Inspection on 23/01/08 for Upaya Ananda

This inspection was carried out on 23rd January 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Upaya Ananda 20/03/07

Upaya Ananda 20/02/06

Upaya Ananda 22/11/05

Upaya Ananda 23/03/05

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Newton Court (1-2)

Kings Lane (32)

Pemdale

Beau Sejour

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Upaya Ananda 9 Station Road Hadleigh Suffolk IP7 5JF Lead Inspector Deborah Kerr Unannounced Inspection 23rd January 2008 09:00 Upaya Ananda DS0000061223.V358584.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Upaya Ananda DS0000061223.V358584.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Upaya Ananda DS0000061223.V358584.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Upaya Ananda Address 9 Station Road Hadleigh Suffolk IP7 5JF 01473 823802 01473 823802 fun1993@onetel.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Fun Ms D Margerison Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Upaya Ananda DS0000061223.V358584.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th March 2007 Brief Description of the Service: Upaya Ananda is a large modern detached house, with garden and grounds, situated near the centre of Hadleigh. Upaya Ananda are Sanskrit words meaning ‘Expedient means to joy’, and the project is operated by a charity called FUN. The statement of purpose states that the home aims to provide short fun breaks to young adults with learning difficulties. Upaya Ananda provides a respite service only, and those using the service are referred to as guests in line with the philosophy identified in the statement of purpose. Upaya Ananda provides a service to young adults, and some children between the ages of 1618. The ratio of service users under the age of eighteen is less than is required for registration as a Children’s Home; therefore the registration category of Care Home is sufficient. Three single bedrooms provide accommodation; one of the bedrooms and one of the bathrooms is wheelchair accessible. Wheelchair accessible transport is provided by the home. The brochure states clearly that the home is not equipped to meet the needs of people with a history of violence, and does not provide nursing care. All placements are planned. Staffing is arranged by the manager on the basis of bookings for the month. Once the bookings are made, the manager identifies the most suitable staffing arrangements on the basis of the needs and preferences of service users. The rates charged by the service have remained the same since they opened in 2004. There are two separate rates. Guests funded by Social Services are charged at a rate of £125 per night or £130 per 24-hour stay. Other guests are charged at a charitable rate of £25 per night or £30 for a 24-hour period. This was the information provided at the time of the key inspection; people considering using this service may wish to obtain more up to date information from the home. These charges include a single room, evening and breakfast meal (packed lunch, where required) laundry and transport to leisure activities. Upaya Ananda DS0000061223.V358584.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. This was a key inspection, which focused on the core standards relating to adults, aged 18-65. The inspection was unannounced on a weekday, however there were no guests staying on the day of the inspection, therefore arrangements were made to return on the 28th January to meet with a guest. This report has been written using accumulated evidence gathered prior to and during the inspection, including information obtained from a selection of guests, relatives and staff ‘Have Your Say’ surveys and the Annual Quality Assurance Assessment (AQAA), issued by the Commission for Social Care Inspection (CSCI). This document gives providers the opportunity to inform the CSCI about their service and how well they are performing. We (CSCI) also assessed the outcomes for the people living at the home against the key Lines of Regulatory Assessment (KLORA). A tour of the premises was made and a number of records were inspected, relating to people using the service, staff, training, the duty roster, medication and health and safety. Time was spent talking with a guest and two members of staff. The manager was not available during this inspection, however the assistant manager and training manager were available and fully contributed to the inspection process. What the service does well: Upaya Ananda continues to provide a flexible service, based on the needs and expressed preferences of those who use the service. The environment has modern facilities, with spacious rooms, which are pleasantly decorated and well maintained. When entering the home there is a friendly, happy and relaxed atmosphere. Information obtained in guests, relatives and staff surveys and verified at the inspection confirmed that guest are provided with the opportunities to make choices and are supported to do what they want to do, allowing them to be as independent as they can be. Feedback about the service provided in surveys, the homes own quality assurance surveys and conversations with a guest and staff was extremely positive. Comments included “Upaya Ananda has given my relative a new dimension to a some what limited lifestyle, their self esteem and pleasure from these visits are very apparent” and “I like staying at Upaya Ananda, I enjoyed my visit very much and I can not wait to go again” and “you are very nice, it is good to stay at Upaya Ananda and I enjoy it there”. The service provides respite care for up to sixty-five guests per annum, with a good success rate of repeat visits. Upaya Ananda DS0000061223.V358584.