Inspection on 15/12/08 for Sunnyhill Road 99

This inspection was carried out on 15th December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sunnyhill Road 99 18/12/06

Sunnyhill Road 99 15/11/05

Sunnyhill Road 99 29/07/05

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Sunnyhill Road 99 Sunnyhill Road 99 London SW16 2UW     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: Lee Willis     Date: 1 5 1 2 2 0 0 8 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. the things that people have said are important to them: They reflect 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 36 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.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: Sunnyhill Road 99 Sunnyhill Road 99 London SW16 2UW 02086775369 02086775369 clifford.mobile6@fsnet.co.ukallcorrespondencebypost Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: 229 Mitcham Lane Ltd care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home 99 Sunnyhill is privately owned residential care service which is registered to provide support for up to five generally younger males of African descent who have a diagnoses of a past or present experience of mental ill health. The registered provider is a Mr Oakley, who also owns three similiar services in nearby areas. Mr George Asante, who is a qualified mental health nurse, has been the registered manager of Syunnyhill for over four years and remains in operational day-to-day control of the home. Situated on a suburban street the home is within easy walking distance of Streatham High street and consequently is well served by a wide variety of local shops, cafes, takeaways, restaurants, pubs and banks. The service is also relativley close to some very good transport links, including numerous bus stops and two local train stations. This mid-terrace Vicotrian property is built over three storeys. All the people who live their have their own single occupancy bedrooms. Communal areas are relativley well maintained and consist of a living room, an open plan kitchen- diner, and first floor office. There are sufficient numbers of toilets and bathing facilities located throughout the home. There is also a relatively well maintained garden at the Care Homes for Adults (18-65 years) Page 4 of 36 Over 65 0 5 Brief description of the care home rear of the property, which has a covered area smoking area in it. The people using the service are all suppiled with copies of the homes Statement Of Purpose, Guide, and their terms and conditions of occupancy. The service currently charges between £900 and £1,300 a week for facilities and services provided. Care Homes for Adults (18-65 years) Page 5 of 36 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: The new quality rating for this service following its most recent Key (main) inspection is now 1 star. This represents a deterioration in the standard of care provided by this service mainly as a result of poor medication recording and inadequate arrangements for carrying out pre-employment checks on new staff. This means the people who currently live at 99 Sunnyhill Road are experiencing adequate quality outcomes. Nonetheless, these comments notwithstanding, from all the evidence gathered during the inspection process we do judge the service to have a substantial number of strengths and are confident it will be able to manage all the weaknesses identified in this report well. Care Homes for Adults (18-65 years) Page 6 of 36 We spent six hours at the home. During this period we spoke at length to two people who use the service, the registered manager, a support worker, and the proprietor. We also looked at various records and documents, including the care plans for two people whose package of care they received we chose to case track. The remainder of this site visit was spent touring the premises and the garden. Finally, we received our Annual Quality Assurance Assessment (AQAA), which the manager had completed and returned to us when we asked for it. This self-assessment was very clear and gave us all the information we asked for about what the service believed it did well, what they had improved in the past year, and what they could do better in the future. What the care home does well: What has improved since the last inspection? What they could do better: All the positive comments made above notwithstanding there remains a number of things the service could do much better at in order to improve the lifes of the people who use the service, as well as keep them safe: The services most recently recruited member of staff must not be permitted to work at 99 Sunnyhill Road until the provider has obtained a satisfactory Protection Of Care Homes for Adults (18-65 years) Page 8 of 36 Vulnerable Adults (POVA) check in respect of that person. The provider was reminded that satisfactory pre-employment checks, which includes a POVA check, must be obtained in respect of all new staff before they commence working at the care home in order to minimise the risk of people who use the service being harmed and/or abused by individuals who have already been deemed unfit to support vulnerable adults. Documentary evidence in respect of all the relevant training and qualifications the homes staff team have achieved must be kept on their personal file and made available for inspection on request. This will enable anyone authorised to inspect these records to determine whether or not the care homes staff team are suitably trained and qualified to meet the needs of all the people who use the service. When medication is administered to the people who use the service is must be clearly recorded. This will ensure the services medication handling arrangements are made more transparent for ease of auditing purposes. This will minimise the risk of the people who use