Inspection on 09/04/09 for Shalom Home

This inspection was carried out on 9th April 2009.

CQC 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 19 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Shalom Home 11/11/08

Shalom Home 16/05/08

Shalom Home 12/10/07

Shalom Home 05/04/06

Shalom Home 22/11/05

Shalom Home 27/07/05

Shalom Home 04/01/05

Shalom Home 02/08/04

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Shalom Home Shalom Home 143 Caistor Park Road Stratford London E15 3PR     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lea Alexander     Date: 2 0 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 37 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 37 Information about the care home Name of care home: Address: Shalom Home 143 Caistor Park Road Shalom Home Stratford London E15 3PR 02084719533 02084719533 b.fadojutimi@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Bodi Fadojutimi care home 3 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Additional conditions: 3 The maximum number of service users who can be accommodated is: 3 The registered person may provide the following category 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 within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home Shalom Home is a small care provider for 3 adults with a history of mental illness. It was registered in July 1999 and the registered provider is also the registered manager. The premises are located in a terraced house on a residential street in Stratford. The accommodation comprises of a communal lounge and attached kitchen diner, bathroom with wc and garden. There is a staff office/sleep in room and two service user bedrooms located on the first floor, and a third service users bedroom located on the ground floor. There is a garden to the rear of the property and a large park nearby. The home has easy access to transport links and community facilities. Care Homes for Adults (18-65 years) Page 4 of 37 1 3 1 1 2 0 0 8 Care Homes for Adults (18-65 years) Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: Two Inspectors visited the home over the course of one day. We spoke with the Manager and with the member of staff on duty. We also spoke privately with two residents. In addition we looked at a range of records and documentation relating to the running of the home including residents personal files and staff personnel files. We requested that the home complete an Annual Quality Assurance Assessment, however we did not receive this within the required timescales. Care Homes for Adults (18-65 years) Page 6 of 37 What the care home does well: What has improved since the last inspection? What they could do better: A number of requirements made at a previous inspection are restated. Details of these can be found in the Outstanding Statutory Requirements section at the rear of this report. If the home fails to comply with these restated requirements at the time of the next key inspection the Care Quality Commission may consider enforcement activity to Care Homes for Adults (18-65 years) Page 7 of 37 ensure the homes compliance. As a result of this inspection 21 requirements and 2 recommendations are made. The home must ensure that a person centred approach to risk assessment is implemented. Any bars to residents involvement in community activities, such as mental state or motivation should be reflected in the individual plan. A varied menu should be offered to people who use the service. Residents must be supported to attend a range of healthcare appointments. The outcome of healthcare appointments along with any follow up must be recorded. Care plans must clearly identify any staff support that is required to underpin residents who are self medicating. Care staff must be evidenced as having received training and been assessed as competent by an appropriate trainer to monitor blood sugar levels. Medication must be administered in accordance with its prescription. When required, the home must seek appropriate advise from a pharmacist. Medicines with a limited shelf life must be date labelled once opened. Care workers must demonstrate a basic knowledge of how medicines are used and how to recognise and deal with problems in use. The home must maintain a record of all medicines received, administered and leaving the care home or disposed of to ensure that there is no mishandling. Correspondence or file entries detailing key advise from health care professionals (such as acceptable blood sugar levels) must be easily accessible on file. The home should update its British National Formulary at least every two years. The broken wardrobe door handle in one residents bedroom must be replaced, and appropriate storage facilities provided. A training needs assessment should be carried out for the staff team as a whole. The home must develop a training and development programme, with a dedicated training budget. Each staff member must have an individual training and development assessment. Each staff member must be evidenced as having received five paid training and development days each year. The home must ensure that a qualified first aider is on duty at all times. The Manager must ensure that the outcomes of the quality assurance survey are collated and made available to interested parties. The home must forward to the Care Quality Commission a copy of its most recent LFEPA report. