Inspection on 27/09/08 for The Summers

This inspection was carried out on 27th September 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

The Summers 19/09/07

The Summers 23/08/06

The Summers 23/11/05

The Summers 09/06/05

The Summers 30/09/04

The Summers 15/06/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Sutton Lodge Nursing Home

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Summers Yeend Close West Molesey Surrey KT8 2NA     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: Patricia Collins     Date: 2 7 0 9 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 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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 33 Information about the care home Name of care home: Address: The Summers Yeend Close West Molesey Surrey KT8 2NA 02089794689 02089410468 hannah.thorogood@surreycc.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Kingston & Wimbledon YMCA Type of registration: Number of places registered: care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users to be accommodated is 28. The registered person may provide the following category of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Physical disability - (PD) Physical disability, over 65 years of age - (PD(E)) - 5 Learning disability - (LD) - 4 Mental disorder, excluding learning disability or dementia - (MD) - 1 Dementia - (DE) 1 Date of last inspection Brief description of the care home The Summers is a care home providing personal care and accommodation for up to 28 adults with primary care needs of physical disabilities, on admission. There is also provision of a limited number of places for adults with a learning disability, mental disorder or dementia. Service provision includes short-term care. The home is conveniently located with good access to West Moleseys shops and other community Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 0 28 28 Brief description of the care home facilities. The property is a detached, two-storey building with a passenger lift. There is a secluded garden area and car parking spaces.The service provides a good standard of accommodation, equipped to comply with disability and national minimum standards for adults. The 28 bed sitting rooms are grouped into four flats, with their own communal lounges, dining and kitchenette facilities, wheelchair accessible toilets and assisted bathrooms. Kingston and Wimbledon YMCA own the service and staff are employed by Surrey Social Services. Care Homes for Adults (18-65 years) Page 5 of 33 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: Date of Last Inspection - 19th September 2007. The weekly fee is 1051.88 pounds. Additional charges apply of 35p per mile per person to cover the costs of transport for personal and social purposes. People using services pay for their own holidays and the cost of holidays for staff escorts. They also purchase their own toiletries, hairdressing and clothing.There is an annual charge of 5.00 pounds for television licences. The unannounced inspection visit formed part of the key inspection process using the ‘Inspecting for Better Lives’ (IBL) methodology. The inspection visit was undertaken by one inspector over six hours. The report will say what ‘we’ found as it is written on Care Homes for Adults (18-65 years) Page 6 of 33 behalf of the Commission for Social Care Inspection (CSCI). The inspection process incorporated discussions with an assistant team manager on call and two senior support workers in charge of the home during the visit. We also spoke with four care staff, including two agency workers, five people using services and two visitors. We had brief discussions at the time of the visit with the responsible individual for the organisation. The inspection has taken into account information provided by the person designated to temporarily manage the home after the visit. We spoke with five people using the homes services. They told us about their experience of life at the home and opinion about the quality of their care and support. Because we were not able to communicate with all of the people using the homes services we spent time indirectly observing care practice. Also the behaviours and body language of these individuals, assessing their state of wellbeing. We noted the quality of interactions between these people and staff, with others using services and with their environment. Practice observations included medication administration and a meal time. We have taken into account all available information when forming judgements about how well the home meets the national minimum standards for adults. These are based on the cumulative assessment, knowledge and experience of the home since its last key inspection. The inspection process involved sampling records and a tour of all communal areas, viewing three bedrooms with the consent of their occupants. We have also considered the information in surveys completed by one relative, two members of staff and from six people using services, with staff assistance. Also information provided by management in the homes Annual Quality Assurance Assessment (AQAA). This is a self-assessment sent to us annually, informing us of how well the home is doing and providing some numerical data. We wish to thank all who contributed information to the inspection process. Also people using the home’s services and staff for their time, hospitality and assistance throughout the inspection visit. What the care home does well: What has improved since the last inspection? The homes statement of purpose and service users guide has been revised and updated. We were informed these had been issued to people using services. Pre-admission assessments had been developed and procedures ensure that prospective people using services can be confident in the homes capacity to meet their needs. Care plans are much improved and risk assessments have been further developed. Care plans are comprehensive and sufficiently detailed. The care planning approach is person-centred and holistic. Some people using services had signed their care plans and others were signed by their representatives. These are now reviewed on a monthly basis. Care