Care Home: 72 Croydon Road

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Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 72 Croydon Road 72 Croydon Road Beddington Surrey CR0 4PB     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lee Willis     Date: 2 5 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 37 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 37 Information about the care home Name of care home: Address: 72 Croydon Road 72 Croydon Road Beddington Surrey CR0 4PB 02086865693 TBA kdaaku@cmg-icingoperations.co.uk www.caremanagementgroup.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Care Management Group Ltd care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category of service only: Care Home Only (CRH - PC); to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Date of last inspection Brief description of the care home 72, Croydon Road is owned and managed by CMG a specialist provider of services for people with learning disabilities. This service is registered with us to provide residential accommodation and personal support for up to six generally younger adults (i.e. under 40 years of age) of either gender with Autistic Spectrum Disorders and/or behaviours that challenge. There are currently three males and one female using the service. Margaret Mohammed has been in operational day-to-day control of 72, Croydon Road since being appointed its new acting manager in May 2008. The house is Care Homes for Adults (18-65 years) Page 4 of 37 Over 65 0 6 Brief description of the care home located conveniently close to a local park (Waddon Ponds), and also is within a relatively short distance of the Valley Park and the Purley Way shopping and leisure complexes. The service has its own transportation and is within easy walking distance of several main line bus routes and Waddon train station, which all have good links to central Croydon, Sutton, and London. This large detached property comprises of six single occupancy bedrooms all with en-suite toilet and bathing/shower facilities. Communal areas include a recently refurbished open plan lounge/dinning area, a new sensory room, newly fitted kitchen, a new outside laundry room, entrance hall, and ground floor office. There is a well maintained garden at the rear of the property which contains all manner of well established trees, shrubs, and a large lawn. The home has developed clear information to help people who use the service and their representatives to understand what facilities and services are provided. CMG currently charges between GBP1,517.31 to GBP1,804.75 per week for these services. Care Homes for Adults (18-65 years) Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The outcomes the people who live at 72, Croydon Road experience has significantly improved since the services last Key inspection. Consequently, we have increased its rating from a 2 to a 3 star excellent performing residential care home. From all the available evidence gathered during the inspection process it was evident this service now has a substantial number of strengths and where areas for improvement emerge the new management team recognise them and manage them well. The service is committed to developing innovative approaches to delivering good quality care. We spent 6 hours at the service spread over two days. During these site visits we spoke with three people who currently live at 72, Croydon Road, the new acting manager and her deputy, and three support workers. We also looked at various records and documents including, the care and health action plans for two people who use the service. On the second day of the inspection we were invited to join a number Care Homes for Adults (18-65 years) Page 6 of 37 of the people who use the service and several members of staff for lunch. The remainder of the visit was spent during the premises and the grounds. Finally, the new acting manager completed and returned our Annual Quality Assurance Assessment (AQAA) when we asked for it. This self-assessment document tells what the providers think they do well, what has improved since the homes last inspection, and what the manager thinks they could do better. What the care home does well: What has improved since the last inspection? The appointment of a new acting manager and her deputy in May 2008 has been the single most significant change at the home since its last Key inspection. In a relatively short period of time (i.e. 10 months) the new management team has significantly improved the service. The acting manager has a very clear vision about how she intends to continue making things better for the people who live at 72, Croydon Road now and in the future. All the requirements and good practise recommendations made in the homes previous inspection report have been managed well within the prescribed timescales for action. As required - the services Guide has been revised to include all the information the people who use the service need to know about their home; a copy of the London Borough of Suttons safeguarding protocols for vulnerable adults has been obtained and is available from the office; sufficient numbers of staff have now up dated their basic food hygiene training; and all the shortfalls relating to the services environment have all been addressed including; the fitting of electromagnetic door holders in the lounge, the replacing of frosted glazing in the sensory room with ordinary glass, staff lockers, the fitting of new kitchen units and work-surfaces; uneven patio slabs in the rear garden levelled, and the creation of a new laundry room. Staff know and record the preferred communication style of all the people who use the service, and use innovative methods to enable everyone to be continually consulted about how their home is run. For example, the service uses: pictorial menus; easy read Guides; staff photographs; communication passports in care plans; One to one interaction and keyworker sessions; Visual activity