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 37 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Previous inspections have evidenced that the home has produced a statement of purpose. There have been no new admissions or discharges from the home since the last inspection. Evidence: There have been no discharges or new admissions to the home since the last inspection. Care Homes for Adults (18-65 years) Page 10 of 37 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is some evidence that individuals are involved in the homes decision making processes. Each individual has a care plan, but the practise of involving residents in the development and review of the plan is variable. There is little evidence that plans are person centred. There is little evidence of individualised, comprehensive risk assessments. Those risk assessments that are available are generic and often inappropriate to the residents needs. Evidence: We looked at the personal files of two people who use the service. This evidenced that the home has developed a range of plans to address their personal, healthcare and social needs. However, our discussions with people who use the service and with the care worker on duty evidenced that some significant areas of need had not been addressed. These included one residents mobility needs whilst in the community and the arrangments for managing their finances. We also noted that the plans developed did not identify residents activities of daily living, giving clear information on daily care Care Homes for Adults (18-65 years) Page 11 of 37 Evidence: tasks that they were able to do for themselves and identifying areas where support was required, for example meal or snack preparation. Whilst examining residents personal files we noticed some evidence of the home undertaking life story work with one resident. There was limited evidence of individual plans being person centred, with some plans duplicated across several residents. Not all the plans we saw were signed by the resident to evidence their participation in the planning process. Discussion with the Manager and residents evidenced that each has their own bank account. These discussions and sampling of records also evidenced that one resident receives support in managing their weekly cash allowance. Their monies are held in a locked cash box, and as required the resident deposits and withdraws monies. For each deposit and withdrawal a financial transaction sheet is completed with the date, amount and nature of the transaction. This is signed by the resident and care worker on duty. We looked at these sheets and spoke with the resident and found everything to be in order. However, whilst the arrangements for supporting this resident to manage their weekly cash allowance were reflected in an individual plan, the wider arrangements for managing their finances were not clearly identified in the plans. We were aware that this resident has in the past received assistance from an outside agency in managing their finances, but from discussions with them and examination of their personal file it was unclear whether this was ongoing. The home organise regular residents meetings as a forum for people who use the service to participate in the day to day running of the home. We looked at the minutes of these meetings and spoke with people who use the service. This evidenced that during recent meetings residents had been stating that they were happy with the home. We noted that the agenda for these meetings was often the same. The home should consider ways in which other matters that affect the day to day running of the home could be incorporated into these meetings. We examined the risk assessments available for two residents. We noted that an individualised approach had not been taken in their completion, and that risk assessments for arson, aggression and knife attack had been completed for all residents, even though there for two residents there was no evidence of these ever having occurred or their having exhibited behaviours that would cause concern for potential risk in these areas. Potential risks for one resident that had been identified such as poor mobility, had not however been subjected to a risk assessment. Care Homes for Adults (18-65 years) Page 12 of 37 Care Homes for Adults (18-65 years) Page 13 of 37 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Educational and community activities are explored with people using the service. However, where specific issues may present a barrier to community engagement there is little evidence of how the home works with individuals to overcome these. Evidence: Discussion with residents and the Manager and sampling of documentation, evidenced that residents are engaged in community activities according to their interests and abilities. Some of the homes residents experience enduring mental health issues and Manager told us that these impact upon their motivation to engage in activities. However, this was not reflected in their individual plans and it was not evidenced from their personal files that activities or motivational issues were regularly discussed or reviewed with residents. Care Homes for Adults (18-65 years) Page 14 of 37 Evidence: We spoke to two residents. One told us that they were happy with their current community activities. The second told us that since the last inspection they had been supported to access additional activities within the community, and were pleased with this improvement. The residents we spoke to also told us that they were happy with the entertainment provided within the home, and that their daily routines were flexible, with residents choosing when they would like to get up or go to bed. Discussion with people who use the service, sampling of their individual plans and discussion with the Manager evidenced that residents are in contact with their families at a frequency they choose and feel comfortable with. During our visit to the home we observed that the care worker on duty regularly interacted with the homes residents. We spoke with residents and looked at the homes log of meals provided. This evidenced that nutritious meals that are reflective of the preferences and cultural backgrounds of people who use the service are provided. However, we formed the view that the weekly menus should include more variety, with dishes rotating so that the menu is not duplicated from week to week. Two people who use the service have medical requirements that govern their diets. These were