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The statement of purpose and service user guide is dated 2004. These need to be reviewed and updated, to reflect where there have been changes within the service, including the new management structure. The service user guide and complaints procedures would be more meaningful and interesting to the people who use the service, if they were produced in a similar format to the brochure, using photographs and quotes from guests, giving their comments and experiences about the service. The adult protection and whistle blowing policy and procedures need to be updated to reflect the new Adult Safeguarding Board (ASB), which replaces the former Suffolk County Council, inter agency policy. These also need to reflect the change in the contact details of the CSCI. Following a Fire and Rescue service visit to the home on the 25th September 2007, requirements were made for work to be undertaken to comply with Fire Safety Regulations. A tour of the home confirmed steps had been taken to address most of the work. Where work required to install self-closing devices to a number of internal doors is currently being discussed between Fun and the Fire Service. The inspector has requested that written confirmation of any decisions agreed is forwarded to the CSCI. The current provision of cash tins for guests to lock valuables and/or medication is not secure and does not protect them from the risk of financial abuse. Upaya Ananda DS0000061223.V358584.R01.S.doc Version 5.2 Page 7 The home’s brochure states clearly that the home is not equipped to meet the needs of people with a history of violence. Information seen in incident reports identified where some guests had presented behaviour that staff had found challenging. This was discussed with the training manager who identified a need for future training to ensure staff have the skills and knowledge to manage and understand behaviours that can present as challenging to others. The last full quality assurance and quality monitoring review was undertaken in 2005. This needs to be undertaken on an annual basis and include feedback from relatives, guests and other health professionals associated with the service. The results of the survey need to reflect how the home is achieving the aims and objectives and the action(s) they need to take where improvement is required. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Upaya Ananda DS0000061223.V358584.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Upaya Ananda DS0000061223.V358584.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4, 5, People who use the service experience excellent quality outcomes in this area. Prospective people to use this service will have their needs assessed and they and their representatives will be provided with information, which clearly tells them about the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is no standard form of contract between the home and the guest, due to the nature of the business, providing short-term care. The service however, does have a block-booking contract with Social Services for fourteen guests. The service has a detailed statement of purpose, service users guide and brochure, which clearly tells prospective guests about the service, the fees and facilities. The brochure has been developed using photographs and quotes from guests, giving their comments and experiences about using the respite service. These included “ I come here to get away and have fun” and “I get to know loads of other people, guests and staff”. The service user guide and complaints procedure would be more meaningful and interesting to the people who use this service, if they were produced in a similar format as the brochure. Information provided in the AQAA and verified at the inspection confirmed that there is a comprehensive induction procedure to suit each individual when introducing a prospective guest to the service. Upaya Ananda DS0000061223.V358584.R01.S.doc Version 5.2 Page 10 The introduction procedure includes the date the individual is referred to the service, referral form and the date of a home visit when a needs assessment is undertaken by the homes manager or other suitably qualified member of staff. Following completion of the needs assessment, the individual is invited on a familiarisation visit to Upaya Ananda and invited for a trial overnight stay or teatime visit before commencing any period of respite. Examination of three guests care plans confirmed each person had a comprehensive needs assessment in place, in conjunction, where appropriate with a Social Services Community Care Assessment. Taken in combination, the assessments identified the preferences and needs of each guest in relation to a wide range of physical and emotional needs as well as daily routines, family support, resource issues and independence. Information provided in ‘Have Your Say’ surveys confirmed guest’s had been involved in making a choice to use this service. Comments included, “I was asked if I wanted to stay at Upaya Ananda and my parents explained the information to me” and “carers listen and act on what I say, I would like to live at Upaya Ananda all the time”. Upaya Ananda DS0000061223.V358584.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, People who use the service experience good quality outcomes in this area. Individuals are involved in decisions about their daily lives and play an active role in planning the care and support they receive. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The files of three guests who have recently used the service were inspected. Only one of the three files contained an individual care plan, which included a structured programme to support the individual’s independent living skills and to maintain their self-esteem and confidence. However, the pre admission assessments combined with moving and handling profiles developed in consultation with the individuals and their relatives, provided all the required information needed by the home to produce a comprehensive and person centred package of care, suited to the individual. The AQAA identifies where the home are planning to improve the service by developing individual care plans for regular guests. They have also identified a need to ensure key support staff are rostered to support individual guests, each time they use the service, which will provide consistency and ensure that the persons current needs and wishes are kept up to date and conveyed to other staff. Upaya Ananda DS0000061223.V358584.R01.S.doc Version 5.2 Page 12 Each guests’ file contained a current photograph of the person together with their personal details, including next of kin and other important contacts. The files are well organised and provide information covering the individual’s health, personal and social care needs. Each file contained an independence criteria form, completed as part of the assessment process, which reflects the level of independence and /or the level of support the guest requires to meet their daily living needs. These include specific needs and preferences in relation to all aspects of daily routines, medical and health needs and emotional and behavioural support. Discussions with staff confirmed that guest’s care is reviewed at each period of respite. Relatives are good at providing up to date information regarding health and welfare issues and changes in medication. Any changes are recorded on alteration forms. These are held at the front of the individuals’ file and provide staff with relevant and current information about the needs of the guest. Guests are encouraged to manage their own money when they use the service, however where they require support, money is held in the staff office on their behalf. For those able to hold their own money, lockable money tins are provided in the guest rooms. However these are not secured and could be removed from the premises without the guest’s knowledge and therefore do not protect the individual from the risk of financial abuse. A member of staff spoken with confirmed they had completed risk assessment training and are responsible for completing risk assessments for individuals, where required. Risk assessments seen provided information where there is an identified risk to the individual and gave detailed information to staff to positively help and support the guest using the service to lead the life they want. Time was spent talking with and observing a guest and a member of staff. The interaction with each other was friendly and appropriate, chatting about dayto-day events and interests. The AQAA and home’s brochure reflects that guests are supported to make their own decisions and choices. Observing the guest choosing and making their own supper confirmed this. The carer provided support, only when requested by the individual. The guest commented, “I am always happy here, especially at weekends, I like the food and at weekends we often have a take away”. They confirmed they are able to spend their time as they choose, stating “ I like to go to the cinema, swimming and play games with my friend”. Upaya Ananda DS0000061223.V358584.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17, People who use the service experience excellent quality outcomes in this area. Guests who use this service are supported to make choices about their lifestyle and take part in social and recreational activities, which meet their expectations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Upaya Ananda provides a respite service, and therefore, does not take on a lead role in identifying long term educational and employment resources for the guests. However, the home does provide transport for guests to access educational and employment establishments. Information provided in the AQAA and verified at the inspection confirmed guests are supported in their daily activities, to attend clubs and associations, and to maintain contact with families and other guests. The routine of daily life for people living in the home is flexible and varies according to their needs. The key principle of the home is that people using the service are in control of their lives. A guest spoken with confirmed “I can do what I want during the day and at weekends, I get up and go to bed when I choose”. Upaya Ananda DS0000061223.V358584.R01.S.doc Version 5.2 Page 14 The brochure states that the home ‘offers people a ‘break away’ service, which provides time to do something different, with different people, in a different place’ within this they aim to invite guests who are compatible and enjoy each others company. Discussion with a guest confirmed they stay at the service on a regular basis with a friend. They confirmed they are able to access a wide range of recreational activities, both within the home and trips out. These include, access to the homes colour television, radio, music systems and a computor with internet access. Guests are able to bring their own CD players, CD’s magazines, games and puzzle books. Activities outside of the home include the cinema, pubs, dance clubs, swimming pools, bowling, theatre, shops and local supermarkets, churches, seaside walks and other places of interest to the individuals. The home has an annual Bar-be- que, which provides an opportunity for guests, relatives and staff to get to know each other. The AQAA states that the service offers a flexible structure to the day, with no rules other than those required for safety. Guests have unrestricted access around the home, with the exception of other guest’s rooms. Guest’s confirmed in the surveys that they are able to spend time on their own in their room, if they chose to do so, and that staff respect their privacy and will knock before entering