Inspection on 23/05/06 for Smitham Downs Road (7)

This inspection was carried out on 23rd May 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Smitham Downs Road (7) 14/11/05

Smitham Downs Road (7) 09/11/04

Smitham Downs Road (7) 06/04/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Smitham Downs Road (7) 7 Smitham Downs Road Purley Surrey CR8 4NH Lead Inspector Lee Willis Key Unannounced Inspection 23rd May 2006 10:45 Smitham Downs Road (7) DS0000025837.V294124.R01.S.doc Version 5.1 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 Smitham Downs Road (7) DS0000025837.V294124.R01.S.doc Version 5.1 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. Smitham Downs Road (7) DS0000025837.V294124.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Smitham Downs Road (7) Address 7 Smitham Downs Road Purley Surrey CR8 4NH 020 8645 0873 020 8645 0873 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) www.caremanagementgroup.com Care Management Group Limited Mr Joseph Benedict Awolowo Kpebi Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Smitham Downs Road (7) DS0000025837.V294124.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th November 2005 Brief Description of the Service: 7 Smitham Downs Road is owned and managed by the Care Management Group (CMG) and is currently registered to provide personal support and accommodation for up to nine younger adults with moderate learning disabilities and behaviours that challenge the service. Joseph Kpebi, who has been the homes registered manager for nearly two years, remains in operational day-to-day control. This detached property is set back from a main road in a quiet residential suburb of Purley and is within a mile radius of the centre of town, with its wide variety of local shops, cafes, take-aways, pubs, and banks. The Home is also within five minutes walk of a main line bus route and quite near a couple of local train stations with good links to Croydon and central London. The main building comprises of seven single occupancy bedrooms; a main lounge; separate dinning area; games/smoking room; kitchen; small utility room, and a ground floor office. The two bed-roomed flat attached to the side of the main house is self-contained and has its own kitchen and ensuite shower and toilet facilities. The sloping garden at the rear of the property is well maintained. Service users and their reprensentatives have access to copies of the homes Statement Of Purpose, Residents Guide, CSCI reports and their terms and conditions of occupaoncy. These documents contain information about the services and facilities provided and the fees charged for them, which currently stands at £4,800 to £5,600 per month. Smitham Downs Road (7) DS0000025837.V294124.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. From all the available evidence gathered, which included a site visit to the home, the Commission for Social Care Inspection (CSCI) has judged this service to be an ‘adequately’ performing one. The home has substantially more strengths than weaknesses, but there remains areas of concern that require improvement through a mandatory action plan which the Commission will use to monitor progress. This comment notwithstanding most key National Minimum Standards are almost met and the service has been assessed as safe for residents. The Commission is confident the home will acknowledge the weaknesses identified in this report and resolve them in a timely fashion. The unannounced site visit to the home was carried out on Tuesday 23rd May 2006 between 10.45am and 4.45pm. During the course of this six-hour visit six residents were met, of whom four were spoken with at length. The homes Registered, Regional Operations, and Deputy managers, were also met, along with two support workers who were both on duty at the time. A service users Care Manager was also contacted by telephone prior to this site visit. Three service users said they were happy to participate in a CSCI survey and helped complete ‘have your say’ questionnaires about their experiences of life at Smitham Downs. The manager also completed a Pre-Inspection Questionnaire and been asked to carry out an Equalities survey of the home. The remainder of the site visit was spent examining the homes records and touring the premises. What the service does well: The majority of service users met during the site visit said they liked living at Smitham Downs Road and generally viewed the home in a positive light. Most service users spoken with said the ‘best thing’ about living at Smitham Downs was having the freedom to do what you wanted when you liked. Similarly, most service users met agreed that the choice of meals on the weekly menus, which they helped plan, were also very good and went on to say that most of the staff were very approachable and easy to get along with. All staff on duty were observed interacting with service users in an extremely friendly and respectful manner during the course of the site visit. It was clear from the practices observed and comments received that staff continue to actively support the service users to maintain and develop their independent living skills by encouraging them to cook their own meals, tidy up their bedrooms and participate in regular meetings about the homes day