reflected in their individual plans and in the weekly menus developed by the home. During our site visit we noted that bulk quantities of simliar food stuffs had been purchased, particularly pasta sauces and baked beans, which would also evidence a lack of variety within the homes menu. Care Homes for Adults (18-65 years) Page 15 of 37 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to access a range of health care services. There is a record of general health care information, although this has some gaps. People who use the service are able to administer their own medication. People who use the service are happy with the way staff deliver their care. However, staff are not evidenced as having received appropriate medication training, and some medication practises are unsatisfactory. The home does not have suitable medication stock taking systems in place. Evidence: Discussion with residents, the care worker on duty and sampling of records evidenced that people using the service are independent in their personal care and only require prompts and reminders. At a previous inspection we had located individual plans on some residents personal files headed inappropriate toiletting behaviour. We had found these plans to be insensitive and demeaning towards residents. We also noted that these plans did not idenfity any particular needs residents might have in these areas that could contribute Care Homes for Adults (18-65 years) Page 16 of 37 Evidence: towards poor toilet hygiene. As a result of the previous inspection we had required the home to provide sensitive support to people who use the service in order to promote their dignity and respect. We were disappointed to note that these plans remained in place unchanged at the time of this inspection. We looked at the records available to evidence healthcare appointments residents had been supported to attend. We noted that generally residents had been supported to attend healthcare appointments including the GP, Optician, District Nurse, Diabetic Nurse and hospital outpatient appointments. However, we noted that there was no record of one resident having attended for a dentist appointment. For a second resident with a dermatology appointment there was no record of the outcome of this appointment or any follow up. Previous inspections have evidenced that the home has developed a medication policy that complies with National Minimum Standards. Discussions with one resident and sampling of their individual plan evidenced that they are self medicating daily insulin injections to manage their diabetes. We noted that their individual plan stated the parameters within which their blood sugar should be maintained. However, there was no evidence where this figures had been obtained from. Good practise would suggest that the home should have on file and readily accessible a letter from the GP or Diabetic Nurse confirming these parameters. The individual plan we saw relating to this residents self medication of insulin was also misleading, as whilst the resident injects themself, prior to this a member of staff must test their blood sugar levels. This assistance by care staff was not reflected in the self medication plan or subject to a risk assessment. The home has however developed a seperate plan which does identify that that staff will assist with blood sugar monitoring. However, this states that if the levels are within acceptable limits staff should give insulin. We were concerned that details of this key medication were split over different plans, with contradictory information recorded on each. Another resident self medicates for short periods whilst they stay with a family member. We noted that this activity was clearly identified in the individual plan and subject to a risk assessment. We spoke with the care worker on duty and looked at training records. We could not evidence that care workers had received appropriate training and been deemed competent by a suitably qualified person (such as the diabetic nurse) to undertake blood sugar level monitoring. Care Homes for Adults (18-65 years) Page 17 of 37 Evidence: At the time of this inspection no residents were taking any controlled medications. We examined the homes medication cupboard and looked at Medication Administratin Records (MAR) we found that only current medications were being held by the home, and any discontinued medications had been appropriately disposed off. The MAR sheets we saw were generally in good order, however a number of issues relating to medication were identified. The majority of medications were provided by the pharmacy in ready prepared blister packs. Some blisters contained a number of different tablets. No clear descriptions were given of the tablets contained within each blister. This raised a particular issue as one blister contained a dispersible aspirin that should be dissolved in water prior to administration. However, the care workers on duty had not been able to identify which tablet was the dispersible aspirin. This meant that it had been supplied in tablet form to be swallowed along with the other tablets in that blister. It was evidenced from MAR sheets that this had occurred over a four day period, and that during this time none of the care workers or the Manager had contacted the pharmacist to seek advice. Some medicines, such as procyclidine had been received by the home in bottles, rather than blister packs. However, from discussions with the care worker on duty and with the Manager and from sampling available records we were unable to evidence that the home had developed and was using a stock control system to evidence how many tablets had been been received for health and safety reasons. At the time of this inspection one resident was being prescribed eye drops. We noted that these should be disposed off within 28 days of opening. However, they had not been labelled with the date they were first opened, so there was no way of