timetables, and symbol cards. Care Homes for Adults (18-65 years) Page 8 of 37 These initiatives are all overseen by the deputy manager who has been designated the services new communications champion. These developments have ensured all the information available to the people who use the service is far more accessible, meaningful, and interesting. The services arrangements for enabling the people who use the service to take greater control of their lives has also improved in the past year. Staff have more of a can do attitude toward supporting the people who use the service to take responsible risks in order to help individuals lead the life they want. e.g. Within appropriate risk framework people who are willing to do more for themselves are actively encouraged and supported by staff to self medicate, go out on their own to the local shops or post a letter, and engage chores around the house - such as making hot drinks, cooking meals, and setting the dinning room tables. Since the services last key inspection the old quiet room has been converted into a well equipped sensory area; all the communal areas and several of the bedrooms have been redecorated in autism friendly colours; new ornaments and pictures hung in all the communal areas; two new tables, sofas, and curtains put in lounge; and a large trampoline erected in the rear garden. Finally, 100 of the current staff team have achieved a National Vocational Qualification Level 2 or above in care - thus ensuring all the people who work at the home have the necessary skills and knowledge to meet the needs of the people who live there. We highly commend the service for achieving this aim and exceeding National Minimum Standards in relation to staff training. What they could do better: All the positive comments made above notwithstanding the new manager openly concedes the service is far from perfect and must do better in certain areas of practise. Firstly, despite improvements made to the number of activities the people who use the service can choose to participate in both inside and outside the home (e.g. new sensory room and trampoline in the garden), the manager acknowledges people should have more opportunities to engage in more meaningful and interesting activities, especially in the wider community. Progress made by the service to achieve this aim will be assessed at its next inspection. Secondly, although we commended the service for actively encouraging people who use the service to take greater control of their own medication, the arrangements that have been put in place to minimise the risk of the individuals involved being harmed should be made clearer and fully documented. The services new laundry room must be provided with a wash hand basin comply with infection control and environmental health standards. Despite the vast majority of the current staff team being suitably trained in order for them to carry out their duties of care, insufficient numbers have yet to received CMGs new British Institute of Learning Disability (BILD) approved Preventing, Managing Challenging Behaviours (PMCB) training. We also recommend as a good practise measure more staff receive Makaton sign language training, which has been specifically Care Homes for Adults (18-65 years) Page 9 of 37 designed to enable people to communicate more effectively with individuals who are non-verbal. Finally, although the people who work at the service are in the main well supervised, there remains scope to improve the frequency of the one to one sessions staff attend with senior members and the way the outcome of these meetings are recorded. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 37 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comprehensive Statement of Purpose which ensures that all necessary information about the service is available both for people who use the service and others enquiring about the home. Prospective users of the service can be confident that they will have the opportunity to find out about the home through planned visits and a thorough assessment of their needs and wishes to enable individuals to make informed decisions about whether or not the placement is appropriate for them. Evidence: As required in the last inspection report the services Guide had been reviewed in the past year and up dated accordingly to reflect all the information people who live at 72 Croydon Road need to know about their home. The acting manager told us it was custom and practise to review the services Statement of Purpose and Guide every six Care Homes for Adults (18-65 years) Page 12 of 37 Evidence: months to ensure these documents always accurately reflected any changes in provision. The manager showed us an easy read version of the Guide which contained a variety of coloured photographs and pictures. A person who lives at 72 Croydon Road told us they had seen the new Guide and thought the pictures were nice, but had decided not to keep their own copy in their bedroom. The manager demonstrated an excellent understanding of what constituted best practise regarding the admissions process and was able to provide us with two good examples of how the service had dealt with a couple of referrals they had recently received. In line with recommended good practise both the manager and another experienced senior of staff had both visited the two prospective service users in their own homes and carried out a comprehensive assessment of their needs and wishes. In each case the manager had also obtained a copy of the prospective new service users care management assessment undertaken by the relevant funding authority. The manager told us that although she works closely with senior managers from CMGs own assessment team the final decision regarding whether to accept or decline a new referral lies with her. The manager confirmed that she had not accepted the first of the aforementioned referrals on the grounds that the needs of this individual were far too challenging