to day operation. Smitham Downs Road (7) DS0000025837.V294124.R01.S.doc Version 5.1 Page 6 Furthermore, because the home has experienced relatively low levels of staff turnover in the past year the service users continue to be supported by experienced individuals who are familiar with their unique needs and preferences. What has improved since the last inspection? What they could do better: The positive comments made above notwithstanding the manager acknowledges that the home could do much better in a number of clearly identifiable ways: The homes Statement of purpose, Residents Guide and each service users terms and conditions of occupancy need to include more detailed information about what additional costs prospective service users and their representatives can be expected to be charged for so called ‘extra’ facilities and services that are not covered by the basic price of each service users placement. Arrangements for notifying the Commission about the occurrence of ‘significant’ events in the home that adversely affect the health and welfare of service users need to be improved. Documentary evidence of all the relevant training undertaken by staff needs to be kept in the home at all times. With so many gaps in training records with regards certificates of attendance it was difficult to determine whether or not the homes staff team are suitably qualified to effectively carry out all their core duties and responsibilities. The manager needs to develop a more consistent approach to keeping information about staff training. Smitham Downs Road (7) DS0000025837.V294124.R01.S.doc Version 5.1 Page 7 Similarly, records revealed that not all staff, which included the homes most recent recruit, were not being formally supervised by a suitably qualified senior member of staff on a regular basis. It is essential the home increase the frequency of staff supervision sessions and views any probationary periods of employment, including induction, as being an extension of the recruitment process. 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. Smitham Downs Road (7) DS0000025837.V294124.R01.S.doc Version 5.1 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 Smitham Downs Road (7) DS0000025837.V294124.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 5 Quality in this outcome area is adequate. This judgement has been made using all the available evidence including a site visit to the service. Prospective service users and their representatives have all the information needed to choose a home, which will meet their needs. However, each service user and their representatives have not been provided with copies of their terms and conditions of occupancy, which clearly tells them about the facilities and services they will receive. EVIDENCE: The home helps prospective residents to understand the service by providing them with a Statement of Purpose which sets out clearly what the homes objectives, ethos, and the services and facilities it offers. The Statement of purpose is precise in what the prospective resident can expect and gives a good detailed account of the quality of the accommodation, qualifications and experience of staff, and how to make a complaint. The document was last reviewed in May 2006 and up dated accordingly to reflect recent changes in provision. Smitham Downs Road (7) DS0000025837.V294124.R01.S.doc Version 5.1 Page 10 The home also has a Residents Guide that the manager said all the service users are given copies of. A couple of service users met said they kept a copy of the guide in their bedrooms. The text of the Guide is illustrated with all manner of photographs, pictures, and symbols, to ensure the people for whom the service is intended can understand it. A copy of the homes most recent CSCI report is kept in the office and can be viewed on request. The home has not accepted any new referrals in the past six months as it continues to operate at full capacity. The manager was fully aware of the provider’s admissions procedures and the homes criteria for accepting new referrals. The manager said each service users is provided with a statement of their individual terms and conditions of occupancy, which gives basic information on what they and their representatives can expect to receive for the fees they are charged. However, having requested to sample three contracts at random one could not be located and the other two contained very different information about the homes fees. Only one contract specified the exact cost of so called ‘extras’ charged for services not covered by the basic price of an individual placement. It was not clear from the information contained in the homes Statement of purpose/guide and contracts when service users and their representatives should be charged ‘extra’ for additional services. This sentiment was echoed by a Care Manager representing one service users placing authority who said it was not uncommon for their client to be charged ‘extra’ for services they believed to be included in the basic fees. The homes Regional Operations manager, who was visiting the home at the time, gave some good examples of situations when service users would be charged ‘extra’, but acknowledged this was not always made clear in peoples terms and conditions of occupancy or