accurately knowing when they should be disposed of. We also noted that the storage instructions for these eye drops stated that once opened they should be stored at room temperature. We noted that they were actually being stored in the fridge. Our enquiries with the pharmacist confirmed that this method of storage would not affect the efficacy of the medicine, but that the lower temperature could cause irritation to the eye when administered. The home should ensure that it reads all instructions that accompany medicines, and that these instructions are complied with. We spoke with the care worker on duty and asked them about two medications that residents are regularly prescribed. The care worker was unable to describe the purpose of the medication, or why it might be prescribed. We asked to see the homes medication guidance book and were shown a British National Formulary (BNF) dated 1995. We recommend that homes update their BNF every two years. Care Homes for Adults (18-65 years) Page 18 of 37 Care Homes for Adults (18-65 years) Page 19 of 37 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has developed a complaints procedure that complies with National Minimum Standards. Residents understand how to make a complaint. The home keeps a full record of complaints that includes the investigation and action taken. The home understands the procedures for safeguarding adults. Evidence: We spoke with two residents, the care worker on duty and the Manager. We also looked at the homes complaints log, residents meeting minutes and the daily contact sheets for two residents. This evidenced that since the last inspection the home has maintained comprehensive records of all complaints received, along with the nature of the investigation undertaken and its outcome. From our discussions with residents we noted that some recurring complaints had now been dealt with and were resolved to the satisfaction of the complainant. Both the residents we spoke with were familiar with the homes complaints policy. There have been no safeguarding matters identified since the last inspection. We also noted that records addressing safeguarding matters identified at a previous inspection were available and that these detailed the investigation undertaken and evidence that the matters were unfounded. Care Homes for Adults (18-65 years) Page 20 of 37 Evidence: Previous inspections have evidenced that the home has developed complaints and safeguarding policies and procedures that comply with National Minimum Standards. We spoke with the care worker on duty. The demonstrated a sound understanding of safeguarding issues, and their responsibilities should they have any concerns. Care Homes for Adults (18-65 years) Page 21 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a range of shared and private spaces, and residents have their own bedrooms. A range of maintenance issues identified at an earlier inspection have been addressed. Evidence: The home is situated in a Victorian terraced property in a quiet residential location close to public tranpsort links and the nearby shopping centres at Stratford and Green Street. There is also easy access to the nearby West Ham Park. Entrance to the home is via a small porch that leads into a hallway. A small lounge leads off this hallway and this has a range of seating, a satellite TV and a stereo. The lounge leads into a kitchen with dining area. There are a range of fitted units and appliances. From the dining area there are patio doors to a paved rear garden. From the kitchen there is a small hallway that leads onto the bathroom. This has a WC, handbasin, and bath tub with shower over. One residents bedroom is also located on the ground floor. This is equipped with a double bed, chest of draws, wardrobe and other suitable bedroom furniture. Access to the first floor is via a staircase and two residents bedrooms and a staff office Care Homes for Adults (18-65 years) Page 22 of 37 Evidence: are located on this level. We saw one residents bedroom on this level and noted that it was equipped with a single bed, wardrobe and other suitable bedroom furniture. Two residents showed us their rooms. We noticed that in one bedroom a large supply of incontinence pads were prominently displayed in open shelving. We were of the view that these could be more discreetly stored. We also noticed that the wardrobe door handle in one residents bedroom was broken. We observed that a number of requirements relating to repairs and maintenance issues identified at the previous inspection had been satisfactorily addressed. The Manager told us that a schedule for decorating the communal areas of the home was in development. Care Homes for Adults (18-65 years) Page 23 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are generally satisfied with the care that they receive, but there are times when they may need to wait for a short time for staff support and attention. The training provided by the home is limited, with individual staff needs neither identified or targeted. The training that is provided tends to be internal, with a lack of documentary evidence about the actual training provided. There is no comprehensive training plan, and staff training records are unreliable. Some staff training is provided whilst staff are rostered on duty, which may have an adverse affect on people using the service. Evidence: We looked at the homes current staffing rota and spoke with the Manager. This evidenced that at the time of this inspection the home employs four care workers. The home has a day shift and night shift over a 24 hour period, and one member of staff is rostered on duty for these. Staff are currently employed to provide a sleep in night cover. The Manager told us that 3 staff are currently studying for their NVQ level 2. We looked at the current staffing rota and found that this reflected the situation we Care Homes for Adults (18-65 years) Page 24 of 37 Evidence: found in the home