Homes for Adults (18-65 years) Page 8 of 33 The appointment of a full time activities organiser is a new development since the last key inspection. A staff training programme is in evidence. The quality assurance system is now more inclusive, ensuring people using services are consulted for their views. Written records are now maintained to evidence safety checks for monitoring hot water temperatures. What they could do better: 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 9 of 33 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 10 of 33 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. Prospective people using services and their representatives receive information to help them make an informed choice of home. Pre-admission assessment procedures ensure they can be confident in the homes capacity to meet their needs. Evidence: The homes statement of purpose and service users guide was not available for inspection however staff confirmed these document had been revised and updated since the last inspection. The service users guide was in draft at that time and it was understood that a personal copy had been given to all people using the homes services. The people using services consulted however were unable to recollect receiving the same and these were not openly displayed in the bedrooms viewed. We examined a copy sent to us after the visit. The document clearly stated the homes aims and objectives and care philosophy. It also describes for the benefit of prospective people using services, what they can expect, giving a clear account of the homes services and facilities, of staff training and the complaints and compliments procedure. The guide is available in a standard format and it is suggested this be Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: produced in a range of formats suitable to meet the communication needs of the people for whom the home is intended. This is important to ensure access to sufficient information to enable an informed choice of home. A minor amendment is needed to update the service users guide with the latest contact details of the Commission for Social Care Inspection. The service users guide describes the provider organisation as a Christian movement that welcomes into its fellowship people of other religious faiths and those of none. There is a statement that the organisation is committed to equality of opportunities for people using services and staff. This means people will be treated fairly regardless of their race, colour, age, gender, disability or sexual orientation. All the policies and procedures are stated to support this and the organisation will act in accordance with equality legislation. Services are purchased by Surrey County Council. No permanent placements had been made since the last inspection, only admissions for respite care. Observations of records confirmed assessments for past permanent placements were undertaken over a twelve week period, with a review after six weeks so that adjustments to care plans can be made, if necessary. Respite placements are reviewed after the first placement. The service users guide refers to emergency admission assessments taking place after admission, making clear that an offer of a long-term placements may not necessarily follow. Since the last inspection a pre-admission assessment form had been developed. It was evident from all available information that comprehensive assessment information is obtained for planned admissions, from a range of sources, to be confident in the homes capacity to meet individual needs. The assessments focus is on achieving positive outcomes and supports the involvement of prospective people using services. Care Homes for Adults (18-65 years) Page 12 of 33 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. People using services are involved in decisions about their lives and play an active role in planning their care and support. They are also supported in informed risk-taking as part of an independent life style. Evidence: The care records of three people using services were randomly selected for inspection. All three care plans were detailed and comprehensive in content, the approach to care planning being person-centred and holistic. Some had been signed by people using services with capacity to do so, others by their representatives. All were reviewed on a monthly basis. People using services are involved in planning their care. Risk plans viewed were mostly comprehensive and subject to frequent review. We spoke with all people using services present at the time of the visit and had individual in-depth discussions with five people. The information gathered during these discussions and from surveys indicated they knew their assessed and changing needs Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: and had been involved in setting the personal goals in their care plans. All confirmed that they had opportunities for making choices in their daily lives. Examples of these are the time they get up and go to bed, choice of meals, how they spend their days, choice of clothing and hairstyles, expenditure of personal money, holidays and friendships. Their rights are respected to have partners and relationships. Observations included regular interaction between staff and people using services and staff supporting people using services in planning their menu for the following week. Records of reviews demonstrated people using services had a choice of where they live and were offered opportunity to move to other establishments and care settings in accordance with individual preferences and individual needs. Care Homes for Adults (18-65 years) Page 14 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using services are able to make choices about their life style, are supported in developing life skills and are offered a healthy diet. Social, educational, cultural and recreational activities do not fully meet individual expectations or sufficiently support social inclusion. Evidence: Currently two of the four flats are not operational owing to low occupancy levels. At the time of the visit there were nine people using services present in the home, one person on holiday and another