Residents Guide. Smitham Downs Road (7) DS0000025837.V294124.R01.S.doc Version 5.1 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using all the available evidence including a site visit to this service. Sufficiently robust arrangements are in place to ensure care plans are reviewed on a regular basis and continually up dated to reflect any changes in each service users unique need and/or personal goals. Overall, suitable arrangements are in place to ensure service users have opportunities to be consulted on, and participate in, all aspects of life in the home and take responsible risks as part of a structured programme to promote independence. EVIDENCE: Three service users files sampled at random contained care plans which outlined the individuals personal, social and health care needs and what support they each required to achieve their personal goals. Each of these plans had been formally reviewed in the past six months and up dated accordingly to reflect any changes in need or personal goals. Each service user had been invited to attend their bi-annual care plan review, along with a relative, their Smitham Downs Road (7) DS0000025837.V294124.R01.S.doc Version 5.1 Page 12 Care manager, and Keyworker. A Care manager spoken with on the telephone confirmed that they had recently been invited to attend their clients last care plan review meeting at the home. The minutes of residents meetings revealed that three had been held in the home since the beginning of 2006. These meetings had all been well attended and covered a wide range of diverse topics, including bullying, household chores, littering, and day trip destinations. Furthermore, three of the service users spoken with at length also confirmed that regular meetings are held every Sunday to plan the forthcoming weekly menus. At various stages of this site visit the managers and other support staff on duty were observed taking their time to deal with service users queries and appeared to actively encourage them to participate in the daily running of the home. Risk assessments were included in care plans sampled at random that set out in detail all the action to be taken to minimise the likelihood of any identified risks occurring. Service users spoken with said staff actively encouraged them to use their practical life skills around the home and to do things for themselves. The manager said service users are supported to take ‘responsible risks as a means of promoting greater independence, providing the risks associated with a particular activity have been thoroughly assessed. Smitham Downs Road (7) DS0000025837.V294124.R01.S.doc Version 5.1 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 15, 16 & 17 Quality in this outcome area is excellent. This judgement has been made using all the available evidence including a site visit to this service. The social, leisure and recreational opportunities the service users have to engage in, both at home and in the wider community, are well managed, ‘age’ appropriate, and provide daily variety and stimulation. Suitable arrangements are in place to enable service users to maintain good links with their families and friends, and daily routines ensure service users rights’ and responsibilities are recognised and respected as a means of promoting independence. Dietary needs and preferences are well catered for and the meals nutritionally well balanced, providing daily variation and interest for service users. Smitham Downs Road (7) DS0000025837.V294124.R01.S.doc Version 5.1 Page 14 EVIDENCE: It was evident from comments made by one service user that staff continue to support them to attend Sunday services at a local church. This particular wish is noted in the individuals care plan. Service users appear to lead very active lives both in the home and in the wider community. Throughout the course of this site visit staff were continually observed actively encouraging and supporting service users to get ready to go out to prearranged social or educational activities in the local community. By the end of this visit the majority of service users had either been out to work, attended classes at a local college or day centre, visited relatives, been to the bank or carried out domestic chores around the house. The home continues to have an open visitors policy and all the service users spoken with said they were not aware of any restrictions on visiting times. One service user said his girlfriend often comes to visit him who he can entertain in the privacy of his flat. As previously mentioned there is an expectation that service users should be encouraged to take greater responsibility for the day-to-day running of the home and consequently are actively encouraged to undertaken certain household chores. During the site visit one service user was observed tidying up their flat and another was overheard making arrangements with a member of staff to visit the bank. This expectation that service users are responsible for undertaking certain household chores on designated days was clearly noted in care plans sampled at random. Service users met in the games room were all aware that this was the only area inside the house where they were permitted to smoke if they wished. All the service users met said they liked the choice of meals