the service being administered incorrect levels of medication. All staff authorised to handle medication on behalf of the people who use the service should also have their training in this area refreshed and be reminded about their medication recording responsibilities. Furthermore, the way in which the service quality controls and monitors its medication handling practises should also be reviewed in order to minimise the risk of medication recording errors occurring. The way in which the service assesses risks associated with the people who use the service should be reviewed. Risk management strategies should be developed to cover more aspects of the lifes of the people who use the service to enable them to take more responsible risks - thus promoting their rights to make informed choices and to live their lifes as independently as possible. The way in which staff supports the people who use the service to plan the weekly menus and go food shopping should be reviewed and advice sought from suitably qualified dietitians and/or nutritionists sought about how the service could do more to promote healthier eating. The way in which the service records the occurrence of accidents involving the people who use the service should be reviewed. This information should be recorded separately in a stand alone document for ease of referencing purposes. A copy of the Local Authoritys safeguarding protocols should be kept in the home at all times and be made available for inspection on request. This will ensure staff have access to all the information they require to enable them to deal with witnessed and/or suspected abuse in accordance with the Local Authoritys safeguarding protocols in order to keep the people who use the service safe. The way in which the service arranges for the premises to be up graded should be reviewed. A rolling programme with realistic time frames for the redecoration of the home should be developed to ensure the people who use the service continue to live in a well maintained and comfortable environment. The way in which the service involves the people who use the service in the selection Care Homes for Adults (18-65 years) Page 9 of 36 of new staff should be reviewed. People who use the service should have more input in the staff recruitment process in order to increase the influence they have on the running of their home. The service should develop an action plan that sets out how it intends to ensure all the people who work at the care home achieve a National Vocational Qualification in care level 2 or above or at least enrol on a suitably course by a specific date. The person who runs the service on a day-to-day basis should have achieved a suitable management qualification that is equivalent to an NVQ level 4 or at least enrolled on a suitable course. Finally, the results of all the services satisfaction surveys it receives back from its stakeholders should be analysed and published in an annual report, which is accessible to any interested parties, including the people who use the service, their representatives, and the CSCI. This will demonstrate the service takes the views of all its major stakeholders seriously and acts upon them. 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 36 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 11 of 36 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. The people who use the service have access to all the information they need to decide whether or not the home is the right place for them. Evidence: Copies of the services Statement of Purpose and Guide were both made available on request. These documents contained all the relevant information people who use the service and their representatives need to know about the home. These documents had been up dated in the past year to reflect changes in provision. The manager confirmed the statement he had made in the services AQAA - that the home had not accepted any new admissions since the last inspection. The manager demonstrated a good understanding of what constituted best practise regarding procedures of assessing the suitability of new placements and was very clear that he was always consider what impact any new admissions would have on the people Care Homes for Adults (18-65 years) Page 12 of 36 Evidence: already living at 99 Sunnyhill Road. The two people who use the service told us they were both given Guides about the home before they moved in and had also been given copies of their tenancy agreements, which they had both signed. These Agreements were transparent regarding the range of fees people would be charged for services and facilities provided. Care Homes for Adults (18-65 years) Page 13 of 36 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans reflect what is important to the people who use the service and emphasise individuals unique strengths and aspirations. The people who use the service are encouraged to participate in the day-to-day running of their home and are continuously consulted about important decisions that affect their lives. Overall, people who use the service are protected by arrangements that are in place to identify and manage risk, but there remains considerable to scope to improve the way in which staff assess and review risk. More detailed records should be appropriately maintained by the service to demonstrate how it actively encourages and supports the people who use it to take responsible risks and develop their independent living skills. Evidence: The two care plans chosen to examine in depth were relatively person centred and Care Homes for Adults (18-65 years) Page 14 of 36 Evidence: made numerous references to the relevant individuals unique strengths and wishes. A person who uses the service told us their keyworker had helped them draw up their care plan. Plans viewed were written