and as a consequence would not have been compatible with the others already residing at 72 Croydon Road, which we commended her for. The second referral is still on going and the manager confirmed that in line with best practise it was customary for prospective service users and their representatives to visit the home and stay for short periods pf time before any decision about moving in is taken. Finally, it was positively noted that the manager had enabled the parents of a prospective service user to be fully involved in the admissions process by getting staff who could communicate with them in their first language involved in the admission process from the beginning. Care Homes for Adults (18-65 years) Page 13 of 37 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience excellent quality outcomes in this area. We have made this judgement using arrange of evidence, including a visit to this service. The homes approach to care planning is person centred and focuses on individuals unique strengths and personal preferences. The plans also set out in detail how peoples current requirements and aspirations will be met through positive individualised support. The service has a much more can do attitude to responsible risk taking, which are being managed more positively in order to help the people who use the service lead the life they want. People who use the service now have more opportunities to maintain and development their independent living skills and participate in the day to day running of their home. Finally, the communication arrangements that the service has in place have significantly improved since the appointment of the new management team who has ensured the people who use the service have far more opportunities to be consulted Care Homes for Adults (18-65 years) Page 14 of 37 Judgement: about how their home is run, as well as make informed decisions about how they live their lives. Evidence: We looked at two care plans in depth. Both plans were person centred and set out in great detail how these individuals current personal, social, and health care needs were being met through positive interventions, and what their unique strengths and preferences were. Both plans had been reviewed in the past six months and up dated accordingly to reflect any changes in provision. The manager told us that in line with best practise the people who use the service, their relatives, professional representatives (i.e. care manager), and keyworkers are always invited to participate in care plan reviews. The manager told us that 50 of the peole who currently use the service had Autistic Spectrum Disorder and that CMG were planning to fill the remaining places with individuals with similar needs. As part of this process a professional representing the National Autistic Society who visited the home in March 2008 wrote in the visitors book that the service was very person centred and autism friendly.Improvements made to the service since it was last inspected to make it more autism friendly included autism training for the vast majority of the staff team, information regarding good autism practise made more available to staff in the form of guides, research and more detailed care plans, the creation of a new sensory room, better colour scheme awareness in terms of the overall decor of the home, and the introduction of better communication tools (See below). Both care plans inspected set out clearly details of these individuals specialist communication needs and what suport staff were required to provide them in order to meet these needs. The relatively new deputy manager is the services communication champion and since their arrival they have introduced a range of communication initiatives to improve the lives of the people who use the service. This includes several information boards conspicuously displayed throughout the home which are used to pin up photographs of all the staff who are on duty each shift, and what meals choices are available from the planned menu that day. The deputy manager also told us staff now use a variety of different communication tools including widget symbols and a specialist audio machine to enable the peole who use the service greater freedom to choose what activities they participate in each day, and where they go on holiday - for example. Two suport workers have received Makaton training and we recommend the rest of the current staff team also attend a similar or another suitable communication course. Care Homes for Adults (18-65 years) Page 15 of 37 Evidence: In addition to these arrangements, document evidence was provided on request that indicated that the peole who use the service are actively encouraged and supported to help staff plan the menus and have one to one sessions with their designated keyworkers each month. Minutes of these sessions are kept by keyworkers, but the manager conceded record in this are is somewhat variable. We recommend this is improved. Finally, a person who uses the service told us they often sit on interview panels for new staff and can ask them questions. The service is highly commended for all the good practise improvements it has made in the areas autism and communication since it was last inspected. Comprehensive sets of risk assessments were contained in the two care plans being case tracked, which covered every aspects of these individuals personal, social, and health care lives. The manager demonstrated she had a positive attitude toward supporting the people who used the service to take responsible risks and do as much for themselves as they were willing and able too. For example, the manager told us in the past six months one person who uses the service is now actively encouraged to post their own letters with minimal staff suport and another individual now goes out to the local shops unaccompanied. One person who uses the service told us they liked living at 72 Croydon Road because they were allowed to do things for themselves, like