Care Home: 23 Fox Lane

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What the care home does well The statement of purpose clearly sets out the philosophy and objectives of the home. The home provides a statement of purpose that is specific to the individual service, and the residents who live there. One person said, "I got information about the home." People coming to live at the home have sufficient information about the home, so that they are confident their individual needs will be met. A full needs assessment is carried out to establish whether the home can meets the prospective residents needs. Admissions to the home are made onthe basis of a detailed initial assessment that make sure the needs of prospective residents can be met. Risk assessments were found to cover all areas that affected the people`s daily life. Comprehensive risk assessments are in place to ensure the safety and independence of people living at the home. People told us that they were participating in courses and activities. People who live at the home are involved in meaningful daytime activities of their own choice, according to their individual interests and capabilities. A person said, "the food is all right and they ask you what you would like to eat." A variety of meals are provided that reflect the individual preferences of people who live at the home. A person spoken to said, " If I had to complain I know they would do something about it" The home has an open culture that allows residents to express the views and concerns in a safe and understanding environment. People who live at the home told us that they could challenge and raise concerns about the way they were treated. People living in the home feel safe and well supported by an organisation that has their protection and safety as a priority. Comment cards from the people living at home and their relatives all stated that they felt the home was well decorated and provided a safe environment. People spoken to confirmed that there was enough staff to meet their needs. The service has plentiful staff available at all times to support the needs, activities and aspirations of people living at the home. People told us that they felt staff understood how to meet their needs. The home ensures that all staff receives relevant training that is focused on delivery of improved outcomes for people using the service. What has improved since the last inspection? This is the first key inspection since the service has been registered with the Commission. What the care home could do better: Two areas for improvement are identified in this report. Clear guidance needs to be provided to make sure that people`s mental health and well being is supported. The manager explained that she has not completed the registered managers award. The manager needs to have the necessary skills to manage the home in the best interests of people. CARE HOME ADULTS 18-65 23 Fox Lane 23 Fox Lane Palmers Green London N13 4AB Lead Inspector Tony Brennan Unannounced Inspection 10th April 2008 11:00 23 Fox Lane DS0000070875.V361252.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 23 Fox Lane DS0000070875.V361252.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. 23 Fox Lane DS0000070875.V361252.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 23 Fox Lane Address 23 Fox Lane Palmers Green London N13 4AB 020 8885 1000 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) enquries@cascade-care.co.uk Cascade Care Ltd Vacant Care Home 5 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (5) of places 23 Fox Lane DS0000070875.V361252.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Male whose primary care needs on admission to the home are within the following categories: 2. Mental Disorder, excluding learning disabilities of dementia - Code MD The maximum number of service users who can be accommodated is: 5 N/A Date of last inspection Brief Description of the Service: 23 Fox Lane is owned and managed by Cascade Care Ltd. Cascade Care Ltd has a number of homes in London. The home is registered to provide care and support for five men who are recovering from mental illness. The house is a five bedroomed Edwardian house on three floors. The home is located in a residential street in Palmers Green. There is a spacious garden at the rear of the home. The home is well served with local transport, shops, parks and other community facilities. 23 Fox Lane aims to enable the people recovering from mental illness to develop their independence. Fees range between £1054 and £1888 depending on the assessed needs of the person. Copies of this report are available on the Commissions website. 23 Fox Lane DS0000070875.V361252.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 2 star. This means the people who use this service experience good quality outcomes. This unannounced key inspection was undertaken as part of the annual inspection programme. This is the first key inspection since the service has been registered with the Commission. Prior to the inspection the home had completed its annual quality assurance assessment. The annual quality assurance assessment provided us with information about the home and how it was seeking to provide the best outcomes for people. We also looked at any other information we had received about the home. This included any information regarding incidents that the home had told us about. We also received comment cards from residents and professionals. The inspection took place over one day. We were assisted by Anita Nicholas, the acting manager and Marvine King, regional manager, with the inspection. Four people living at the home and one professional returned comment cards. We spoke with the three people who live at the home, and two members of staff. We observed care practice and interaction between staff and people living at the home. We toured the building and examined a number of records relating to the care, health and safety and management of the home. At the end of the inspection feedback was given to the manager, and areas for improvement were discussed. We would like to thank the staff that assisted us by answering questions about the running of the home. We would also like to thank the three people who live at the home who discussed their views of the service they receive. What the service does well: The statement of purpose clearly sets out the philosophy and objectives of the home. The