during our visit. We examined the personnel files for two care workers currently employed by the home. This evidenced that the home had obtained two satisfactory references and a Criminal Records Bureau (CRB) check for each prior to their starting employment. Sampling of these files also evidenced that staff receive copies of their employment terms and conditions. We also found copies of completed induction training records on the staff files we sampled. The male service user group are from diverse cultural backgrounds and have differing ages. Whilst the staff group has mixed gender, their cultural backgrounds are not reflective of the local community or people who use the service. We discussed this with the Manager who told us that they recognised this as an issue and were planning to address this through further staff recruitment. We spoke with the Manager and care worker on duty. We also looked at the homes training records. This evidenced that limited training had been offered to staff since the last inspection. However, we were advised that additional training was planned. During our discussions with the Manager they advised us that staff are encouraged to attend NVQ level training, and that these training sessions are scheduled for when staff are rostered on duty. We expressed our view to the Manager that this practise could have a negative impact upon the care residents receive whilst the training is in progress. We also spoke with the Manager regarding the limited mental health experience of one care worker within the home. The previous inspection had required the home to ensure that all staff are able to demonstrate a basic understanding of mental health issues. We asked the Manager what mental health training had been provided since the last inspection to this staff member and were advised that a 30 minute learning set had been included in a recent supervision session. We formed the view that this uncertificated, undocumented training would not satisfy the requirement we had previously issued. Examination of the training records for one member of staff evidenced that they had completed health and safety training and first aid training as part of a two day care assistant training programme in January 2007. However, there was no evidence of them having completed more comprehensive training in these areas since. For a second care worker we noted that their personal file had been annotated to record attendance at a number of mandatory training events, however copies of attendance certificates were not available on the personnel file. For a third care worker their was no evidence of fire training or medication training. They were evidenced as having Care Homes for Adults (18-65 years) Page 25 of 37 Evidence: completed first aid training in 1994, however this had now expired. We looked at three personnel files and spoke with the care worker on duty. This evidenced that care staff receive a minimum of six supervisions in a year. Care Homes for Adults (18-65 years) Page 26 of 37 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Manager is suitably qualified and experienced. They are aware of the need to promote safeguarding. Where ever possible residents are encouraged to manage their own finances. However, the service did not complete and return its AQAA within the specified timescales. The training and development of staff is inconsistent. Evidence: We spoke with the homes Manager who told us that they had completed their NVQ level 4 studies and were awaiting their certificate. The Manager has been in post for some years and had previoulsy worked as a Mental Health Nurse. We looked at residents personal files and other documentation. We also spoke with people who use the service and the Manager. This evidenced that since the last inspection the home has obtained the views of resdients on the service provided. However, the home had not collated or published the outcomes of this quality assurance excercise. Care Homes for Adults (18-65 years) Page 27 of 37 Evidence: The home maintains a log of fridge and freezer temperatures. We looked at these and found that daily entries had been made that evidenced that temperatures are maintained within acceptable parameters. Available records also evidenced that the home carries out weekly fire alarm tests. The home also maintains accident and incident reports, we looked at these and found them to be in order. At a previous inspection we had required the home to forward to the Commission a copy of its most recent London Fire and Emergency Planning Authority (LFEPA) report. We noted that this had not been forwarded to us and was not available during this inspection. After the inspection the Manager contacted us to say that they were requesting a visit from the LFEPA and would forward their report from this visit as soon as it became available. The home has obtained adequate insurance cover and a current insurance certificate is displayed within the home. One resident within the home is responsible for paying their own fees. We asked to see records of the monies requested and collected from this resident. Shortly after the inspection the Manager submitted to the Commission copies of invoices for fees that had been sent to this resident. They also submitted a record of payments received in response to these invoices. Care Homes for Adults (18-65 years) Page 28 of 37 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 6 14 The home must ensure that 30/08/2009 individual plans appropriately detail the health, social and personal needs of people who use the service. To promote the safety and well being of people who use the service. 2 6 15 The home must evidence that plans are drawn up and reviewed with the involvement of the resident. To promote the well being of people who use the service. 30/08/2009 3 7 16 Where appropriate residents must be supported to manage their finances. The nature of this support and the reasons it is required must be documented and reviewed. For the safety and well being of people who use the service. 