Inspection on 09/03/07 for Woodbourne Avenue, 31

This inspection was carried out on 9th March 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Woodbourne Avenue, 31 06/12/05

Woodbourne Avenue, 31 14/06/05

Woodbourne Avenue, 31 24/01/05

Woodbourne Avenue, 31 16/08/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Woodbourne Avenue, 31 Streatham London SW16 1UP Lead Inspector Mary Magee Unannounced Inspection 9th March 2007 10:00 DS0000022773.V328654.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 DS0000022773.V328654.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. DS0000022773.V328654.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodbourne Avenue, 31 Address Streatham London SW16 1UP 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) 020 8769 1865 0208 677 0720 woodbou.hirch@btconnect.com The Frances Taylor Foundation Pamela Jane Margaret Hirsch Care Home 8 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (0) of places DS0000022773.V328654.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. to include one service user aged 65 years or above Date of last inspection 6th December 2005 Brief Description of the Service: 31 Woodbourne Avenue is one of a number of care homes owned and managed by the Frances Taylor Foundation. This is a registered charity providing social, health and pastoral care services. This care home is registered to provide care and accommodation for eight adults with a learning disability. It is a threestorey semi-detached house located in a pleasant quiet residential street and just a short walk away from the busy shopping area of Streatham. The locality provides a variety of recreational and leisure facilities and is conveniently located for rail and bus links. The premises provide a pleasant and homely environment. Bedrooms are single occupancy. There is a large well-kept garden to the rear of the home. No vacancies present at the time of inspection. Charges range from £580 to£748 per week. DS0000022773.V328654.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day and lasted seven hours. The inspector met with the registered manager and three support workers. All eight-service users were spoken with during the inspection, the majority were interested in the inspection and told of their experiences. A tour of the building was conducted. This included all communal areas and three bedrooms. A number of records were examined. These included the personnel records for two support staff and for two service users, a pre inspection questionnaire and records relating to the maintenance of the building. The inspector spoke by telephone to the relatives of two service users to gain their views on services What the service does well: The home is warm and welcoming for anyone visiting the home. Two relatives spoke of the excellent communication that they value, “ I am always kept informed of my relatives’ well being, this is very reassuring” were comments received from two service users’ relatives. Management and staff recognise how traumatic it can be for new service users moving to the home. In recognition of this staff play a supportive and sensitive role that ensures the admission process is as smooth and stress free as possible. The home’s philosophy and style of living (small scale) is structured in a manner to be service user focused. Service users receive the appropriate support and encouragement that enables them lead valued and fulfilling lifestyles. The small-scale setting makes a major contribution to the homely and inclusive environment that service users experience. People feel valued as individuals and their views matter. “This is the nicest home to live in, life is good we are like a big family” was a comment received from a number of service users. The service is consistent and stable with service users benefiting from the presence of a strong and skilled staff team that reflect the caring ethos of the organisation. The maintenance programme is very good, all areas of repair are responded to promptly with an ongoing refurbishment programme in place to retain the high standards of presentation. DS0000022773.V328654.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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. DS0000022773.V328654.R01.S.doc Version 5.2 Page 7 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 DS0000022773.V328654.R01.S.doc Version 5.2 Page 8 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 3 5 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Prospective service users are provided with all the necessary information and have the opportunity to test drive the home before making the choice to move there. Service users know that if they choose this home it will meet their needs. EVIDENCE: The inspector met with all eight service users over the day of inspection. One service user recently admitted to the home appeared at ease with service users and staff and expressed that she had made the right choice of home. She said that she had settled well in her new environment and liked the fact that she could be more independent. The service user referred to had lived in the family home prior to admission. She made a number of visits to the home before moving in permanently. The trial period was quite lengthy but this was a valuable exercise in making sure that it was the right setting. The service user although only a week living at the home demonstrated that she was at ease in taking the initiative in using the facilities such as the kitchen and lounge. She found that she related well with other service users, some of a similar age group and knew it was the right choice. The inclusiveness of the environment is demonstrated, when a service user moves to the home both service users ands staff do everything possible to ensure that individuals feel welcome. DS0000022773.V328654.R01.S.doc Version 5.2 Page 9 Service users were involved in the consultation process at the pre admission stage and met the service user on the occasions when she visited. Recognising the importance of service users feeling included this transition ensures that service users moving to the home get a good feel of the lifestyle offered and how they relate to other service users. Prospective service users are able to recognise if the home is suitable to meet their needs. When visiting the home there