in relatively plain language, and two people who use the service told us they found them fairly easy to understand. Both these plans had been reviewed in the past six months and it was evident the community based Care Coordinators who represented these individuals are been actively involved in the review process. The manager told us all the people who currently use the service are subject to the Care Planning Approach to developing care plans in line with best practise guidelines for people with a past or present experience of mental ill health. Two people who use the service told us they each had a keyworker who they got on well with. A support worker met demonstrated a good understanding of their keyworker role and responsibilities. Throughout the course of this visit a number of people who use the service were observed visiting the office to ask the manager questions. The manager always dealt with these queries in an extremely prompt and professional manner. The service clearly operates an open door office policy. A person who uses the service told is was good that they could talk to the owner, the manager or their keyworker whenever they wanted. This individual also told us you can share your views about the home at house meetings. Four such meetings have been held during the course of 2008. The minutes of the September 2008 meeting revealed house rules regarding food storage, household chores, security, and visitors were all discussed. The meeting had been well attended by the people who use the service and the actions agreed constructive. Care plans looked at each contained a limited number of risk assessments that covered certain aspects of the lifes of the people who use the service, but not all. Furthermore, the assessments viewed were last reviewed and up dated accordingly to reflect any changes in risk in 2006. The manager told us the people who use the service are actively encouraged and supported to take responsible risks as part of the services philosophy of care to promote independent living wherever practicable. However, the manager acknowledged that the way in which staff identified and reviewed risk needed to be improved. For example, no recorded risk assessments were in place for any of the people who use the service that make it clear whether or not they were willing and able to manage their own medication and finances. We therefore recommend the services risk assessing arrangements are reviewed. Care Homes for Adults (18-65 years) Page 15 of 36 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have sufficient opportunities to pursue social, leisure and recreational activities that match their interests. Consequently, the lifestyles experience by the people who live at Sunnyhill meets their expectations and preferences. The services published menus are relatively varied and clearly take into account the food preferences and cultural heritage of the people who use the service, thus ensuring their dietary wishes are well catered for. Evidence: On arrival all the people who use the service were either out in the wider community or relaxing in the privacy of their bedroom. The manager told us encouraging the Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: people who use the service to get more involved with their local community was an area of practise the service had improved upon in the past year. Two people who use the service and a support worker all told us they believed everyone who currently lived at 99 Sunnyhill Road was getting out more these days. Care plans viewed contained activity schedules, which a person who used the service told us was a rough guide they had developed with the help of their keyworker regarding the various social activities they may wish to participate in each week. The manager told us the people who use the service had recently all agreed at a house meeting that everyone should have an allocated day when it would be their turn to choose what everyone could watch on the communal television in the living room, and have their own cupboard space and plates in the kitchen. All the people who use the service and staff spoke with about these relatively new rules told us they believed they were working well. The two people who use the service were both extremely positive about the homes visitor arrangements. Typical comments included, my girlfriend is always coming to visit me here, its a house rule that all visitors leave by 11pm at night, but providing you run it by staff first there is some flexibility regarding it, and staff dont expect your visitors to ring ahead and are pretty relaxed about your friends turning up unannounced. The manager told us everyone who uses the service is expected to do their own laundry and do as much cooking for themselves as they are able to. A person who uses the service told us they help staff write up the forth coming weeks menu most Sundays. Last months menus and a record kept by staff of all the food actually eaten by the people who use the service revealed a lot of the meals provided contain chips, burgers, or sausages. Two people who use the service confirmed this type of food was very popular in the house because everyone liked the taste and was relatively easy to cook. We agree with the comments made by the manager on the topic of food - that the people who use the service have the right to choose what meals they prepare and eat every day, but would also recommend some professional advice and input from dietitians and/or nutritionists is sought in order to explore different ways in which the service could promote healthier eating at Sunnyhill. This comment notwithstanding it was positively noted that the services domestic cooks an Afro-Caribbean style meal once week, which everyone is encouraged to sit together in the kitchen and enjoy. The record of