home provides a statement of purpose that is specific to the individual service, and the residents who live there. One person said, “I got information about the home.” People coming to live at the home have sufficient information about the home, so that they are confident their individual needs will be met. A full needs assessment is carried out to establish whether the home can meets the prospective residents needs. Admissions to the home are made on 23 Fox Lane DS0000070875.V361252.R01.S.doc Version 5.2 Page 6 the basis of a detailed initial assessment that make sure the needs of prospective residents can be met. Risk assessments were found to cover all areas that affected the people’s daily life. Comprehensive risk assessments are in place to ensure the safety and independence of people living at the home. People told us that they were participating in courses and activities. People who live at the home are involved in meaningful daytime activities of their own choice, according to their individual interests and capabilities. A person said, “the food is all right and they ask you what you would like to eat.” A variety of meals are provided that reflect the individual preferences of people who live at the home. A person spoken to said, “ If I had to complain I know they would do something about it” The home has an open culture that allows residents to express the views and concerns in a safe and understanding environment. People who live at the home told us that they could challenge and raise concerns about the way they were treated. People living in the home feel safe and well supported by an organisation that has their protection and safety as a priority. Comment cards from the people living at home and their relatives all stated that they felt the home was well decorated and provided a safe environment. People spoken to confirmed that there was enough staff to meet their needs. The service has plentiful staff available at all times to support the needs, activities and aspirations of people living at the home. People told us that they felt staff understood how to meet their needs. The home ensures that all staff receives relevant training that is focused on delivery of improved outcomes for people using the service. What has improved since the last inspection? This is the first key inspection since the service has been registered with the Commission. 23 Fox Lane DS0000070875.V361252.R01.S.doc Version 5.2 Page 7 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. 23 Fox Lane DS0000070875.V361252.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 23 Fox Lane DS0000070875.V361252.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): 123456 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The statement of purpose is an accurate description of the service provided. People’s needs are assessed prior to admission to the home to ensure they receive the care and support required. People understand how the home will meet their needs. EVIDENCE: The statement of purpose clearly sets out the philosophy and objectives of the home. The commission has recently registered this home. As part of this process a statement of purpose was developed for this service. We found that the needs of the people case tracked were within a range of those specified in the statement of purpose. The statement of purpose also identified the skills and staffing resources that are available to meet the needs of people living at the home. The home provides a statement of purpose that is specific to the individual service, and the residents who live there. 23 Fox Lane DS0000070875.V361252.R01.S.doc Version 5.2 Page 10 The statement of purpose confirmed that staff would support people to express their religious beliefs. We discussed the issue of equalities and diversity with the manager. She demonstrated that she would respond positively to people’s diversity. As is outlined in the following outcome areas these resources generally meet the needs of people living at the home. All Comment cards received from people and their relatives confirms that they had been told about the home and what it provides. We found that a detailed service users guide is available for people. It was available in a form that was assessable to all the people living at the home. One person said, “I got information about the home. It told me what I needed to know.” The annual quality assurance assessment stated that people were informed in the service user guide of “their right to receive an antidiscriminatory service.” A person who lives in the home commented on this, “ staff are supportive and encouraging me to live a fulfilling life.” People coming to live at the home have sufficient information about the home, so that they are confident their individual needs and preferences will be met. Comment cards received from people who live at the home confirmed that they felt that their needs were understood and met. The annual quality assurance assessment highlighted that a full needs assessment is carried out to establish whether the home can meets the prospective residents needs. The manager explained that initial assessments are carried out with the involvement of the person. We found that the initial assessments for the three people case tracked were detailed. For example, the initial assessment for one person case tracked included information from medical professionals. Is outlined the person is specific forensic history. This was related to how his mental health needs affected how he chose to live. The initial assessment highlighted behavioural issues, how these were affected by substance misuse and medication compliance. Staff were able to describe how they met his needs. The person told us, “ staff understand my background.” Admissions to the home are made on the basis of a detailed initial assessment that make sure the needs of prospective residents can be met. The annual quality assurance assessment stated that people are encouraged to make daily visits and have overnight stays at the home prior to them coming to live there. The manager explained this allows staff and people living at home to develop a relationship with the new resident. A person who lives at the home said, “ I came and saw the home. They helped me by arranging regular stays until I finally moved here permanently.” Comment cards from people living at the home and relatives confirm that they had visited the home before deciding to come and live there. All three people case tracked told us that they had made a number of visits to the home before finally choosing to live there. We found there were notes of these visits, and they had been discussed as part of people’s regular care plan approach meetings. People are supported to make an informed decision about whether the home can meets their needs. 