is evidence that the home has the capacity to meet service users’ needs. The inspector observed how comfortable service users feel. Interaction with staff is good with service users at ease and relaying the day’s events and experiences from attendance at college and work. Experienced staff are on hand to offer support and encouragement and show interest in the welfare of service users. One support worker was heard discussing with a service user how her work experience had been that day. An example of how service users feel in control was seen, for a newly admitted service user she took the initiative, was using the kitchen and making drinks for others present. When spoken to by the inspector she said that she liked to have to opportunity to entertain and use her skills, as she felt competent at a doing a number of chores. Information is available in the form of a service user’s guide. This is given to prospective service users and their families so that they can determine if it is the appropriate service. The Statement of Purpose was revised recently to include recent changes to staffing personnel. The home takes all the necessary steps to make sure that the service delivered is appropriate to the individual’s needs. Service users admitted have mild to moderate learning disabilities. The home does not accept emergency admissions. New service users are not admitted unless a full assessment is undertaken first and based on this information the home is confident that it can deliver the necessary care and support to meet these assessed needs. Care management assessments and full medical histories are also sought for new referrals. The environment is nurturing and caring with emphasis placed on enabling individuals to grow and become more independent as individuals while considering capacity and vulnerability. Another service user spoken to had transferred from another home recently. She was familiar with service users and often visited in the past. She told the inspector that she is much happier in her new surroundings, “ I like to mix more here as people are friendly and we have more in common” she said. The inspector recognised that she appeared outgoing and interested and not as withdrawn as she had appeared in the past. The inspector viewed a copy of the contract issued to a service user that was recently admitted. A copy of this contract was available in easy read format. DS0000022773.V328654.R01.S.doc Version 5.2 Page 10 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 9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The systems in place to support service users are very good. Person centred support plans are agreed and drawn up with service users to record all areas of support needed and how to manage safely the risks involved. Service users are consulted on and participate in all aspects of life in the home. EVIDENCE: Service users receive the necessary support and care with arrangements well organised and consistent to achieve this. Written person centre plans are agreed and in place for service users recording aims, goals and objectives. A key worker system operated provides additional support enabling one to one involvement. The written plans for two service users were viewed. Copies of agreed person centred plans are held by service users in their rooms so that they have ownership of them. One of the plans examined was for a service user that has lived at the home for numerous years, the other for recently admitted service user. DS0000022773.V328654.R01.S.doc Version 5.2 Page 11 The support plans in place for one service user include all areas where service users need support and guidance including vulnerability and how this is supported. The risk assessments highlight areas of risk and how this is to be managed effectively. The service user referred to above spoke to the inspector about the plans and indicated her input in developing these. The inspector was involved in discussions between one service user and the manager and talked about risks. It was evident that for a service user to grow and develop circumstances may arise when a service user will take risks. Staff at the home ensure that a service user is fully informed on managing risk and are aware of the consequences when they take identified risks. A service user spoke of attending a party later in the day, she agreed that she would keep the home informed of her planned return time and her understanding of the safety aspect in getting back later in the night. For a recently admitted service user the home had completed a comprehensive assessment of need, they also secured important information on medical conditions, communication, mobility and the promotion of independence. From this information they had started to develop a person centred plan on how to support the individual in all of these areas. This plan will be developed further as the service user demonstrates further what areas she would like to pursue in order to achieve her goals. The risk assessments are highlighted and agreed; they demonstrate how staff at the home support the service user to safely develop skills. Examples seen were of supervision by staff when service users carried out certain tasks, records maintained clearly stated when staff felt satisfied that the service user could manage these chores safely without having supervision. Evidence was seen on risk assessments of how risks in travelling to events in the community were managed appropriately. Evidence was available on records held for two other service users confirming that care plans and risk assessments are reviewed and revised as necessary; all plans and risk assessments are reviewed at least every six months. For another service user the inspector viewed records received of the outcome of a recent review. The service user is progressing well and the home is fully meeting her needs. The registered manager has written to local authorities requesting statutory reviews where they are outstanding for other service users. In addition to care and support plans individual books are held for service users. These are used as daily diaries for individuals for staff to record all notable events. They give a good indication of the services provided from other bodies such as hospitals and colleges and of progress or any set backs. The home is run in the best