in hospital. A person using services expressed feeling lonely at times and felt it would help if there were more younger people using services to talk with. The flats that are not being used are on the first floor of the building. The spacious Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: sitting area outside these flats is used for in-house activities. This area has comfortable seating, a range of activity equipment and materials. These include a karaoke system, a large, flat screen television, an organ and pay phone. Some people using services have their own phones in their rooms. A full time activities organiser is a new development since the last key inspection. The activities programme demonstrated opportunities available for people using services to access community resources. Twice weekly shopping trips are planned at times when there is access to a mini bus and driver. There are established links with specialist day and community services. Some people attend a day centre, the frequency of attendance ranging between half a day to five days a week. Another person enjoys going to the gym. Activities include health and beauty sessions, bingo, music and video sessions, exercise classes, outings to pubs, restaurants, to the river and other local places of interest. The home has regular social parties. During the course of the inspection, two people using services were sat outside the front of the home in their wheelchairs, for part of the afternoon, enjoying the warm sunshine. Throughout the visit carers went out with wheelchair users for a walk and to the shops. Televisions were on in both flats in communal lounges and people taking an interest in the programmes. Photographs were displayed in lounges of outings and holidays enjoyed this year and previous years. One person was looking forward to a holiday in Cornwall later this year. Though the activities programme affords opportunity for age-appropriate stimulation and access to community facilities, survey feedback from people using services identified significant dissatisfaction with social activities arrangements. The homes own quality assurance findings had the same outcome. Conversations with staff and the person designated to temporarily manage the home confirmed the key problem related to the high use of agency staff. Unplanned staff absences sometimes resulted in planned community activities not taking place. This was due to the need to ensure a safe balance of permanent staff who know and can manage the complex needs of the people using services, both when out in the community and of those left at home. Some people using services were also said to want to go out with staff familiar to them which was not always possible. Some staff were clear in their views that staffing levels were not adequate and felt this was a barrier to people using services being part of their community. They also felt the home should have increased access to a driver and suitable vehicle given the complex physical needs of the people living at the home. It was clear from the records seen and on speaking with people using services and staff that healthcare needs are well managed and a number of healthcare professional involved in their care and support. Weights are monitored and professional assessments had been undertaken for people with swallowing problems, of oral health Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: and of nutrition, as necessary. Catering staff prepare meals in a commercial kitchen on the premises and food is transported to the flats in heated trolleys. The kitchen was not inspected on this occasion however indirect observations confirmed it to be clean. An assistant cook was on duty. The menus sampled offered a varied diet and were produced one week in advance, in partnership with people using services. Each day their choice of meals is assured. If an alternative to the choices on the menu is preferred this is recorded and the cook prepares what they would like. People using services were complimentary about the standard of meals. Each flat has a small kitchenette and people using services can, with staff support, prepare drinks, light meals or snacks, whenever they wish. They may also choose to invite other people using services to their flat for a meal or visitors. Dining furniture is wheelchair accessible and eating aids provided. Staff practice at meal times respects the dignity and ensures the safety of people using services. Visitors are welcome at any time and on occasions people using services can have overnight guests in their room. A number of visitors were seen during the course of the day. Some evidently had developed positive relationships with individual staff members. Care Homes for Adults (18-65 years) Page 17 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. People using services are protected by the homes management of medication. Evidence: Since the last inspection a number of people using services whose needs had changed or who wished to do so, had moved to other care settings or were in the process of moving. Observations confirmed a good standard of care and attention to the personal appearance of individuals living in the home who were dressed appropriate to their culture and age. We randomly sampled the care documents of three people using services to assess the standard of personal and healthcare support. People using services have access to all healthcare and remedial services and are registered with a general practitioner. A staff member told us that occasionally, staff shortages prevent people using services from Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: keeping appointments with general practitioners and dentists. Service provision includes aids and equipment suitable to support people using services in daily activities of living. A record is made of all contact and input from professionals from external agencies. People using services have named key workers involved in planning and reviewing their support needs. The care plans sampled provided a comprehensive overview of needs and demonstrated how support is responsive to the varied needs and preferences of each individual. Care plans were being reviewed