on offer, which they could pick from published menus they helped to plan each week. At these meetings held every Sunday each service user is invited to choose several meal they would like to eat the following week, which they are then expected to help staff plan and prepare on a designated day. These menus are conspicuously displayed on a notice board in the dinning room. One service user who had chosen to lay in that morning was observed helping themselves to breakfast and a hot drink around 11am. The kitchen door remained open throughout the course of this visit and during a tour of the premises a wide variety of nutritious foodstuffs was noted to be correctly stored in the homes fridges and freezers. It was positively noted that some plantain had been purchased to prepare a Caribbean style dish to meet the specific culturally preferences of the homes black British service users. Smitham Downs Road (7) DS0000025837.V294124.R01.S.doc Version 5.1 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made using all the available evidence including a site visit to this service. The home has sufficiently robust arrangements in place to ensure the health care needs of the service users are recognised and met, but the manager still seems unclear what constitutes a ‘significant’ incident and when external agencies such as the Commission should be notified of there occurrence. Sufficiently robust systems are in place to ensure medication records are appropriately maintained and monitored to safe guard and protect the best interests of the service users. EVIDENCE: All the service users met during the course of this site visit said they could choose what time they got up and went to bed; what activities they engaged in; and what they wore. Care plans sampled at random all contained information about all the health care appointments service users have recently attended with their GP’s, Community Psychiatric Nurses, dentists, and opticians. The homes Accident book revealed that no accidents involving service users had occurred in the Smitham Downs Road (7) DS0000025837.V294124.R01.S.doc Version 5.1 Page 16 past six months. However, their had been a number of ‘significant’ incidents in the same period, of which the two most recent ones had not been reported to the Commission, contrary to the Care Homes Regulations (2001). These two incidents had clearly challenged the service and therefore the CSCI should have been notified without delay about their occurrence. Medication records are appropriately maintained by staff and no errors were noted on administration sheets sampled at random. These records also accurately reflected medication stocks currently held by the home on service users behalves. All medication is securely stored in a metal cabinet, which remains locked when it is not in use. Protocols for the use of ‘as required’ (PRN) medication were available on request ensuring staff are clear when and how to administer this type of medication. Smitham Downs Road (7) DS0000025837.V294124.R01.S.doc Version 5.1 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is adequate. This judgement has been made using all the available evidence including a site visit to this service. The homes arrangements for dealing with complaints and allegations of abuse are in the main sufficiently robust to ensure the service users feel confident that any concerns they may have will be listened and that they are, so far a reasonably practicable, protect from avoidable harm. However, to ensure appropriate action is always taken by staff to deal with incidents of aggression more detailed guidance needs to be established to minimise the risk of service users being harmed. EVIDENCE: The service has a complaints procedure that is up to date and is available in a number of formats to enable anyone associated with the service to complain or make suggestions for improvement. The complaints procedure is widely distributed and copies are included in the residents guide and pinned to the notice board in the dining room. One service user met said they felt staff always listened to their point of view and they knew they could speak to their keyworker or the manager if they were unhappy with anything at the home. The complaints log revealed that two formal complaints had been made about the homes operation in the past six months, which had both been investigated and resolved to everyone’s satisfaction without the complaints actually being upheld. Smitham Downs Road (7) DS0000025837.V294124.R01.S.doc Version 5.1 Page 18 It was evident from entries made in the homes incident book that one service users behaviour had increasingly challenged the service in the past three months and it was therefore concerning to note that this particular individuals care plan did not contain more specific guidance to help staff deal with such incidents. Staff spoken with were very aware of their responsibilities under the homes vulnerable adults protection procedures. Financial records sampled at random all contained up to date information about all the transactions taken by staff on their behalves, which tallied with the amounts of money in the homes safe for each service user. This money is individually stored and receipts are also kept of all the purchases made by staff