23 Fox Lane DS0000070875.V361252.R01.S.doc Version 5.2 Page 11 People living at the home told us that they had been given a contract. This had been agreed with them prior to their admission. We found that the contracts clearly outlined their rights and responsibilities. People told us staff had discussed the contract with them. The contract was written in plain English. This meant that it was assessable to people. Copies of these contracts were signed by people living at the home to show they agreed and understood them. A person told us, “ I know what to expect from the home.” People have agreed and understand how the home will meet their needs. 23 Fox Lane DS0000070875.V361252.R01.S.doc Version 5.2 Page 12 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 10 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans need to provide detailed guidance on how the needs of people are to be met. People are consulted about their preferences and how they wished to be supported. People are supported to make decisions about their lives and they know staff will maintain the confidentiality. Risks to people are assessed to ensure their safety and independence. EVIDENCE: The annual quality assurance assessment stated that people are involved in the development of their care plans with the support of their key workers. Comment cards from people living at the home showed that day felt that their needs were met. We case tracked three people and found their care plans highlighted how their needs will be met. Care plans were based on the initial assessments of people living at the home. While care plans identified how the 23 Fox Lane DS0000070875.V361252.R01.S.doc Version 5.2 Page 13 people case tracked might exhibit their mental illness. The care plans did not, however, provide detail guidance for staff to address these needs. While the care plan from one of the people case tracked stated that he would exhibit fear of particular religious practices. The care plan did not give staff ways that they might address this so as to support his well being. Clear guidance needs to be provided to make sure that people’s mental health and well being is supported. One person case tracked is Muslin he told us that staff had supported him by helping to contact the local mosque. This is recorded as part of his care plan. The registered manager explained that staff would be assisting the person living at the home by purchasing a prayer mat. He told us, “ Staff understand and support me. They have helped me to be a good Muslin.” People are supported to express their religious and cultural needs. All people living in the home had a key worker to make sure that their individual needs are met. We found that care plans had been developed with the involvement of people living at the home. One person commented, “I have agreed with the staff what support I need.” We observed that staff took time to understand people and do things in the way they had been asked. We also found that people were able to leave the home to visit the shops when they wished. Given the forensic history of the people living at the home clear guidance had been put in place about this. A person said, “ I can do what I want a loss of the time. I have agreed with the staff and a social worker that I will attend appointments and take my medication regularly to keep me well.” The home involves individuals in the planning of care that affects their lifestyle and quality of life. Risk assessments were found to cover all areas that affected the people’s daily life. Risk assessments identified the specific risk facing people. Risk assessments were detailed based on the history of previous risk-taking on the part of people living at the home. These are reflected in care plans. Risk assessments had been reviewed. Changes to the level of risk had been addressed. Staff were able to describe how they prevented risks to make sure that people were safe and were supported to exercise control over how they live. Risks relating to behavioural issues were identified. I observed that staff engaged with people in an appropriate adult way. Comprehensive risk assessments that are reviewed regularly are in place to ensure the safety and independence of people. People told us that they felt that staff kept confidential issues private. There were clear policies on how confidentiality must be maintained. Both observation and discussions with staff showed us that they were sensitive and aware of the importance of maintaining confidentiality. People told us they had seen their records and had provided information about their needs. People know that their confidentiality will be maintained at all times. 23 Fox Lane DS0000070875.V361252.R01.S.doc Version 5.2 Page 14 23 Fox Lane DS0000070875.V361252.R01.S.doc Version 5.2 Page 15 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): 11 12 13 14 15 16 17 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are supported to engage in a range of activities that meet their needs. People have community contacts and are supported to maintain personal relationships. People are supported to have a nutritious diet that reflects their personal choice. EVIDENCE: The annual quality assurance assessment completed explained that people were encouraged to take part in a range of activities. Records showed that people are supported to find work. They told us that they were participating in courses and activities. People had been supported to make use of local facilities such as shops, libraries and mosques. The manager explained that when necessary the home has funded taxis for people to participate in activities. Staff told us they regularly assist people to plan bus routes and 23 Fox Lane DS0000070875.V361252.R01.S.doc Version 5.2 Page 16 offer to escort them to new activities. We observed two people who live in the discussed and planned a shopping trip. The member of staff accompanied them. The daily notes and care plans showed that one person has been referred to the Richmond Fellowship (a local service which