each month. These also addressed dietary needs and fluid balance charts were being maintained, where necessary. District nurses support staff in the management of stoma and catheter care. Care plans had clear instructions on the safe use of hoist and for individualised use of slings. Records and practice observed, also feedback from people using services confirmed staff respected the privacy and dignity of people using services. Risk assessments had been further developed since the last inspection. Areas of discussion with the person designated to manage the home included a shortfall in care planning by not producing a behavioural management plan for a person with challenging behaviours. This is important to ensure consistency of staffs management and reaction to these behaviours. Other necessary improvements were the need for comprehensive risk assessment specific to the use of bedrails. Also, for a more pro-active approach to pressure sore prevention. We were informed that none of the people using services had pressure sores. The home has an efficient medication policy supported by procedures and practice guidance which staff understand and follow. A list was maintained of all staff trained and designated responsibility for the administration of medication. The storage, recording and disposal of medication was compliant with regulations. Care Homes for Adults (18-65 years) Page 19 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is able to demonstrate that the views of people using services are listened to and acted upon. Management understands the procedures for safeguarding adults from abuse and for protecting their rights. Evidence: Complaints and protection procedures reflect the needs of people under the six strands of diversity: gender, including gender identity, age, sexual orientation, race, religion or belief and disability. Of the six surveys received from people using services, five knew who to talk to if they were unhappy and one person said sometimes. The service users guide includes information about the complaint procedure. There are also complaint and compliments leaflets by the visitors register situated near in the entrance area. These set out three stages of the complaint procedure and include information about how to make a complaint and who to direct complaints to. Also displayed is an information leaflet about Surreys safeguarding adults procedures and Surreys adult physical disability register. An out of date leaflet displayed regarding the homes former regulator should be removed, to avoid confusion. In the homes AQAA the homes management has recognised the need for improvement to the way the complaint procedure is communicated to people using services and their representatives. It was stated that it is the intention to reissue the complaint procedure to all stakeholders. It is suggested Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: that the complaint procedure be produced in a range of formats to meet the communication needs of all people using services. A complaint book is kept beside the visitors register for recording complaints or compliments. This contained one entry in August this year, which was a compliment about staff recorded by a former person using services. Other entries had been detached by management and according to the AQAA there had been no complaints received since the last key inspection. We have not received any complaints about the home but was copied into a letter of concern from a relative, addressed to the current provider after completion of the AQAA. This expressed concerns about the ongoing restrictions on staff recruitment and high use of agency staff, which this person said was adversely impacting on the care and support of people using services. This provider has no control over the homes staffing due to contractual arrangements that exist for Surrey County Council to staff the home. All six people using services who completed our survey said they felt safe at the home and that staff treat them well. Individuals commented at the time of the inspection visit however that some agency staff did not know how they liked their personal care to be given. Policies and procedures for safeguarding adults are available, giving clear specific guidance to those using them. There is a system for staff to report concerns about colleagues and managers. Multiple investigations under Surreys safeguarding adults procedures have been concluded this year into a range of allegations against staff. An independent investigator was commissioned under these procedures, by Surrey County Council. These investigations and industrial employment issues have been disruptive to the home. During this time counter allegations were made by some employees against former managers. Allegations were mostly unsubstantiated, owing to a lack of evidence. Lessons have been learnt from these proceedings by management, who are aware of the need to follow procedures and policies at all times; also to ensure effective and prompt communication with social care teams and the safeguarding team in response to any concerns raised with them. At the last safeguarding meeting professionals expressed a view that the homes culture had changed under the new management team. All concerns had been resolved. The AQAA states that staff are trained in safeguarding and whistle blowing procedures, though this was not reflected in the records viewed. The person designated to manage the home stated refresher safeguarding training was planned. Care Homes for Adults (18-65 years) Page 21 of 33 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 physical design and layout of the home enables people who use the service to live in a safe, well maintained and comfortable environment that promotes independence and is clean and hygienic. Evidence: The home was purpose built in 1997 and is fully wheelchair accessible, incorporating design principles appropriate to the homes stated purpose. The building is equipped to maximise independence, with electric hoists as standard and hoist-tracking equipment provided in bathrooms and bedrooms. First floor accommodation and facilities are accessible by passenger lift. Car parking facilities are available at the front of the premises. The living accommodation is divided into four flats, two on each floor. These provide all single occupancy bed-sitting rooms, spacious combined lounge and dining rooms for communal use with kitchenette facilities, assisted toilet and bathing facilities. At the time of the inspection visit a bath in one of the assisted bathrooms was awaiting repair. The AQAA at the time of the last inspection referred to the intention to convert a bathroom into a wet room. This work had not been carried out though staff were under the impression this was still a possibility. Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: Observations confirmed an overall good standard of accommodation with quality furnishings and specialist equipment specific to the individual needs of people using services. The three bedrooms viewed with the consent of their occupants were comfortably furnished and personalised, reflecting their tastes and interests. They each had a washbasin and lockable storage and had private telephone lines. The ground floor flats have French windows opening out onto a small, private garden area and the two upstairs flats have balconies. Since the last key inspection work had been carried out to improve security in the garden by fitting external lighting. A tour of the premises confirmed the home was clean and hygienic and systems were in place to ensure good infection control. Care Homes for Adults (18-65 years) Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing arrangements do not always support the smooth running of the service to ensure the needs of people using services are fully met by staff in sufficient numbers. Staff have received training to enable them to provide the support and care needed by people using services. Evidence: The homes staff are employed and managed by Surrey Adult and Community Services, in accordance with existing contract arrangement between Surrey County Council and Kingston and Wimbledon YMCA. There is an established,stable workforce, though currently depleted, and a number of staff have worked at the home for many years, some having left and returned. Wherever possible regular use of agency staff is organised to ensure continuity of care. They are managed the same as permanent staff and included in the staff supervision structure. No new staff have been employed since the last key inspection. On the day of the inspection visit staffing levels were below the minimum level set by the organisation. This had not been planned and was due to short term sickness of two care assistants, a permanent worker and an agency worker. The staff rotas confirmed Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: that the usual staffing levels were five care assistants and a senior care assistant across the waking day and three waking care staff, including a senior care assistant, at night. Daily ancillary staff include a cook, domestic assistant and laundry assistant. During the week the person designated to manage the home works office hours with a permanent assistant team manager and agency team manager. The management team provides on-call support at weekends. Though the home was operating below usual staffing levels, substantially increasing the workload and responsibilities of those on duty, staff demonstrated good-will and a flexible approach to ensure continuity of routines, in the best interest of people using services. They deferred and cut short their breaks and some staff on the late shift responded to requests to come in early and others on the early shift stayed over their time. A high use of agency staff continues and whilst a number of agency staff have worked continuously at the home for two years and more, this can create difficulties, owing to procedures limiting and restricting their activity. These circumstances can adversely impact on areas of service provision. Individual people using services made the same comments as at the time of the last key inspection, expressing the view that not all staff were familiar with their support needs preferences. A relative made positive comments about staff who work regularly at the home, whilst stating that agency staff new to the home were not always aware of the care and support needs of this persons relative. Whilst some permanent staff felt that staffing levels were usually adequate others expressed opinion that there was never sufficient staff. The high use of agency staff increased the workload and responsibilities of permanent staff. Though effort is made to use regular agency staff, this is not always possible and new agency workers need to be supervised and directed. It was evident that staff morale had been low over the past year due to multiple factors. Individual staff described the current management team as supportive. There was no opportunity to access staff files during the inspection visit. The responsible individual wrote to us following the last inspection confirming compliance with all requirements. This included ensuring references were maintained on staffs personnel records, to evidence safe recruitment practice. An assistant team manager has delegated responsibility for ensuring agency staff are vetted and trained and have relevant employment documentation. A first day check list is in place for new agency staff. The assistant team manager had compiled records of agency staffs Criminal Record Bureau disclosures (CRB) and of checks against the national register of people unsuitable to work with vulnerable adults (POVA). A new system was stated to be in place for checking CRB and POVA information for all employees, also their immigration and visa documents, as applicable. After the inspection visit we received information from management confirming agreement with Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: agencies to supply care staff that have had all statutory training. This includes first aid, moving and handling, safeguarding adults awareness, food hygiene, infection control and medication training. Agency staff were said to produce original training certificates before commencing their first shift at the home. The AQAA states that fourteen of the twenty care