on service users behalves. Smitham Downs Road (7) DS0000025837.V294124.R01.S.doc Version 5.1 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28 & 30 Quality in this outcome area is good. This judgement has been made using all the available evidence including a site visit to this service. Overall the physical design and layout, which is currently maintained to a reasonably high standard, ensures service users are able to live in a relatively comfortable and safe environment. The risk of service users tripping over the uneven driveway at the front of the house needs to be assessed and a wash hand basin fitted in the laundry. EVIDENCE: The home was very clean, pleasantly warm, and free from any offensive odours at the time of this site visit. The home is also decorated to a reasonably good standard and only routine maintenance and repair issues, which have already been noted by the providers, were observed at the time of this visit. The risk of service users tripping over the uneven patch of driveway near the front gate has been identified as relatively ‘high’. The hazard has been caused by the roots of a near by tree pushing the tarmac up from beneath and all the homes senior managers agree this environmental matter needs to be resolved as soon as reasonably practicable. Smitham Downs Road (7) DS0000025837.V294124.R01.S.doc Version 5.1 Page 20 The three service users who gave their permission to view their single occupancy bedrooms said staff always knocked on their bedroom doors to seek their permission before entering. All the bedrooms viewed were decorated to a good standard and very personalised with a wide variety of personal effects noted, including pictures, photographs, videos, CD’s, and televisions. The temperature of water emanating from a bath and shower outlet nearest the staircase on the first floor were both noted to be a safe 40 degrees Celsius at 13.40. The homes washing machine is capable of washing clothes at appropriate temperatures and also has a sluice facility. No laundry has to be taken through areas where food is stored, prepared, or eaten and the utility rooms floors and walls are readily cleanable. However, contrary to environmental hygiene standards no hand washing facilities are prominently sited near the laundry room. A small wash hand basin could easily be fitted in the corner nearest the door. Smitham Downs Road (7) DS0000025837.V294124.R01.S.doc Version 5.1 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 Quality in this outcome area is poor. This judgement has been made using all the available evidence including a site visit to this service. In the main sufficient numbers of suitably competent and qualified staff are employed on a daily basis to ensure the individual needs of the service users are met, although more staff will need to develop their core knowledge and skills and documentary evidence of this training made more accessible. The homes arrangements for ensuring all staff, including new recruits, all receive at least one formal supervision session with a suitably qualified senior once every two months are woefully inadequate. Consequently, service users are not reaping the benefits of receiving support from a well-supervised staff team. Smitham Downs Road (7) DS0000025837.V294124.R01.S.doc Version 5.1 Page 22 EVIDENCE: Several service users spoken with at length said staff always treated them well and that they generally got on well with their keyworkers. The managers and other staff on duty at the time of the visit were all observed taking their time to politely deal with service users requests and questions. It was positively noted that over 50 of the homes current team have now achieved a National Vocational Qualification in care (Level 2 or above) and that a further three have already enrolled on a suitable course to ensure the home continues to meets this training target. The number of staff on duty matched the duty roster for that day. The manager said a minimum of three staff are always on duty in the home during the day and usually a fourth or fifth member will work across the day (i.e. 9 to 5) or a late shift. Two waking staff are employed at night. The manager was adamant that these staffing ratios remain adequate to meet the assessed needs of the service users. It was positively noted that the managers have developed flexible approaches to planning rotas by ensuring additional staff are on duty at ‘peak’ periods of activity to meet service users needs. For example, a fourth member of staff was employed to work a Saturday morning in May to enable service users to go on a prearranged day trip. The homes current staff team consists largely of individuals from black British Caribbean or African backgrounds, and while it is acknowledged that this is generally quite reflective of the area, it does not represent the ethnic mix of the service users, the majority of who are white British. The manager has agreed to be mindful of this ethnic and cultural imbalance when he next recruits new staff. The home has experienced relatively low levels of staff turnover in the past six months and consequently no new members of staff have been employed during this period. The homes recruitment practises will be examined in greater depth at its next inspection. The providers