their room. The AQAA states that guests are encouraged to participate in a healthy eating programme. Training has been scheduled to improve staff’s knowledge and understanding of healthy eating options to support guest to make the healthy choices. The kitchen and dining room are open plan and offer a family style environment. There are facilities for guests to make hot and cold drinks and preparing snack foods, as well taking part in the preparation and cooking of their evening meal. Fresh fruit and drinks are freely available. The fridge and cupboards contained a good range of fresh and pre packed quality foods, including well known brands. Guests are encouraged to help shop for food. The needs assessments examined, documented the individual’s ability to eat and drink and provided detailed information where they required special equipment to enable them to eat their meal independently and where they required support. Upaya Ananda DS0000061223.V358584.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, People who use the service experience excellent quality outcomes in this area. Guests using this service can be assured that the principles of respect, dignity and privacy are put into practice and that the health and personal care they receive is based on their individual needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a comprehensive set of policies and procedures, focused on ensuring the care provided is delivered in a way, which promotes ‘the rights of each guest to dignity, respect, self-determination and individuality’. Information provided in the AQAA and verified at the inspection confirmed the home are able to support a variety of health care needs. Guests’ preferences in terms of care provision are ascertained during the pre admission process. Their personal and health care needs are clearly recorded and detail how these will be delivered and the level of support the guest requires promoting and maintaining their independence. Information about the guest’s general practitioner, dentist and other relevant health professionals were seen in their files. The individual’s plan includes their medical history, current health needs and appointments with healthcare professionals, where appropriate. Upaya Ananda DS0000061223.V358584.R01.S.doc Version 5.2 Page 16 A tour of the environment confirmed the home has a wide range of aids and equipment to encourage maximum independence and comfort for guests using the service. These include grab rails, hoists, slings, and a shower bed. Where an individual is assessed as requiring equipment, for example to aid their mobility, risk assessments were seen, which detail the actions required by staff to aid safe moving and handling procedures. The assessments confirmed that the staff receive in house training for moving and handling, including the use and regular maintenance checks of the equipment provided. Records seen confirmed the equipment is regularly serviced to ensure they are in good working order. The home has developed an efficient and comprehensive medication policy, procedures and practice guidance for ordering, prescribing, storing, administering and disposal of medicines. Training in first aid and the administration of medicines was evidenced in the training records and confirmed in discussion with staff, who clearly understood their role and responsibilities. Guests, who are able, are encouraged and supported to manage their own medication. This was confirmed in discussion with a guest who was able to name their medication and when and how often they should take it. The homes medication policy states guests whom manage their own medication must be aware this is their responsibility, however there is no lockable space in the bedrooms for guests to keep their medication secure. Small money tins are provided in people rooms to lock valuables, however these are not sufficiently sized to keep larger items of medication. Medication is stored in a locked cupboard in the kitchen and senior staff hold the key. Medication that requires refrigeration is stored in locked boxes and kept in the kitchen refrigerator. The practice of administering medication is generally safe and well managed. Records showed that medication was counted, recorded and signed for when guests arrived and left, providing an audit of the amount of medication administered during the guests stay. Medication administration records were examined and found to be well maintained, with clear entries and no gaps. The AQAA identifies where the service needs to provide refresher training, for medication, diabetes awareness and epilepsy management. Upaya Ananda DS0000061223.V358584.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23, People who use the service experience good quality outcomes in this area. People who use this service have access to a robust and effective complaints and safeguarding procedures, which protect them from abuse, neglect and self harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA and verified at the inspection confirmed that the home has a clear and effective complaints procedure. As previously mentioned in this report, the procedure would be more meaningful to the people who use the service, if it was produced in a format suitable for the people for whom the service is intended, for example easy read language and pictures. Neither the Commission for Social Care Inspection (CSCI) or the home have received formal complaints or adult safeguarding referrals in relation to this service. The homes has an appropriate adult safeguarding policy in place, which includes clear guidance of the procedures staff must take to report allegations of abuse, including referral forms, if needed. However, the adult protection and whistle blowing policy and procedures need to be updated to reflect the new Adult