food eaten revealed that in the past few months all manner of Caribbean style dishes that reflect the cultural heritage of all the people who currently live at Sunnyhill had been prepared, including rice and peas, and curried goat. Care Homes for Adults (18-65 years) Page 17 of 36 Care Homes for Adults (18-65 years) Page 18 of 36 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. Suitably robust arrangements are in place to ensure the people who use the service have their unique emotional health care needs continually recognised and met in the way the prefer. People who use the service are actively encouraged to manage their own medication if they are assessed as willing and able to do so. However, its medication recording and monitoring arrangements are inadequate and need to be improved in order to keep the people who use the safe from avoidable harm. Evidence: Both the people who use service told us they could get up, go to bed, have a bath, eat, and go out, whenever they liked. On arrival the manager was involved in a meeting with a community based health care professional about the changing emotional needs of one person who uses the service. The manager confirmed he had made the initial referral to the relevant external agency and was very clear when the service needed to seek additional input from outside health care professionals. The manager also told us the service has developed extremely good working relationships with a number of external agencys, including GPs and community based psychiatric nurses (Care Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: coordinators). The manager told us there had been no significant incidents or accidents involving any of the people who use the service since it was last inspected. The manager demonstrated a good understanding of what constituted a significant incident and knew which external agencys should be notified without delay regarding such an occurrence. A support worker told us staff maintain up to date records of all the accidents that occur in the home. We noted this information is not kept in a separate stand alone document specifically designed for keeping a record of there occurrence of accidents in the home. We recommend the service purchases such a book for ease of referencing purposes. The manager confirmed a statement made in the services AQAA that all the people who use the service are actively encouraged to take as much responsibility for handling their own medication as reasonably practical. One person who uses the service told us they had been provided with a lockable space in their bedroom for keeping their medication safe. The manager told us the service does not currently stock any Controlled Drugs on behalf of the people who use the service. It was positively noted that as recommended in the services previous inspection report clearer guidelines for the use of as required PRN medication had been introduced. However, the aforementioned positive comments notwithstanding, a high number of recording errors were noted on Medication Administration Record (MAR) sheets sampled at random where staff had either failed to sign for medication given or signed the MAR in the wrong place. Consequently, not all the services medication records accurately reflected current medication stocks held in the home on behalf of the people who use the service. The manager told us all his staff team who were authorised to handle medication on behalf of the people who used the service had received medication training, but conceded staffs would need to be reminded about their medication recording responsibilities in light of the number of errors noted during this inspection. Furthermore, the manager also acknowledged that the services medication monitoring arrangements had clearly failed to spot the recording issues at any early stage and would therefore need to be reviewed as a matter of urgency. Care Homes for Adults (18-65 years) Page 20 of 36 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 homes arrangements for dealing with complaints are sufficiently robust and understood by the people who use the service to ensure they feel listened too and safe. Overall, the services arrangements for dealing with safeguarding issues are sufficiently robust to protect the people who live at Sunnyhill from avoidable harm, although the lack of information regarding the local authoritys safeguarding protocols means staff do not have access to all the guidance they need to effectively deal with any disclosures of abuse. Evidence: The two people spoken with at length about their home told us staff were generally very good at listening to them and taking their views seriously. As previously mentioned in this report one individual was observed speaking to the manager on several occasions about preparing their own meals, which were respectfully listened too. People met confirmed a copy of the services complaints procedures was included in the Guide they had each been given. One individual told us they would have no hesitation about talking to their keyworker, the manager, and even the proprietor - if they felt unhappy about how the service was being run. The services complaints book showed that no concerns about its operation had been Care Homes for Adults (18-65 years) Page 21 of 36 Evidence: made in the past year as stated in its AQAA. The manager told us his staff team always take complaints seriously, and would investigate any brought to their attention as soon as was reasonably practicable. The manager and a support worker spoken with about safeguarding matters both demonstrated a good understanding of what constituted abuse and which external agencys should be notified without delay. Unfortunately, the manager was unable to find the correct contact details for the host Boroughs safeguarding protocols