seem to recognise the importance of training, and in the main deliver a programme that meets the service users needs. The manager said that sufficient numbers of his current staff team had received training in fire safety, first aid, basic food hygiene, handling medication, and Dignified Management of Conflict (physical intervention techniques) training. However, despite the creation of a new training and development record by the manager, which clearly identified each member of staffs training achievements to date, very little documentary evidence by way of certificates of attendance could be produced on request. Furthermore, insufficient numbers of the homes current staff team have updated their equal opportunities, basic food hygiene, and vulnerable adult protection knowledge and skills. The manager was aware Smitham Downs Road (7) DS0000025837.V294124.R01.S.doc Version 5.1 Page 23 of these training shortfalls and is in the process of arranging some dates to rectify the problem. The staff file for the homes most recent recruit revealed that despite working at the home for the past six months they had still not completed their induction programme, or at least their induction record had not been signed off by the senior responsible for their training. Furthermore, records indicated that the same member of staff had not received any formal supervision sessions with their line manager in that time, despite being on a probationary period of employment. Two other staff files inspected at random revealed that only one had received any formal supervision sessions with a suitably qualified senior in 2006. With only the homes manager and deputy suitably trained to supervise their colleagues it is recommended that a suitably competent senior member of staff should also receive training to enable them supervise their colleagues and support the managers in this task. Smitham Downs Road (7) DS0000025837.V294124.R01.S.doc Version 5.1 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40 & 42 Quality in this outcome area is good. This judgement has been made using all the available evidence including a site visit to this service. The home has effective quality assurance and monitoring systems in place, which enables service users, and their representatives to voice their opinions about the quality of the service provided and affect the way it is delivered. In the main service users rights and best interest are safeguarded by the homes procedures, although the providers bullying and racial harassment policies could be expanded upon to include all the groups who have a stake in the service. Sufficiently robust arrangements are in place to ensure that so far as reasonably practicable the health, safety and welfare of service users, their guests and staff are promoted and protected. EVIDENCE: Smitham Downs Road (7) DS0000025837.V294124.R01.S.doc Version 5.1 Page 25 The registered manager has now been awarded the management component of his National Vocational Qualification Level 4. In the past six months the manager has also undertaken training to up date his skills in understanding challenging behaviour as a way of communicating needs; preferences and frustrations; and plans to attend an infection control and a safe handling medication courses. The home has a new Regional Operations manager who although not directly involved in the day-to-day running of the home, nevertheless regularly visits the service and is always on hand to offer his advice and support. The homes Operations manager is responsible for undertaking the provider’s monthlyunannounced inspections and compiling reports for the Commissions perusal. The Regulation 26 reports received by the Commission in recent months have been extremely detailed and have proofed useful tools for measuring how successful the home has being at achieving its stated aims and objectives. The minutes taken of staff meetings revealed that three had been held since the beginning of the year. Topics covered were wide ranging and included keyworking, care planning, training, and dealing with complaints. The manager said it is very much the responsibility of each service users designated keywoker to liaise with their relatives and professional representatives to keep them informed about the care being provided. However, concerns were raised by a care manager representing one service users placing authority that they were not always consulted about the home spending ‘significant’ sums of their clients money to purchase so called ‘additional’ services not covered by the basic price of the placement. The management of money looked after by the home on service users behalves needs to be more transparent and communication between service users relatives and their professional representatives regarding financial matters improved. The providers have established a professionally recognised quality assurance system, which the home has been, supplied a copy of. Surveys have been distributed to all the major stakeholders to ascertain their views about the quality of the service provided. Several questionnaires that had been completed by service users and their relatives were made available at the time of this site visit. The manager said the home is still in the process of collating the results