Safeguarding Board (ASB), which replaces the former Suffolk County Council, inter agency policy. These will also need to be amended to reflect the change in the contact details of the CSCI. The AQAA states that the service constantly refreshes and reviews their procedures with staff and guests regarding complaints and adult safeguarding and ensures staff receive up to date training, as required. Records showed that adult protection training is provided to care staff as part of their induction. Upaya Ananda DS0000061223.V358584.R01.S.doc Version 5.2 Page 18 Staff spoken with were aware of residents rights and how to refer a complainant to a senior member of staff and were clear about their duty of care and what they would do if they had concerns about the welfare of a resident. Information obtained in discussion with a guest and from the ‘have your say surveys’, confirmed guests know who to speak to if they are unhappy with the service and felt staff treated them well and felt safe when using this service. To ensure the safety and protection of people living in the home, robust recruitment procedures are in place. Staff files seen confirmed that all newly employed staff are subject to Criminal Records Bureau (CRB) and Protection Of Vulnerable Adults (POVA) check. Information about the home is clear that the home is not equipped to meet the needs of people with a history of violence. Examination of incident report forms confirmed that incidents are well documented. Fourteen incidents had been recorded during the period April to November 2007, eight of which reflected where guest’s behaviour had been challenging to staff and / or other guests. Where individuals have been identified as having unpredictable behaviour, management of behaviour procedures have been implemented. These provided a detailed plan of care to support the individual and identified where certain circumstances would cause them distress. This information provided staff with information and identified triggers, which alerts them to changes in mood, behaviour and general well being of the individual. They also identified the action staff should take to ensure that physical and/or verbal aggression and unpredictable behaviours are understood and dealt with appropriately. Discussion with staff and training records confirmed staff have not received training in this area. This was discussed with the training manager who identified a need for future training to ensure staff have the skills and knowledge to manage and understand behaviours that can present as challenging to others. Upaya Ananda DS0000061223.V358584.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30, People who use the service experience excellent quality outcomes in this area. The physical layout and design of the home enables guests to stay in a safe, well maintained and comfortable environment, which encourages independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA and verified at the inspection confirmed that Upaya Ananda provides comfortable warm accommodation, which is well maintained to a high standard and provides a homely atmosphere. The premises are bright, cheerful, airy and free from any unpleasant odours. It is a large modern detached house, set in it’s own garden and grounds, situated near the centre of Hadleigh and has good access to community facilities and services. All rooms are spacious, and well furnished with modern equipment and domestic style furniture, carpets and curtains. There are three single bedrooms providing accommodation, one of which has it’s own hoist and an adapted ensuite shower room and toilet for wheelchair users. Upaya Ananda DS0000061223.V358584.R01.S.doc Version 5.2 Page 20 The guests bedrooms are nicely decorated, each with a different colour scheme and matching accessories. All bedrooms promote privacy, doors are fitted with door locks and guests are offered the choice of holding the key to their room, however staff hold an override key in case of emergencies. Each bedroom has en suite toilet and bathroom facilities. These are homely and include aids and adaptations to meet the needs of the people using the service, including a hospital’ style bed and shower bed to enable the home to care for people whose physical disabilities, who require this sort of equipment. There is an additional communal bathroom, and separate staff toilet facilities. The home has been designed to maximise guest’s access to all parts of the building. There is a selection of communal areas both inside and outside of the home. These consist of a large conservatory, opening up onto a decked area outside, open plan kitchen, dining and lounge area. Corridors in the home are wide enough to allow wheelchair mobility and all entrances are accessible by ramps. Appropriate aids for safe moving and handling were sited around the building. ‘Have your say’ surveys and discussions with a guest and staff confirmed that Upaya Ananda provides a lovely welcoming place to stay, with nice facilities and open space for people to do what they want to do. Guests described the home as always fresh and clean and that they are able to choose the room they use. One individual stated they prefer the yellow room as it has a double bed. The laundry facilities seen were clean and tidy with appropriate equipment to launder clothing and bedding, however the washing machine does not have a sluice cycle. This was discussed with the assistant manager who confirmed that soiled items of clothing and/or bedding occur very rarely. On these occasions soiled linen is rinsed in the sink before putting in the washing machine. This practice does not comply with the Department of Health guidelines for infection control. Appropriate hand-washing facilities of liquid soap and towels are situated in all bathrooms and toilets where staff may be required to provide assistance with personal care. Upaya Ananda DS0000061223.V358584.