regarding adults with mental ill health. We recommend the service obtains a copy of these protocols as soon as reasonably practical. The manager confirmed that no allegations of abuse have been made within the home since its last inspection and that the vast majority of its staff have received recognising, preventing, and reporting abuse training. A support worker confirmed that people who use the service can be verbally challenging at times. A support worker demonstrated a good understanding of what action needed to be taken deescalate a potentially challenging incident, but conceded that they were not aware of any written risk management strategies they could refer too in order to help staff deal with such an event. As previously mentioned in this report we have already identified that the services arrangements for assessing and managing risk need to be significantly improved (See National Minimum Standard No#9 and Recommendation No#1). Care Homes for Adults (18-65 years) Page 22 of 36 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The services decor, fixtures, and fittings are domestic in appearance and well maintained, which ensures the people who use the service live in a relatively homely and comfortable environment. The homes arrangements for controlling infection are sufficiently robust to ensure the people who use the service also live in a very clean and safe environment. Evidence: The two people who use the service we met told us they were happy with the homes environment. Typical comments included, I love my bedroom, i was allowed to decorate how i wanted, and its great that i can stay in my bedroom or watch television in the living room when i want. The furnishings and fittings in communal areas are domestic in appearance and look relatively comfortable. Since the last inspection the manager confirmed that as he stated in the AQAA the kitchen had been repainted, carpets cleaned, and the ground floor toilet and shower improved. The manager acknowledged that some of the homes communal areas could do with repainting. We recommend the service develops a rolling programme that gives a clear time frame for the living room, bathrooms and Care Homes for Adults (18-65 years) Page 23 of 36 Evidence: hallway to be redecorated. During a tour of the premises it was noted the home was spotlessly clean. A person who uses the service told us the cleanliness of the place was one of the main reasons why they liked living at 99 Sunnyhill Road. Both the bedrooms viewed with the the current occupants permissions were relatively well decorated. These bedrooms were extremely personalised and clearly reflected the unique tastes and styles of the two people who occupied them. The service has a separate laundry room attached to the kitchen which has a washing machine that is capable of cleaning fabrics at appropriate temperatures in line with infection control standards. Care Homes for Adults (18-65 years) Page 24 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are supported by sufficient numbers of staff at all times. The staff met also came across as suitably competent, although a lack of documentary evidence and records kept on their personal files regarding the qualifications they had each achieved made it difficult to determine whether or not they were all suitably trained to meet all the needs of the people who use the service. The services recruitment arrangements are inadequate because the provider has failed to ensure satisfactory pre-employment checks are carried out in respect of all new members of staff. This represents a major shortfall and has placed the people who use the service at serious risk of being harmed and/or abused by individuals who maybe unfit to work with vulnerable adults. Staff do receive one to one supervision sessions with their manager, but there remains scope to improve there frequency. This will ensure the people who use the service benefit from being supported by a well supervised and competent staff team. Evidence: Typical comments made by the people who use the service about staff included, i like most of them, i can talk to my keyworker about most things, and staff here tend to Care Homes for Adults (18-65 years) Page 25 of 36 Evidence: let you get on with your own thing. Duty rosters sampled at random showed that the service employs sufficient numbers of staff across the day and at night. One person who uses the service told us there was always enough staff around both during the day and at night. It was positively noted that the current staff team, which comprises of mainly black British and black AfroCaribbean men, reflects the ethnic and gender mix of the people who currently use the service. The service is commended for achieving this balance. A support worker informed us that before they were able to commence working at the home they had to supply their new employer with two satisfactory employment references and up to date Criminal Records Bureau (CRB) and Protection Of Vulnerable Adult (POVA) checks. The manager also stated in the services AQAA that satisfactory pre-employment checks are carried out in respect of all new staff. However, the personal file we examined in depth in respect of the homes most recently recruited member of staff indicated the provider had allowed this individual to commence working at Sunnyhill without being checked against the POVA register. An Immediate Requirement Notice was issued at the time of this inspection for the aforementioned member of staff not to be permitted to continue working at the home until the provider had obtained a satisfactory POVA First check in respect of them. The manager also confirmed that people who use the service are not directly involved in the selection and interviewing of new staff. A person who uses the service told us they would like to