staff employed had attained care qualifications at NVQ Level 2 or above and four care staff were working towards this qualification. Sixteen staff had undertaken medication training earlier this year, including managers. The person designated to manage the home confirmed that a significant number of staff were in need of refresher training and this was planned. Care Homes for Adults (18-65 years) Page 26 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a need for management stability and continuity and for the home to have a registered manager. It is recognised that the current management team led by a temporary manager is striving to run the home in the best interest of people using services. Quality monitoring systems seek the views of people using services and their representatives. Evidence: We received written confirmation from the responsible individual for the organisation of compliance with all requirements following the last inspection. There are changes proposed to the homes ownership however these are not yet finalised. The homes quality assurance systems have been further developed and are more inclusive of people using services and their representatives. A survey of their views demonstrated that people using services and their relatives were mostly satisfied with standard of care and found positive relationships between people using services and staff. . They were pleased with catering provision and healthcare. The survey did Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: however identify a sense that social activities and personal interests were not well supported and life plans shaping the delivery of care were not of a good enough quality. It was positive to note improvements in care plans since then. Staffing constraints outside of the organisations direct control however sometimes adversely impact on the community activities programme. This inspection identified the need to review the adequacy of current staffing levels. The home has not been managed by a registered manager since December 2007. The registered manager was on special leave until recently and is now no longer employed at the home. Interim management arrangements were made during her absence for a designated staff member to fulfil the managers role. This person also recently left and another staff member is now designated to manage the home on a temporary basis. The AQAA did not supply information about this persons qualification or experience. The senior management team includes two assistant team managers, one of whom is an agency worker covering the long-term absence of an assistant team manager. Feedback from the person designated to manage the home confirmed she felt supported by her line manager also the organisations responsible individual. After a sustained, very unsettled period in the homes management, the AQAA states that relationships are improving between management, staff and with people using services. The homes management recognises the need for a period of management stability and continuity; also consistency in reviews of policies and procedures, to ensure the progress made with staff supervision is maintained and to enable the staff training programme to be further developed. Some staff spoke well of the current management team and said they felt well supported. Professionals at the last safeguarding meeting reported their observations of improvement in the homes culture. Not all staff however were of this view, one feeling unable to be open during the inspection process. It was evident that the safeguarding and disciplinary issues at the home over the past couple of years had impacted on the homes operation, management and staff morale. A relative comments indicated a lack of confidence in the homes management and the competence of managers. It was not clear however if these comments were about the present or the past. The inspection process included a review of fire safety records. The fire risk assessment were reviewed in November 2007. Records examined demonstrated arrangements for carrying out fire safety tests, though some gaps in the records demonstrated these were not always carried out weekly, in accordance with the homes policy. The last fire drill was carried out in August 2008. It was suggested to the person designated to manage the home that she consult Surreys Fire and Rescue Fire Safety officer to check that the evacuation procedures comply with current regulations. The inspection also highlighted the need for a proactive approach to Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: pressure sore prevention and for risk assessments to be carried out for the use of bed rails. Observations confirmed that management pro-actively monitors its health and safety performance and staff have an adequate understanding of safe working practices. Care Homes for Adults (18-65 years) Page 29 of 33 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 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 13 16 Arrangements must be in place, after consulting people using services about their social interests, to enable them to engage in local, social and community activities in accordance with their assessed needs and individual plans. This will enable the integration of people using services who wish to integrate into community life and to pursue their chosen lifestyle. 26/12/2008 2 33 18 For the registered person to ensure staff working at the home are in such numbers as are appropriate for the health and welfare of people using services. Additionally, that the employment of any persons on a temporary basis at the home will not prevent people using services from receiving such continuity of care as is 02/12/2008 Care Homes for Adults (18-65 years) Page 31 of 33 reasonable to meet their needs. This will ensure staff support the needs, activities and aspirations of people using services in an individualised and person centred way. 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 Care Homes for Adults (18-65 years) Page 32 of 33 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 © (2008) 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 33 of 33 - 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!