interests of service users with the focus on shaping the home to the needs and choices of service users. Besides individual one to one sessions with key workers service users hold regular meetings to discuss plans for the future and put forward their views. Minutes of these minutes are displayed on notice boards for anyone that may have been absent at the time. DS0000022773.V328654.R01.S.doc Version 5.2 Page 12 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 15 16 17 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Service users are able to make choices about their life style, and supported to develop their life skills. They are supported to attend social, educational, cultural and recreational activities that meet individual’s needs expectations and aspirations. EVIDENCE: The home understands the importance of enabling younger adults to achieve their goals, follow their interests and be integrated into community life and access appropriate leisure activities. Service users are able to enjoy a full and stimulating lifestyle. They have a variety of options to choose from that take into account preferences, age, culture, and religious beliefs. The majority of those accessed are mainly in the community. Service users invite friends and families to social events at the home and link up regularly with service users at the other three Frances Taylor Homes locally. The inspector met all the service users at another home enjoying a social event a few days after the inspection. They told of how much they enjoyed meeting up with other people of similar age group. DS0000022773.V328654.R01.S.doc Version 5.2 Page 13 The home gets the views of the service users and takes on board their varied interests and commitments when planning the routines of daily living and arranging activities both in the home and the community. Routines are very flexible and individual service users make choices in major areas of their life. The routines, activities and plans are user focused. Staff actively supports service users to be independent and be involved in all areas of daily living in the home. They take responsibilities for household chores, these include keeping their rooms clean and tidy, doing laundry, assisting with preparation of meals. The inspector observed that the majority of service users were absent from the home when the inspection started; they were attending work college and external centres. When they returned they spoke about where they attended and indicated that they had varied opportunities to develop and maintain social, emotional, communication and independent living skills. The service has a strong ethos and focuses on involving service users in all areas of their life, and actively promotes the rights of individuals to make informed choices, providing links to specialist support when needed. Userfriendly posters on advocacy services in the community are displayed on the notice board. There is evidence that staff support service users in developing personal and family relationships. The rapport observed between service users and staff is good. Service users spoke with support staff about a range of issues including developing family ands personal relationships. Records viewed show that that service users are supported to attend appointments with doctors and consultants as well as attending frequent check ups. Staff are aware of the medical conditions of service users, they keep these closely monitored. For one service user the follow up appointment with a consultant was spoken of. Potential complications or problems in emotional or physical health are identified early and prompt referrals are made as appropriate to specialists. One service user is of retirement age. She has lived with a number of the service users for many years and now enjoys taking life a little slower. She enjoys doing chores in the home and is involved in shopping locally; she is not as interested in pursuing activities outside the home. Service users choose the meals they like and are encouraged to eat healthy options. They also assist in the selection and purchasing of food. During the inspection support workers and service users returned from the shops with provisions for the home. A number of service users have received training in food hygiene and on the importance of correct storage of perishable food, which helps them achieve their goal of moving towards independence. The inspector observed how this training is reflected. Service users demonstrated that they store food appropriately when they return from shopping; they also label packages when they first open them. They are consulted on choices and because of the size of the home are able to choose a different option at short notice. Service users said that they enjoy DS0000022773.V328654.R01.S.doc Version 5.2 Page 14 meals, it gives them a chance to get together and engage freely with each other, discussing events of the day. Records are maintained of food intake. DS0000022773.V328654.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 21 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A holistic approach is adopted with service users receiving personal support in the way they desire; social educational religious and cultural values are respected. Services delivered are flexible, reliable and consistent. There are effective systems in place to monitor the emotional and physical healthcare needs of service users. EVIDENCE: Service users receive support and assistance with personal support from staff of the same gender. The inspector heard of the innovative ways that staff support service users safely in a way that promotes dignity. One service user at risk of seizures likes to bath independently. Staff support the service user in the appropriate manner respecting her privacy and dignity. The home has ensured that the healthcare needs of service users are met by the implementing of suitable systems. Service users are encouraged and supported to manage their healthcare needs. Systems are in place that enables this. Health action plans recommended by the local authority are completed for service users. Two of these were case tracked. Records were held of appointments and of outcomes. Service users keep a copy of these in DS0000022773.V328654.R01.S.doc Version 5.2 Page 16 bedrooms and are encouraged to keep track of appointments