30/08/2009 4 7 16 & 20 The home must ensure that appropriate advocacy services are provided to people who use the service. The home must seek independent financial advice from appropriate sources for 30/09/2009 Care Homes for Adults (18-65 years) Page 29 of 37 the resident who is liable to pay their own contributions 5 9 13 The home must ensure that identified risks are appropriately assessed and subject to a management strategy. Sensitive support must be offered to people who use the service to promote their dignity and respect. To promote the safety and well being of people who use the service. 30/08/2009 6 18 12 30/08/2009 7 19 12 The home must ensure that 30/08/2009 the health care needs of people who use the service are assessed and procedures put in place to address them. To promote the safety and well being of people who use the service. 8 24 13 A programme of 30/10/2009 maintenance and repair must be undertaken for the homes tired decor. To ensure that people who use the service benefit from a comfortable and well maintained environment. 9 33 18 Staff must be employed in 30/08/2009 sufficient numbers to ensure uninterrupted work with residents in addition to the administration and day to day running of the home. To promote the safety and well being of people who use the service. Care Homes for Adults (18-65 years) Page 30 of 37 10 35 18 The home must ensure that 30/08/2009 all staffs demonstrate a basic understanding of mental health issues. The home must forward a copy of its most recent LFEPA inspection report to the Commission for Social Care Inspection. To ensure the safety of people who use the service. 30/09/2009 11 42 23 Care Homes for Adults (18-65 years) Page 31 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 A person centred approach to risk assessment must be adopted. To ensure the safety and well being of people who use the service. 30/08/2009 2 12 16 Any bars to residents involvement in community activities, such as mental state or motivation should be reflected in the individual plan. To promote the well being of people who use the service. 30/08/2009 3 17 16 A varied menu should be offered to people who use the service. To promote the well being of people who use the service. 30/08/2009 4 19 12 The outcome of healthcare 30/08/3009 appointments along with any follow up must be recorded. Care Homes for Adults (18-65 years) Page 32 of 37 To ensure the safety and well being of people who use the service. 5 19 12 Residents must be supported to attend a range of healthcare appointments. To ensure the safety and well being of people who use the service. 6 20 13 The home must maintain a record of all medicines received, administered and leaving the care home or disposed of to ensure that there is no mishandling. To ensure the safety and well being of people who use the service. 7 20 18 Care workers must 30/08/2009 demonstrate a basic knowledge of how medicines are used and how to recognise and deal with problems in use. To ensure the safety and well being of people who use the service. 8 20 13 Medicines with a limited shelf life must be date labelled once opened. To ensure the safety and well being of people who use the service. 9 20 13 When required, the home must seek appropriate advise from a pharmacist. 30/08/2009 30/08/2009 30/08/3009 30/08/3009 Care Homes for Adults (18-65 years) Page 33 of 37 To ensure the safety and well being of people who use the service. 10 20 13 Medication must be administered in accordance with its prescription. To ensure the safety and well being of people who use the service. 11 20 18 Care staff must be evidenced as having received training and been assessed as competent by an appropriate trainer to monitor blood sugar levels. To ensure the safety and well being of people who use the service. 12 20 13 Care plans must clearly identify any staff support that is required to underpin residents who are self medicating. To ensure the safety and well being of people who use the service. 13 35 18 Each staff member must be evidenced as having received five paid training and development days each year. To promote the safety and well being of people who use the service. 14 35 18 Each staff member must have an individual training and development assessment. 30/09/2009 30/03/2010 30/08/3009 30/08/3009 30/08/3009 Care Homes for Adults (18-65 years) Page 34 of 37 To promote the safety and well being of people who use the service. 15 35 18 The home must develop a training and development programme, with a dedicated training budget. To promote the safety and well being of people who use the service. 16 35 18 A training needs assessment 30/08/2009 should be carried out for the staff team as a whole. To promote the safety and well being of people who use the service. 17 39 24 The Manager must ensure 30/09/2009 that the outcomes of the quality assurance survey are collated and made available to interested parties. To develop the service in line with the views of residents and other stakeholders. 18 42 12 The home must ensure that a qualified first aider is on duty at all times. To promote the safety and well being of people who use the service. 19 42 23 The home must forward to 30/10/2009 the Care Quality Commission a copy of its most recent LFEPA report. 30/10/2009 30/09/2009 Care Homes for Adults (18-65 years) Page 35 of 37 To promote the safety and well being of people who use the service. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 20 21 The home should update its British National Formulary at least every two years. Correspondence or file entries detailing key advise from health care professionals (such as acceptable blood sugar levels) must be easily accessible on file. Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 37 of 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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