provides career advice for people with mental health issues) and another attends Core Arts (an activity centre where individuals can learn to mix music and to play instruments). The manager explained that people who live at the home have been supported to contact Enfield Drug and Alcohol Service (they provide complimentary therapies such as acupuncture). People spoken to gave examples of activities. These included going for walks, visiting local places of interest and going to the local café. One person said, “I like going to the park.” People spoken to told us that they had been consulted and could choose from a range of activities. People who live at the home are involved in meaningful daytime activities of their own choice, according to their individual interests and capabilities. Daily notes and care plans confirmed that people were regularly involved in activities both in and outside of the home. This included household tasks such as shopping, washing and general cleaning. One of the people we spoke to told me he had also been cooking meals with the support of staff. We observed people cleaning their bedrooms and emptying the bins. People who use the service are involved in the domestic routines of the home to further develop their daily living skills. The annual quality assurance assessment confirmed, People were enabled to develop contacts in the local community. Daily records showed that people were supported to maintain contacts with family and friends. A person spoken to confirmed that he regularly went and visited members of his family. The manager explained that staff had maintained close contact by telephone and by visits to the home, with a resident’s mother who required support and reassurance. People who use the service have an opportunity to develop and maintain important personal and family relationships. The menu is prepared at a weekly meeting of people. We saw minutes of these meetings that confirmed people’s suggestions for meals were recorded. People spoken to confirmed that they had been involved in preparing the menu. We found that the menu is varied and reflected the cultural and dietary needs of individuals. A person said, “the food is all right and they ask you what you would like to eat.” We observed that people were able to have a hot drink when they wish. A variety of meals are provided that reflect the individual preferences of people who live at the home. 23 Fox Lane DS0000070875.V361252.R01.S.doc Version 5.2 Page 17 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 People who use this service experience good outcomes in this area. This judgement has been made using available evidence, including a visit to this service. People are supported with their personal care needs to maintain their independence. People are able to access the medical care they need. People are not protected by safe procedures for handling medication. EVIDENCE: Care plans outlined the support people require to maintain their independence in doing their personal care. We spoke with people who explained that staff provided support and encouragement to maintain their personal hygiene. The annual quality assurance assessment stated, “Service users are supported in their personal hygiene where necessary.” Staff explained that they remind and encourage people if they need to support with their personal care. Comment cards from people were all positive about the care provided by the home. Staff were able to explain the personal support needs of people living 23 Fox Lane DS0000070875.V361252.R01.S.doc Version 5.2 Page 18 at the home. One person told us, “ Staff treat me very well and are supportive.” Personal support is responsive to the varied individual needs and preferences of people who live at the home Medical needs had been identified as part of the initial assessment and were referred to in care plans and risk assessments. Daily notes recorded that people had access to the opticians, dentists and chiropodists. Records showed that mental health professionals made regular visits to people. There were records of regular meetings with health professionals and people who live at the home. People told us that they were involved in how their mental health and well being is maintained. People said they had been consulted about end of life issues. We found this was recorded in their care plans. People are supported to access the healthcare they need. Peoples health needs are addressed to ensure their well being. We found that records for the administration of medication were complete. Records of medication received and returned were also complete. People told us that they had agreed to medication being administered by staff. This was recorded in their care plans. Two people at the home are currently selfmedicating. We found that they have a secure lockable cabinet in their bedrooms to hold their medication. We case tracked these people and found this was referred to in their care plan and a risk assessment has been completed. While the care plan referred to the fact that there may be possible side effects with the medication that these people are taking. It did not give examples or explain what the side effects were. Guidance is to be provided on the possible side effects of medication to ensure the safety and well being of people. There is clear guidance on the use of medication as part of managing peoples challenging behaviour. This outlined when it was appropriate to use this medication. It clearly stated the types of behaviour that would indicate when it was appropriate to use medication. Medication is only used to manage peoples behaviour when it is clearly required to meet their needs. Daily notes showed that health professionals had been consulted to ensure that people were receiving the medicines they needed. Training records and discussions with staff confirmed they had training on the safe administration of medicines. Staff that are properly trained to ensure the safety of people administers medication. 