be more involved in the process of recruiting new staff. We recommend the service reviews its current staff selection arrangements. A support worker spoken with at length about their induction and training they had received while working at 99 Sunnyhill was very complimentary about their employer. They told us they had received most of the training they needed to perform their duties of care and that their induction had been very thorough. However, staff files examined at random did not always contain all the relevant training certificates to prove these individuals were suitably qualified to meet the needs of the people who use the service. Furthermore, the manager had not carried out a recent training assessment of his staff teams strengths and needs. Documentary evidence of all the training undertaken by staff must be made available for inspection on request and we recommend all staffs training achievements and needs are assessed at least once a year as part of services appraisal system. The manager also conceded that only one member of his current staff team had achieved a National Vocational Qualification (NVQ) in care - Level 2 or above, although arrangements were in the process of being made for three staff to enrol on a suitable Care Homes for Adults (18-65 years) Page 26 of 36 Evidence: course next year (2009). We recommend a time specific action plan setting out how the service intends to ensure its entire staff are NVQ trained in care is developed. A support worker spoken with at length told us they had one-to-one supervision sessions with their manager at regular intervals. Two staff files inspected at random contained records of all the supervision sessions these individuals had received throughout 2008, which revealed they were being carried out approximately once a quarter. We recommend the manager increases the frequency of these sessions to at least one every two months in line with best practise. Care Homes for Adults (18-65 years) Page 27 of 36 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are confident 99 Sunnyhill Road will continue to be well run because a suitably competent and experienced manager remains in operational dayto- day control. Sufficiently robust systems are place which enable the people who use the service and their representatives to have their say and influence the services day-to-day operation and its future development. The people who use the service, their guests, and staff are kept safe and protected from avoidable harm because the homes fire, and other health and safety arrangements are sufficiently robust. Evidence: George Asante is a Registered Mental health Nurse (RMN) and has been in operational day to day control of 99 Sunnyhill Road for over four years. George is aware that he needs to achieve a recognised management qualification in addition to his professional Care Homes for Adults (18-65 years) Page 28 of 36 Evidence: nursing award in order to be suitably trained to run a residential care home for adults with mental ill health. The manager told us he is in the process of enrolling on a suitable management course which is equivalent to a NVQ level 4. Progress made to achieve this aim will be closely monitored by the Commission. Overall, it was evident from all the feedback received about the manager that the people who use the service and staff like his leadership style. Typical comments included, the manager is very approachable and likable guy, he always takes on board what you have to say, and i like George - best home manager Ive known. George also told us the services proprietor is always on hand or on the end of the telephone to offer him support and advice as and when required. The proprietor made himself available for most of this inspection and we would agree with Georges comments that they are both jointly responsible for running 99 Sunnyhill Road. Reports compiled by the proprietor following unannounced monthly visits to the home were produced by the manager on request. The manager told us he finds these visits very useful in identifying areas where the home could be doing better. The manager also told us all the people who use the service had been invited to complete the homes new satisfaction surveys regarding the standard of care they receive at 99 Sunnyhill Road. We looked at two surveys which had been returned by people who use the service in the past six months. Overall, the comments were very positive about their experiences of living at 99 Sunnyhill Road. We recommend the results of completed satisfaction surveys the home receives are analysed on an annual basis and a report published to enable anyone who has a stake in the home (i.e. the people who use it, their representatives and placing authoritys) can view the providers findings. Documentary evidence was produced on request to show that the London Fire and Emergency Planning Authority (LFEPA) recently visited the home and identified no issues in relation to the services fire safety arrangements. Fire safety records kept by the service also showed us that staff continue to test the homes fire alarm system on a weekly basis and carry out fire drills every quarter, in line with best practise guidance. A support worker told us they routinely participated in fire drills at the home and demonstrated a good understanding of the services emergency evacuation procedures. These procedures are conspicuously displayed on walls throughout the home. Up to date Certificates of worthiness were made available on request to show that suitably qualified engineers had checked the homes gas installations, fire extinguishers, and portable electrical appliances in the past year. The manager told us he was aware that the homes electrical wiring check was last carried out in 2004 and was due for renewal in 2009. Staff maintain a weekly