and when future checks are due. Staff at the home monitors the physical and emotional health of service users effectively, examples were seen of triggers identified by staff and of urgent appointments with GP or other specialists. It was also found that management are vigilant about health needs and make sure full and satisfactory information on service user’s health is received prior to admission. The home has developed efficient medication policy, procedure and practice guidance. MAR sheets examined (two) had signatures on each occasion that acknowledged medication was administered. Daily counts with records held are made by two staff to check that correct amount of medication is available. All medicines received and returned to the pharmacist are acknowledged. Staff are trained in the administration of medication. Records viewed provided evidence of regular medication reviews with the GP. Relatives spoken to by telephone find that communication at the home is excellent, staff are particularly good at keeping them notified of any changes in service users’ conditions and of the outcome of consultations with any professionals externally. It was found that the vigilance of staff has resulted in a positive outcome for a newly admitted service user recently. Prior to admission a service user in addition to that prescribed by her GP had been given homely remedies that could interact with the prescribed medicine. Also too very large quantities of prescribed medication had been received by staff when the service user was admitted. An appointment was made by staff for a consultation with the new GP practice. In the meanwhile a temporary MAR sheet was completed to record all the prescribed medication administered. The registered manager is making arrangements to return the excess medication. It is recommended that consideration is given to further developing medication procedures that make arrangements for safeguarding service users newly admitted. None of the service users are currently assessed as competent at self-administering medicines; consideration should be given to encouraging and promoting service users to develop the skills to self medicate. A recommendation is made. As service users age they like to remain at the home they are familiar with and live among friends. One service user is now in the older age group and is not so keen on frequenting as many activities in the community She enjoys her lifestyle at the home. As the issue of ageing becomes more relevant to more service users the home should make preparations for this. The registered manager has completed training in dementia care and further training is planned for three staff team. Further consideration should be given to developing policies and procedures around ageing and preparing the staff team for this change. DS0000022773.V328654.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An effective complaints procedure operates, service users are confident at expressing their views and making suggestions. They know that their views are listened to carefully and influence decisions taken in the home. Staff are skilled and experienced and know the measures necessary to safeguard service users from abuse EVIDENCE: Service users said that they feel able to express their views or concerns. The inspector observed how much service users were at ease when speaking to staff. There was a strong indication based on talking to all eight service users that they are aware of and know how to make complaints or suggestions regarding the services. A copy of the complaints procedure is displayed on the notice board. There is also a copy of the complaints procedure supplied in service users’ room alongside the contracts of terms and conditions. An open culture is fostered where service users feel safe and supported to share any concerns in relation to their protection and safety. Examples of this confidence was seen as a service user spoke several times to staff about her attendance at an event that evening, staff were observed listening and reassuring her about using safe transport arrangements to get back home later. Staff show that they listen carefully and pick up on areas where a service user displays worries or concerns. The organisation ensures by training, supervision, review and quality monitoring that care staff fully comply with the policies and procedures DS0000022773.V328654.R01.S.doc Version 5.2 Page 18 provided in relation to protecting and safeguarding the rights of service users. The views and experiences of service users are valued and respected. Staff receive training on safeguarding vulnerable adults as part of the induction process. In 2006 staff received further training in POVA, also on the appropriate investigation process needed. From conversations with support staff it was demonstrated that they are knowledgeable about to safeguard service users, staff are also familiar with local authority adult protection procedures. A recently revised policy document makes it clear to staff that an internal investigation into any issue arising under AP must not be commenced unless it has been agreed with the Safeguarding Adults Coordinator of the local authority. DS0000022773.V328654.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 27 28 29 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users enjoy living in a small group setting. The environment is comfortable homely and safe. EVIDENCE: Service users are encouraged to regard this as their home; the feedback received confirmed that this is how service users view it. The home is beautifully maintained and service users are proud to live there. All service users expressed the pleasure they get from living in a homely pleasant environment. A pleasant garden is located to the rear of the house. The home is designed to provide small group living for service users to achieve maximum independence in a discrete non- institutional environment. There is a selection of communal areas, a spacious lounge and conservatory and dining room, this means that service users have a choice of place to sit quietly, meet with family and friends or be actively engaged with other service users. Service users are fully involved in decisions about the décor and any changes to the accommodation. An efficient maintenance programme maintains the DS0000022773.V328654.R01.S.doc