23 Fox Lane DS0000070875.V361252.R01.S.doc Version 5.2 Page 19 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 this service experience good outcomes in this area. This judgement has been made using available evidence, including a visit to this service. People can be confident that their complaints are listened to and acted upon. Adult protection procedures protect people from abuse. EVIDENCE: Comment cards from people confirmed that they knew who to speak to if they were unhappy about the home. The complaints policy explained how to make a complaint and how it would be dealt with. Copies of the complaints policy were available around the home for people to consult. People told us they had been given a copy of the complaints policy. They said that as part of the regular house meetings issues are discussed and resolved. Staff explained that people are encouraged to discuss their views of the service. A person spoken to said, “ If I had to complain I know they would do something about it” The home has an open culture that allows residents to express the views and concerns in a safe and understanding environment. People who live at the home told us that they could challenge and raise concerns about the way they were treated. We observed how staff approach people. This was done appropriately and sensitively. There were policies on handling abuse and adult protection. Training records showed that all staff had 23 Fox Lane DS0000070875.V361252.R01.S.doc Version 5.2 Page 20 received training in adult protection. We spoke with staff and they demonstrated their understanding of adult protection issues. There have been no adult protection issues since the registration of the home. People living in the home feel safe and well supported by an organisation that has their protection and safety as a priority. 23 Fox Lane DS0000070875.V361252.R01.S.doc Version 5.2 Page 21 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 this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live in the home are always provided with a safe and homely environment that is personalise to meet their needs. The home is clean and hygienic. EVIDENCE: The house is a five bedroomed Edwardian house on three floors. The home is located in a residential street in Palmers Green. There is a spacious garden at the rear of the home. The home is well served with local transport, shops, parks and other community facilities. The house has a fairly large garden with chairs and tables where residents can go out and relax in the summer. The dining area is spacious and staff and residents often eat together. There is a 23 Fox Lane DS0000070875.V361252.R01.S.doc Version 5.2 Page 22 spacious modern kitchen for the use people. The home’s environment meets people’s needs and aspirations. Comment cards from people and their relatives all stated that they felt the home was well decorated and provided a safe environment. Three bedrooms, one on the ground and two on the second floor, have en suite facilities. These consist of a bath with shower attachment, toilets and washbasin. On the second floor there is a bathroom and separate toilet for the person whose bedroom does not have an en suite. People told us that the provision of bathrooms and toilets met their needs. People spoken to were pleased with their bedrooms. They had chosen items of furniture for their rooms. People are encouraged to personalise their bedrooms. We observed that people’s bedrooms have been decorated and furnished in ways that reflected their personal preferences. Appropriate measures are in place to prevent cross infection. The home has detailed policies on the prevention of cross infection. The annual quality assurance assessment stated that staff had training on infection control. We found that training records confirm this. Staff spoken to understood how to work to minimise the possibility of cross infection. Staff confirmed that they had access to disposable gloves and aprons. Liquid soap and paper towels were available throughout the home. A proactive infection control policy makes sure that the risk of infection for people is minimised. 23 Fox Lane DS0000070875.V361252.R01.S.doc Version 5.2 Page 23 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): 31 32 33 34 35 36 People who use this service experience good outcomes in this area. This judgement has been made using available evidence, including a visit to this service. Sufficient staff, with the necessary skills and support are available to meet the needs of people. People are fully protected by the home’s recruitment procedures. EVIDENCE: We found that the rota showed that a consistent staffing level was maintained. The manager explained that two staff are on duty at all times. The manager explained this would be kept under continuous review to make sure that there are always sufficient staff to meet peoples needs. People spoken to confirmed that there was enough staff to meet their needs. Daily notes showed that staff was on duty to provide escorts to appointments. Support with activities was also available. Staff spoken to told me that they felt sufficient staff were available to support peoples needs. Sufficient staff are provided at busy times of the day and to meet the changing needs of 23 Fox Lane DS0000070875.V361252.R01.S.doc Version 5.2 Page 24 people. The service has plentiful staff available at all times to support the needs, activities and aspirations of people living at the home. New staff are given a full induction. Records were available to confirm that staff had been on the necessary induction training. All areas of statutory require training had been provided. Discussions with staff showed that they had a detailed knowledge of mental health needs of people. Records showed that training had been provided on mental health issues. These areas were discussed with the registered manager who agreed to ensure the appropriate training was put in place. People are supported by staff that have the necessary skills to understand and meet their needs. Training records showed that 57 of staff has either level 2 or 3 in the National Vocational Qualification in care. Staff have a variety of qualifications including psychology degrees and counselling. People told us that they felt staff understood how to meet their needs. Staff have relevant experience in mental health or in care. The home ensures that all staff receives relevant training that is focused on delivery of improved outcomes for people using the service. We have looked at three staff files. These contained all the necessary documentation to ensure that the member of staff was safe to work with vulnerable people. This showed that the home followed a clear procedure. The manager explained that residents would be involved in the recruitment of new staff. The staff group reflect the cultural backgrounds of people. People living in the home said they felt that staff could be trusted. Robust recruitment procedures are followed to ensure the safety and well-being of people. Staff spoken to explained that they had received regular supervision from the manager. They told us this helps them to understand and meet the needs of people. We found supervision records showed that staff were supported to understand and improve outcomes for people living in the home. The manager explained that appraisals are carried out with staff every three months. Records of these appraisals showed us that they were focused on ensuring that staff had the necessary skills to meet peoples needs. Staff are supported so that they are able to meet the needs of people. 