of these surveys the results that the providers will make available to all the relevant parties by the end of the year. Progress on this matter will be assessed at the homes next inspection. Smitham Downs Road (7) DS0000025837.V294124.R01.S.doc Version 5.1 Page 26 The home has an Equal Opportunities policy, which refers to all the relevant Anti-discrimination legislation, (e.g. Race Relations, Sex, and Disability Discriminations Acts), but its racial harassment and bullying policies need to be revised to include more detailed information about how staff should deal with incidents of racial harassment and bullying between service users; by services users on staff; or by staff. The homes fire records indicated that its fire alarm system continues to be tested on a weekly basis and fire drills involving all the service users and staff are carried at least monthly. All the service users met said they had participated in at least one fire drill in the last couple of months and knew they had to leave the building as quickly as possible and gather outside at the emergency assembly point if the fire alarm was sounded. Up to date Certificates of worthiness were in place to show that ‘suitably’ qualified engineers had checked the homes gas (Landlords) installations, fire extinguishers, and emergency lighting and water tanks for legionella in the last six months. Food kept in a fridge in the self contained flat was observed to be correctly stored in line with basic food hygiene standards. The home also monitors all its fridges and freezers and keeps daily records of their temperatures. Smitham Downs Road (7) DS0000025837.V294124.R01.S.doc Version 5.1 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 3 28 3 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 3 3 3 X 3 X Smitham Downs Road (7) DS0000025837.V294124.R01.S.doc Version 5.1 Page 28 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA5 Regulation 5(1)(b) (c), 17(2), Sch 4.2 Timescale for action A copy of the standard form of 01/06/06 contract given to each service user for the provision of services and facilities, which includes the amount and method of payment of fees, must be kept in the home and made available for inspection on request. The Commission must be 01/06/06 notified without delay of the occurrence of any event, which adversely affects the health, well-being, or safety of any service user residing in the home. The uneven driveway at the 01/09/06 front of the home, which currently represents a tripping hazard, must be levelled to ensure all parts of the home to which service users have access remain safe. Hand washing facilities must 01/09/06 be prominently sited in the homes relatively new laundry room. Documentary evidence of all 01/07/06 the training undertaken by staff, which is relevant to the DS0000025837.V294124.R01.S.doc Version 5.1 Page 29 Requirement 2. YA19 37(1) 3. YA24 13(4)(a) & 23(2)(b) 4. YA30 13(3), 16(2)(j) & 23(2)(j) 19, Sch 2.4 5. YA35 Smitham Downs Road (7) 6. YA35 18(1) & 19, Sch 2.4 7. YA36 18(1) (2) work they are expected to perform, must be kept in the home at all times and made available for inspection on request. Previous timescale for action of 1st January 2006 only partially met. Sufficient numbers of staff 01/09/06 must attend accredited training in equal opportunities, basic food hygiene, and vulnerable adult protection. Documentary evidence of this training must be made available for inspection on request. The homes most recent recruit 01/08/06 must complete their induction training and each member of staff, especially new staff, should receive at least one formal supervision session with a suitably qualified senior every two months or so. Smitham Downs Road (7) DS0000025837.V294124.R01.S.doc Version 5.1 Page 30 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 YA5 Good Practice Recommendations The providers should consider including far more detailed information in the homes Statement of purpose, residents guide and individual terms and conditions of occupancy contacts about the homes charges for extras payable for addition al services not covered by the basic cost of each placement. The manager should be mindful of the cultural and ethnic imbalance that currently exists between his staff team and the service users when he next recruits. Sufficient numbers of the homes senior staff team should be suitably trained to formally supervise their colleagues. The management of money looked after by the home on service users behalves should be made more transparent and communication between services users relatives and their professional representatives regarding financial matters improved. The providers should revise there racial harassment and bullying policies to include more detailed information about how staff should deal with incidents of racial harassment and bullying, not just between staff, but also between service users; by services users on staff; and by staff on service users. 2. 3. 4. YA33 YA36 YA38 5. YA40 Smitham Downs Road (7) DS0000025837.V294124.R01.S.doc Version 5.1 Page 31 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Smitham Downs Road (7) DS0000025837.V294124.R01.S.doc Version 5.1 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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