Version 5.2 Page 20 high standard of the environment. Repairs are attended to promptly and improvements are ongoing. A number of improvements have taken place since the last inspection. These include redecoration to the lounge, dining room and a number of bedrooms. One wall in the lounge experienced a damp problem and is being attended to by maintenance. The staff office has been relocated to a small conservatory area at the rear. The office used previously is now used as a bedroom for night sleepover staff. Bedrooms are single occupancy, comfortable and spacious, four of these were viewed. All contain wash basins. Toilets (four) and bathrooms (two) are located conveniently to rooms. None of the service users have difficulty with accessing the areas currently. The manager spoke of plans to convert one of the bathrooms into a shower, as the majority of service users prefer to use showers. The home is not fully wheelchair accessible, except for the ground floor. Consideration should be given to how the home plans to make provision for disability access in the future. Service users choose the décor and have items around them that they like. A newly admitted service user is pleased with her bedroom; she had taken a number of personal item including family photos with her and is happy to display them. The home is clean throughout. It is good to see that service users are encouraged to maintain high standards of hygiene. They have developed good skills in this area as they take responsibility for household chores; they also take part in food hygiene training. Hand washing facilities are good, additional washbasin supplied in the kitchen for service users and staff to use. The design and layout of the kitchen and laundry enable and promote the involvement of service users in domestic tasks and as part of developing and maintaining self-help skills. DS0000022773.V328654.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 34 35 36 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Service users benefit from receiving support and care from a dedicated staff team that are consistently reliable, are experienced and skilled and where good practice is promoted. EVIDENCE: The service is highly selective, with the recruitment of the right person for the job. The retention of support workers is good; this also demonstrates that staff enjoy working with the organisation where the ethos of caring is fostered. Service users are involved in the recruitment process. Two new bank support workers have been engaged since the last inspection. Recruitment files were viewed for four staff including those for two of the new staff. Application forms were fully completed, for recently recruited staff members appropriate checks had been made with CRB and POVA. For a long standing staff member a CRB check was made prior to the introduction of POVA. A recommendation is made regarding POVA checks for staff employed prior to the availability of POVA checklist. Staff files had two references. Although the organisation had received references from previous employers that corresponded with employment history these had not been stamped to demonstrate authenticity. A recommendation is made in regard to references. DS0000022773.V328654.R01.S.doc Version 5.2 Page 22 The permanent staff team is stable and has not experienced many changes to personnel. Five permanent support workers are employed as well as the manager. Four bank support workers are regularly employed as part of the team. The home places strong emphasis on training and developing the staff team and has effective systems in place to achieve this. The organisation has an induction and foundation programme in which all new staff participates. Records were seen of training and development completed by support staff in the past year. The records demonstrate that staff are up to date in all mandatory training and on issues affecting and relating to service users. It is recommended that a training matrix is developed to keep track of the support and development of each support worker. Two support workers spoken to find that there is good provision made to train and support staff, they enjoying working at the home. The manager completed a project to investigate how diversity issues were addressed with the staff team. She identified that this was an area that needed further development within the staff team. As a result she described the plans in place to respond to this area of development. The manager recognises the importance of development and of the necessity to constantly strive for improvements, one of the areas she is most passionate about is giving staff all the opportunities necessary to develop their potential by ongoing training. Staffing levels reflect the needs of service users, and rotas are flexible to fit around the lifestyles of individuals and enable any additional support for attending activities outside the home and in particular busy periods. The registered manager spoke of contingency plans if circumstances should change. She described how additional staff would be available especially at night if the condition of a service user necessitated this additional support. Key workers are allocated time to work specifically with individuals, enabling appropriate relationships to be formed. Evidence was seen of staff effectively communicating with service users, it was clear that they knew the individuals very well. Staff are supported and supervised. Regular staff meetings are held to discuss practice, development and training; minutes are kept of all these meetings. Records seen of one to one supervision show that is consistent and regular. Staff confirmed that this is what assists them in their role. DS0000022773.V328654.R01.S.doc Version 5.2 Page 23 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 38 39 41 42 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. This service operates a service that has a spirit of openness and respect. It is run in the best interests of service users and their opinions really matter. The good practice promoted leaves service users and members of staff feeling valued and appreciated. The health and welfare of service users and staff is safeguarded by sound effective health and safety management procedures. EVIDENCE: Management changes have taken place, the new registered manager