record of the temperature of hot water emanating from the homes taps. During as tour of the premises we tested the Care Homes for Adults (18-65 years) Page 29 of 36 Evidence: temperature of hot water emanating from a first floor, which we found to be a safe 42 degrees Celsius (i.e. below 43 degrees Celsius). Care Homes for Adults (18-65 years) Page 30 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Adults (18-65 years) Page 31 of 36 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 1 34 19 The services most recently recruited member of staff must not be permitted to work at 99 Sunnyhill Road until the provider has obtained a satisfactory Protection Of Vulnerable Adults (POVA) check in respect of that person. Satisfactory pre-employment checks, which includes a POVA check, must be obtained in respect of all new staff before they commence working at the care home in order to minimise the risk of people who use the service being harmed and/or abused by individuals who have already been deemed unfit to support vulnerable adults. 06/02/2009 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 20 13 When medication is 14/01/2009 administered to the people who use the service is must be clearly recorded. This will ensure the services medication handling arrangements are made more transparent for ease of auditing purposes to Page 32 of 36 Care Homes for Adults (18-65 years) minimise the risk of the people who use the service being administered incorrect levels of medication. This will ensure the safety of the people who use the service. 2 35 19 Documentary evidence 06/02/2009 regarding all the relevant training and qualifications all the staff who work at the care home have achieved must be kept on their personal file and made available for inspection on request. This ensure anyone authorised to inspect the service can determine whether or not the care homes staff team are suitably trained and qualified to meet the needs of all the 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 9 The way in which the service assesses risks associated with the people who use the service should be reviewed. Risk management strategies should be developed to cover more aspects of the lifes of the people who use the service to enable them to take more responsible risks - thus promote their independence and choice. The way in which staff supports the people who use the service to plan the weekly menus and go food shopping should be reviewed and advice sought from suitably qualified dietitians and/or nutritionists sought about how the service could do more to promote healthier eating. The way in which the service records the occurrence of accidents involving the people who use the service should Page 33 of 36 2 17 3 19 Care Homes for Adults (18-65 years) be reviewed. This information should be recorded separately in a stand alone document for ease of referencing purposes. 4 20 The way in which the service quality controls and monitors its medication handling practices should be reviewed in order to minimise the risk of medication recording errors occurring. All staff authorised to handle medication on behalf of the people who use the service should have their training in this area refreshed and be reminded about their medication recording responsibilities. A copy of the Local Authoritys safeguarding protocols should be kept in the home at all times and be made available for inspection on request. This will ensure staff have access to all the information they require to enable them to deal with witnessed and/or suspected abuse in accordance with the Local Authoritys safeguarding protocols in order to keep the people who use the service safe. The way in which the service arranges for the premises to be continually redecorated should be reviewed. A rolling programme with realistic time frames for the redecoration of the home should be developed to ensure the people who use the service continue to live in a well maintained and comfortable environment. The way in which the service involves the people who use the service in the selection of new staff should be reviewed. People who use the service should have more input in the staff recruitment process in order to increase the influence they have on the running of their home. Each member of staff should have their work performance and training needs appraised at least once a year and tiem specific action plans developed to address any gaps identified regarding staffs knowledge and skills. The service should develop an action plan that sets out how it intends to ensure all the people who work at the care home achieve a National Vocational Qualification in care level 2 or above or at least enrol on a suitably course by a specific date. The number of supervision sessions staff recieve should be increased to at least once every two months to ensure the people who use the service benefit from being supported by a well supervised staff team or are suitabley competent. The person who runs the service on a day-to-day basis should have achieved a suitable management qualification Page 34 of 36 5 20 6 23 7 24 8 34 9 35 10 35 11 36 12 37 Care Homes for Adults (18-65 years) that is equivalent to an NVQ level 4 or at least enrolled obn a suitable course as soon as reasonably practical. 13 39 The results of all the services satisfaction surveys it receives back from its stakeholders should be analysed and published in an annual report, which is accessible to any interested parties, including the people who use the service, their representatives, and the CSCI. This will demonstrate the service takes the views of all its major stakeholders seriously and acts upon them. Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk 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 36 of 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!