it is being replaced by the pharmacist to provide more storage space. The pharmacist has provided a separate medication fridge. Ronak Home DS0000010634.V366721.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home have access to an appropriate complaints procedure but this is not always appropriately used. Procedures and training on safeguarding vulnerable adults are in place to protect the residents. Resident’s personal monies are being managed appropriately. Staff have been trained on how to appropriately support people who have complex and challenging behaviours but do not always speak to the residents using appropriate language. EVIDENCE: We looked at the complaints record and saw that there had been no complaints since the previous inspection. An appropriate format is available to record complaints and this monitors the time taken to resolve the complaint. The complaints procedure was also inspected and this was in a format accessible for the residents. One person spoken to during the inspection said that he would feel comfortable raising any problems with the staff. We are aware from an adult protection issue that one relative has raised some concerns. This was discussed with the manager as it would have been positive to see this complaint being recorded and responded to using the complaints procedure. Ronak Home DS0000010634.V366721.R01.S.doc Version 5.2 Page 19 The inspector saw that the home had a protection of vulnerable adults procedure prepared by the company. The staff training records were inspected and showed that all the permanent staff had received training on safeguarding vulnerable adults. Since the last inspection that has been one safeguarding issue in the service that was not substantiated. The staff attended the strategy meeting and contributed appropriately to the process. The staff training records also showed that almost all of the permanent staff had received training on how to work positively with service users who have complex challenging behaviours. It was however observed that one member of staff during the inspection spoke to a resident in an inappropriate manner and said, “don’t be naughty”. Whilst the staff members tone of voice was gentle there needs to be additional training on the use of appropriate language. We spoke to two staff during the inspection and they both showed a good knowledge of the complaints and adult protection procedures. The inspector looked at the personal finances for two service users. One person had their benefits paid directly into their building society account. The other resident was supported by relatives to manage their personal monies and only had spending money held in the home. There were records of expenditure with receipts available held separately for each resident. During the inspection the company internal auditor visited the home to check all the finances in the home and this provides an additional financial safeguard for the residents. Ronak Home DS0000010634.V366721.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24,25,27,28 and 30 were inspected. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home are benefiting from an environment that is clean, tidy and homely. Work is needed to ensure ongoing maintenance issues are addressed. EVIDENCE: We did a tour of the building and the home was clean and tidy. Residents had been supported to personalize their bedrooms. The furniture in the communal areas is designed to meet the needs of the residents by being strong and yet a style that is in keeping with the home. Each resident has a single room. Two residents have a futon bed, one because he had previously wanted to sleep on the floor and has been supported to move onto a low bed and the other because his epilepsy puts him at risk of falling. One resident who has mobility issues has a ground floor bedroom and a bathroom with a shower and shower Ronak Home DS0000010634.V366721.R01.S.doc Version 5.2 Page 21 chair that meets his specific mobility needs. Hygiene is promoted in the home by antibacterial hand wash and disposable hand towels being available in shared bathrooms and toilets. The AQAA prepared by the home explained that since the last inspection a number of environmental improvements had taken place including decorating the lounge and dining area, providing new dining chairs, installing a new tumble drier and providing internet access. The staff also said that the plumbing and drainage issues identified at the last inspection had now been resolved. The people living in the home frequently damage the fabric of the building. There were a number of areas that were observed as being in need of repair including the ground floor bedroom having a very stained carpet, one first floor en-suite bathroom having floor tiles that are lifting up and a couple of broken chests of drawers in bedrooms. It was also observed that the fire doors throughout the home were appropriately closed. Ronak Home DS0000010634.V366721.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32,33,34,35 and 36 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The residents are supported by a committed and stable team of staff. The staff are receiving a range of training and are supported by regular supervision sessions. This enables them to work to a high standard and deliver good care. EVIDENCE: We checked the rota for the home and this showed that there is a team of eighteen permanent staff working in the service. The staffing structure consists of the manager, deputy manager and a team of support workers. There is also a cleaner who works twenty hours a week. During the day there are seven or eight staff on duty and at night there are two waking members of staff. The manager and deputy are shown as being supernumerary. The staff turnover has been low with only two staff leaving in the last year. Most of the staff spoken to during the inspection had worked in the service for several years. Ronak Home DS0000010634.V366721.R01.S.doc Version 5.2 Page 23 The manager and care staff explained that staff team meetings take place on a monthly basis. The staff said they discuss a range of