is in post over ten months, and she is highly regarded by service users and staff. The changes took place when the previous manager retired. The new manager has brought a fresh approach and continued to emphasise the importance of a service user led service. Service users like the fact that she is encouraging and supportive. She is forward thinking and is keen on individuals progressing DS0000022773.V328654.R01.S.doc Version 5.2 Page 24 further. Particular attention is given to enabling better outcomes for individuals. The manager is visionary in her approach to the service and communicates a clear sense of direction. She has the experience and ability and is highly competent in a range of areas. These include good practice areas, current legislation and proposed developments, equal opportunity and diversity issues. Staff see her as an excellent role model. She exudes enthusiasm and is effervescent in her approach to moving the service forward. She is currently undertaking the RMA. A quality assurance system has been developed by the organisation for the home. The most recent report of the quality audit conducted was viewed. This showed that the system used is effective, the views of service users as well the outcome for individuals is incorporated into the report. The process includes continuous self-monitoring that review service users and staff needs and ensure continued developments. The inspector viewed copies of policies and procedures recently reviewed and updated to reflect changes to legislation. The premises is maintained to safe standards with the health, safety welfare of service users and staff promoted and safeguarded. Staff are kept updated with regular training on health and safety issues. All the working practices in the home are safe and there are no preventable accidents. The home has a full range of policies and procedures to promote and protect service users’ health and safety. Staff consistently follows these. The home has a good record of meeting relevant health and safety requirements and legislation. Records are of a good standard and are routinely completed. The inspector found that service users are aware of safety arrangements and have confidence in the safe working practices of staff. There is full and clearly written recording of all safety checks and there is no evidence of a failure to comply with other legislation. The copy of a recent fire emergency plan drawn up was viewed. It was completed following thorough fire risk assessments by a dedicated health and safety representative from the organisation. Records were presented to the inspector in the pre inspection questionnaire as well as at the site visit of dates confirming that essential equipment is regularly serviced. Fire alarm tests are completed in accordance with the procedures; regular fire drills also take place. The home has very efficient systems to ensure effective safeguarding and management of individual’s money including records keeping. Service users have individual bank accounts. Cash withdrawal cards are not used. Service users have to present themselves in person at the bank for withdrawals of cash. A support worker always escorts for safety. Medium amounts of cash are held in safekeeping in a secure safe in the home to avoid unnecessary trips to the bank. The registered manager holds the key. DS0000022773.V328654.R01.S.doc Version 5.2 Page 25 Small amounts of cash are held separately for each service user for day-today expenses. The audit trail is clear, with receipts held to account for transactions. Service users have access to their records and small amounts of cash held whenever they wish. It was clear that in supporting service users to manage finances sensibly there are occasions when service users have learned and experienced the consequences for using money unwisely. The service is faultless in its role of supporting service users to manage their finances and fulfils all requirements. Service users have trust in the way the home helps them mange their money . DS0000022773.V328654.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 3 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 3 ENVIRONMENT Standard No Score 24 4 25 4 26 X 27 3 28 4 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 4 4 3 3 3 3 X DS0000022773.V328654.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. Standard Regulation Requirement Timescale for action 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 YA20 Good Practice Recommendations The registered person should ensure that medication policies and procedures are further developed; these to give consideration to making appropriate arrangements for supporting newly admitted service users with medication. The registered person should endeavour to promote more self-medication among service users, also taking into account capacity and development potential. The registered person should ensure that the needs of older service users are considered, consultation to take place with service users and outcomes to be reflected in planning for growing older. The registered person should give consideration in future planning on how it plans to address and make provision for disability access. The registered person should consider seeking POVA checks for those staff employed before this check was first available. DS0000022773.V328654.R01.S.doc Version 5.2 Page 28 2 3 YA20 YA21 4 5 YA29 YA34 6 7 YA34 YA32 The registered person should request that referees from previous employment provide a stamp on references supplied to confirm authenticity. The registered manager should ensure that staff receive training on issues and conditions that affect older people. According to plans for future training provision has been made to respond to this recommendation. The registered person should consider using a training matrix in order to identify easily training and development progress. 8 YA35 DS0000022773.V328654.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection SE London Area Office River House 1 Maidstone Road Sidcup Kent DA14 5RH 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. Extracts may not be used or reproduced without the express permission of CSCI DS0000022773.V328654.R01.S.doc Version 5.2 Page 30 - 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. 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