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36, People who use the service experience excellent quality outcomes in this area. Staff in the home are trained, skilled and in sufficient numbers to support the guests who use this service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Discussion with the assistant manager and examination of the staff rotas confirmed these are planned around the needs of guests. Shifts patterns Monday to Thursday are from 3.30pm –9.30am to cater for overnight guests. The service does not provide day support, unless by prior arrangement, for example, summer holidays. Weekend shifts commence Friday afternoons through to Sunday. Staffing levels are adjusted to facilitate the number of guests and their choice of recreational interests. The duty roster confirmed that the staff ratio is normally two staff to three guests. Discussion with staff confirmed that there is definitely enough staff on shift to meet the needs of guests and that they are always willing to do more shifts, if required. Seven care staff (including the Assistant Manager) are employed to solely work at Upaya Ananda, however on occasions staff have worked at one of Fun’s other projects in emergencies. Upaya Ananda DS0000061223.V358584.R01.S.doc Version 5.2 Page 22 The home operates a robust recruitment process and where ever possible guest involvement is encouraged. The AQAA identified that full staff checks are carried out on appointment. Staff files examined confirmed all the relevant documents and recruitment checks, required by regulations, to determine the fitness of the worker are obtained prior to commencing employment. These included Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks, 2 references, photographic identification, and a completed application form, which reflected the individual’s career history. The AQAA states a training manager has been recruited to oversee the staff development and training programme and to ensure refresher training is kept up to date. Additionally, an induction training programme has been introduced which meets the requirements of the National Training Organisation (NTO), Skills for Care Induction Standards. Certificates, signing off completion of the six units, which make up the induction training, were seen confirming all newly appointed care staff had completed their induction, within nine weeks of commencing employment. Staff spoken with confirmed they receive training relevant to their role and which helps them to understand and meet the needs of the people using the service. One staff commented that they thought the service excelled at providing training and gave an example of where a new guest, required Percutaneous Endescopic Gastrostomy (PEG) care. Training was provided before their visit to ensure all staff were aware of how to meet the needs of this individual. Records showed that staff training is kept up to date with annual refreshers for all mandatory training, including moving and handling, first aid, fire safety, food hygiene, adult protection, care of medicines and more specific to the needs of people using the service, epilepsy awareness. Information provided in the AQAA states that the staff are encouraged to undertake minimum National Vocational Qualification (NVQ) training, following completion of the Skills for Care Induction standards. The home employs a total of eight staff (including the Assistant Manager and Training Manager), of whom five have obtained NVQ Level 2 and/or above, with the remaining three currently working towards completion of their NVQ. These figures reflect that the service has reached the National Minimum Standard (NMS) target of 50 of care staff to hold a recognised qualification. Three staff ‘have your say’ surveys were received prior to the inspection. These confirmed that staff felt they are sufficiently staffed, are provided with up to date information about the needs of the guests and receive training, so that they have the skills and knowledge to meet different needs of people using service. However, comments included further consideration needs to be given when booking shifts to take into account the skills and competencies of staff, to ensure the choices of the guests can be met, for example, ensuring staff who can drive are available at weekends when guests want to go out. Upaya Ananda DS0000061223.V358584.R01.S.doc Version 5.2 Page 23 Staff confirmed that they are supported in their role and that they do have supervision, however this does not always occur on a regular basis. Staff files confirmed that staff had been issued and had signed a supervision contract, which stipulates that supervision should take place every six weeks. However, of the three files examined, only one had evidence to confirm they had had one recorded supervision session. Upaya Ananda DS0000061223.V358584.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42, People who use the service experience good quality outcomes in this area. People using the service can be confident that the duration of their stay will be well managed and centred around their specific needs, however the quality assurance process needs to undertaken on a regular basis to ensure guests are able to express their views about the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA states that an experienced project manager has been in post since December 2007, replacing the previous registered manager who has taken a different post within the organisation. Although, the manager has overall responsibility for the service, there are clear lines of accountability and delegation of duties within the staff group. All staff have the opportunity to share in the way the service delivery is planned and actioned. Upaya