23 Fox Lane DS0000070875.V361252.R01.S.doc Version 5.2 Page 25 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 40 41 42 43 People who use this service experience good outcomes in this area. This judgement has been made using available evidence, including a visit to this service. Effective management systems are in place to make sure that people’s will being and safety is promoted. People’s views of the service are sought and used as the basis for improvement. People who live at home and staff’s health and safety is always promoted and safeguarded. EVIDENCE: Since the home has registered with the Commission the registered manager has resigned. We were told about this. Cascade care Ltd have put in appropriate management cover. This consists of a manager, Anita Nicholas, who has extensive experience and understanding of people with mental health needs. The manager explained that she has completed NVQ level 3 and has 23 Fox Lane DS0000070875.V361252.R01.S.doc Version 5.2 Page 26 had training on a range of mental health topics. She explained that she has not started the registered managers award. As this is needed as part of her development as a manager and her registration with the Commission it is recommended that she complete the registered managers award. The manager needs to have the necessary skills to manage the home in the best interests of people. The manager explained that she is reviewing all systems and practices in the home. An assistant manager who has been at the home since it was registered with the commission supports the manager. Assistant manager was able to show us that she had clear understanding of how the home was managed to meet the needs of people. People who live at the home and staff felt that the manager was approachable. They told me that the manager understood their needs. The manager has the required qualification and experience, to run the home to ensure the best outcomes for people. As part of the registration process Cascade care Ltd had to show that it had the financial management systems in place to maintain viability of the home. The manager and regional manager both explained how finances are managed. There are appropriate accounting procedures in place to make sure that the homes resources are used in the best interests of people. The home has the necessary insurance cover. We saw that there were insurance certificates to confirm this. Financial systems make sure that the home’s resources are used in the best interests of people. A system is in place to monitor the quality of the service provided by the home. The explained that she carries out quality monitoring on a regular basis. People are consulted about how the home is run. Minutes were seen of meetings held with people to discuss the quality of the service provided. People said that they are encouraged to discuss their views of the service. Action to improve the service had been agreed with people who live at the home. Theres a strong emphasis on being open and transparent in all areas of the running of the home. All the procedures and policies were found to be in place. The only exception to this was the policy on the handling of control medications this has been discussed in the relevant outcome area. The manager explained that policies are regularly reviewed. This was highlighted in the annual quality assurance assessment that showed that policies had been reviewed. The home has the necessary records in place. People told us they had seen their records and where appropriate had been involved in providing information on their needs. The manager explained that important changes in peoples records were discussed with them. The registered manager ensures that the safety risks to people living at the home and staff are identified. Measures are put in place to provide a safe living and working environment. Records showed that fire equipment was 23 Fox Lane DS0000070875.V361252.R01.S.doc Version 5.2 Page 27 tested regularly and maintained. Drills were taking place. The fire risk assessment provides details of potential risks of fire. All health and safety policies were available. Certificates for gas and electrical testing were in date. COSHH guidance is in place and chemicals were stored safely. People living at the home are aware of safety arrangements and have confidence in the safe working practices of staff. 23 Fox Lane DS0000070875.V361252.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 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 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 3 3 3 3 3 23 Fox Lane DS0000070875.V361252.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? N/A 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 YA6 Regulation 15(1) Requirement The registered persons must make sure that care plans give staff guidance on how they should meet people’s mental health needs. Clear guidance needs to be provided to make sure that people’s mental health and well being is supported. Timescale for action 30/05/08 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 YA37 Good Practice Recommendations The registered persons should make sure that the manager completes registered managers award. The manager needs to have the necessary skills to manage the home in the best interests of people. 23 Fox Lane DS0000070875.V361252.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection London Regional Contact Team Caledonia House 223 Pentonville Road London N1 9NG 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 23 Fox Lane DS0000070875.V361252.R01.S.doc Version 5.2 Page 31 - 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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