operational issues and that they feel able to raise any issues they want. The AQAA prepared by the home stated that twelve staff have completed an NVQ in care and four are working towards the qualification. We looked at the recruitment records for four staff including staff who had started working at the home since the previous inspection. It was found that all the staff had two references, ID, POVA check and a CRB disclosure. The staff had completed and signed contracts of employment. We inspected the training records. We looked at the induction records for the four staff and they all had completed an induction programme and recently recruited staff had done an induction in line with Skills for Care. We inspected the training records. The home has a training matrix and this was up to date and so it was possible to accurately tell who had received training and when this had taken place. An ongoing training programme is in place including all the mandatory training. We spoke to the staff who were able to describe their ongoing training and said they found this very useful. We looked at the supervision records. All the staff had received regular individual supervision and this is carried by the manager and deputy. The format used for supervision is appropriate and includes a record of any action agreed. Ronak Home DS0000010634.V366721.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37,39,41 and 42 were inspected. People using this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. A permanent manager who can provide effective leadership is in place but has not started the registration process. Health and safety measures are in place to safeguard the people living in the home. The quality improvement system seeks the views of people involved in the service. EVIDENCE: Since the last inspection a new manager has come into post. He has been working at the home for the past ten months but has not yet started the registration process. He explained that he was arranging to have a current Ronak Home DS0000010634.V366721.R01.S.doc Version 5.2 Page 25 passport so he can complete the criminal record bureau check arranged by the Commission. The Regulation 26 visits to the home had taken place regularly but the manager struggled to find the latest copies and there was no evidence that he was using these as an ongoing operational action plan. It was also evident that he needs to organise his records so they can be located with ease. The manager explained that quality assurance surveys had been sent to relatives and care professionals but unfortunately had not been returned. Staff had supported the residents to complete surveys and the outcomes had been collated into an action plan. In terms of fire safety we looked at the fire safety risk assessment and this was now complete. The AQAA stated that the fire alarm and fire extinguishers had been serviced. The fire alarm records show the alarm is checked weekly and the fire drill takes place each month. The fire alarm records showed that two alarm points were not working and the equipment had since been repaired. Fire safety training has been booked for the whole staff team. The AQAA showed that some of the health and safety maintenance checks were out of date. The certificates were inspected and the portable electrical appliances were meant to have been checked the day before the inspection and the manager explained that the engineer had cancelled the appointment. The gas landlord check was scheduled to take place the day after the inspection. The staff training records show that the staff have either completed or are booked to attend most of the health and safety training including food hygiene, moving and handling, first aid and infection control. Ronak Home DS0000010634.V366721.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 2 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 x 27 3 28 3 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 x LIFESTYLES Standard No Score 11 3 12 3 13 4 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 x 2 x 3 x 3 3 x Ronak Home DS0000010634.V366721.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES 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 YA3 Regulation 18(1)(c) Requirement The registered person must provide the staff with training so they can communicate effectively with the residents including makaton training. The requirement is amended and restated as the previous timescale of 31/10/07 was unmet. The registered person must ensure all the residents have a contract in place that specifies the service being provided to the resident including specific staffing levels. The registered person must ensure the residents receive healthcare treatment by ensuring they have all been supported to see a dentist and optician. The registered person must ensure they use the complaints procedure. The registered person must ensure that building maintenance work is carried out in the home. The registered person must ensure the manager completes DS0000010634.V366721.R01.S.doc Timescale for action 31/10/08 2. YA5 5(1)(b) 31/08/08 3. YA19 13(1)(b) 31/08/08 4. 5. YA22 YA24 22(3) 23(2)(b) 31/08/08 31/08/08 6. YA37 8(1) 31/10/08 Ronak Home Version 5.2 Page 28 the registration process. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA3 Good Practice Recommendations The registered person should ensure that where staff need their epilepsy training refreshed that this is arranged. This recommendation is restated from the previous inspection. The registered person should extend the implementation of person centred planning. This recommendation is restated from the previous inspection. The registered person should ensure that where the staff record the residents weight that the record of measurement is consistent. The registered person should ensure the manager uses the outcomes of the regulation 26 reports. The registered person should ensure the manager keeps records in an orderly manner. 2. 3. 4. 5. YA6 YA19 YA39 YA41 Ronak Home DS0000010634.V366721.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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