Ananda DS0000061223.V358584.R01.S.doc Version 5.2 Page 25 A quality assurance and quality monitoring system has been developed to seek the views of people who use the service, however the most recent quality assurance survey was undertaken, involving guests and relatives in 2005. The ‘About staying at Upaya Ananda’ surveys were looked at during the inspection and overall, feedback confirmed people showed a very high level of satisfaction with the care provided and the professionalism of the staff team. Comments included “Very happy with the staff and environment, loved the BBQ, and other activities” and “XXX enjoyed their visit very much, can’t wait to go again” and “my relative has enjoyed their visit for tea and overnight stay and is looking forward to a longer stay”. Discussion took place with the assistant manager that the views of guests should be sought at least annually, if not after every visit to ascertain how the service is meeting the individuals needs, goals and the aims and objectives of the service. The AQAA identified that FUN needs to further develop the quality assurance assessments. The AQAA provides the service with the oportuinity to carry out a self assessment and inform the CSCI about their service and how well they are performing. Information provided in the AQAA and verified at the inspection confirmed that the service focuses on the individual and encourages the guests to shape the service they recieve. There is a strong staff team who have been recruited and trained to a high standard. Records examined at the inspection and information provided in the AQAA confirmed the home takes steps to safeguard the health, safety and welfare of people living and working in the home. Examination of the fire logbook confirms that a fire safety risk assessment has been completed. The logbook evidenced that the fire alarm and fire fighting equipment is serviced annually and that regular safety checks are undertaken, including testing the fire alarm and emergency lighting. Regular fire drills are held to ensure staff and guests are familiar with evacuation procedures in the event of a fire. Following a Fire and Rescue service visit to the home on the 25th September 2007, requirements were made for work to be undertaken to comply with Fire Safety Regulations. A tour of the environment confirmed steps had been taken to address most of the work, however work required to install self-closing devices to bedroom doors and the utility room are currently being discussed between Fun and the Fire Service. The most recent Gas and Electrical Safety Certificates, including Portable Appliances Testing (PAT) were seen and records showed that all equipment including hoists are regularly checked and serviced. Upaya Ananda DS0000061223.V358584.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 4 3 X 4 4 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 4 25 4 26 4 27 4 28 4 29 4 30 2 STAFFING Standard No Score 31 X 32 4 33 4 34 4 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 4 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 4 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 4 X 3 X 2 X X 3 X Upaya Ananda DS0000061223.V358584.R01.S.doc Version 5.2 Page 27 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA23 Regulation 13 (6) Requirement Where some guests have presented behaviour that staff have found challenging, training must be provided to protect the staff and other guests. This will ensure that staff have the skills and knowledge to manage and understand behaviours that can present as challenging to others. The practice of sluicing soiled garments in the sink before putting in the washing machine must be changed to comply with the department of Health guidance for infection control. This will reduce the risk of cross infection and ensure the safety of using the service. The quality assurance system must be conducted at least annually and include feedback from relatives, guests and other health professionals associated with the service. This will confirm how the service is achieving the aims and objectives set out in the statement of purpose. Timescale for action 31/03/08 2. YA30 13 (3) 31/03/08 3. YA39 24 31/03/08 Upaya Ananda DS0000061223.V358584.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations The statement of purpose and service user guide needs to be reviewed and updated, to reflect where there have been changes within the service. The service user guide and complaints procedures would be more meaningful and interesting to the people who use the service, if they were produced in a similar format to the brochure, using photographs and quotes from guests, giving their comments and experiences about the service. The current provision of cash tins for guests to lock valuables and/or medication is not secure. Secured lockable storage should be provided to ensure people using the service are protected from the risk of financial abuse. The adult protection and whistle blowing policy and procedures should be updated to reflect the new Adult Safeguarding Board (ASB), which replaces the former Suffolk County Council, inter agency policy. These also need to reflect the change in the contact details of the CSCI. Formal supervision sessions should be undertaken at least six times a year. Where work required by the fire and rescue service is currently being discussed between Fun and the Fire Service, regarding installation of self-closing devices to a number of internal doors within the home, written confirmation of the outcome should be forwarded to the CSCI, with the agreed outcomes. 2. YA1 3. YA26 4. YA23 5. 6. YA36 YA42 Upaya Ananda DS0000061223.V358584.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Colchester Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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