cooking their own meals and going out when they wanted. This individual also told us they had been given a key to their bedroom. throughout the course of this two day inspection two people who use the service were observed setting the table for lunch, making hot drinks and being actively encouraged to clean up after themselves. Staff also maintain more generic health and safety environmental risk assessments that cover things like the keypad device attached to the front door, numerous fire safety issues and hot water. There has been one unplanned absence by a person who uses the service in the past year. Details of the incident were clearly recorded, the individuals care plan was reviewed and up dated immediately to reflect the heightened risk, and all the relevant agencies, including the CSCI were notified about this significant event without delay. The manager told us the incident was appropriately dealt with by staff on duty at the time in accordance with CMGs missing person policy and both the police and herself were notified immediately. All the risk assessments and associated management strategies had been reviewed within the past six month and up dated accordingly to reflect any changes. As recommended in the services last report risk assessments and care plans are now Care Homes for Adults (18-65 years) Page 16 of 37 Evidence: located closer to the daily records of each individual who uses the service to ensure the best connection between the intention and reality of the day to day life at the home. Care Homes for Adults (18-65 years) Page 17 of 37 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The range of social, leisure and recreational activities the people who use the service have the opportunity to participate in both at home and in the wider community has significantly improved since the services last inspection, although the home could still do better in this area. Dietary needs and preferences are well catered ensuring the people who use the service are provided with daily variation, choice, and nutritionally well balanced meals. Evidence: During this inspection all the people who use the service were observed accessing the wider community to engage in various activities. This included attending a local day centre, visiting their GP, food shopping with staff for the week, and going out Care Homes for Adults (18-65 years) Page 18 of 37 Evidence: unaccompanied to the local shops. A person who uses the service told us there was always plenty do to at 72 Croydon Road and that they particularly enjoyed shopping for new clothes and eating out at a local fast food restaurant. Entries made in daily diaries for the two people whose care was being tracked and photographs contained in an activities book showed that some progress had been made by the new management team to improve the variety of activities the people who used the service cold choose to participate in each day, both inside and outside the home. Activities introduced since the services last inspection which are proving popular with the people who use the service include the new reflexology and massage sessions, the trampoline in the rear garden, and the new well equipped and resourced sensory room. However, all these positive comments made above notwithstanding the new management team acknowledge that there remains significant scope to continue improving the number and variety of meaningful activities the service has too offer. The manager told us she is in the process of arranging aromatherapy, music and drawing sessions for the people who use the service. Progress made to achieve this aim will be assessed at the services next inspection. One person who uses the service showed us their Freedom pass that entitles them to discounted travel on local public transport, which they told us they regularly use. The manager told us all the people who use the service had been on holiday in the past year, which had included destinations as far away as Brazil and Belgium. CMG still contribute an agreed amount to these annual holidays, which is reflected in peoples terms and conditions of occupancy. As previously mentioned in this report the families of the peole who use the service are invited to attend their loved ones care plans reviews and it was evident from comments made by all the staff met that the service has an open visitors policy. A number of the holidays people who use the service went on last year was with their relatives and not staff working at 72 Croydon Road. The manager told us the parents of the services most recent referral will be invited to visit the home and meet staff who can communicate with them in their first language as part of the admissions process. On arrival on both days of this inspection staff politely asked us to sign in using the homes visitors book in line with best practise. Typical comments made by one person who uses the service about the meals provided included, I like the food here, I cook my own food with staff everyday, I like pizza, which i can make myself, and i can help myself to fruit from the kitchen whenever i want. The service has developed planned menus which rotate every week on a monthly basis. As previously mentioned in this report the people who use the service are actively encouraged to help staff plan them every month. The manger told us the Care Homes for Adults (18-65 years) Page 19 of 37 Evidence: four weekly menus are changed at least once every six months to reflect the changing seasons. The menus sampled at random and the record maintained by staff of the actually food eaten showed us peole who use the service could choose between at least two meal options at breakfast, lunch and tea. A lot of the meals served were typically English/European in style, although curries, jolioffe rice and plantain were frequently mentioned on the menus, which reflected the culturally diverse tastes of the peole who use the service. The deputy told us in order to meet the specific religious needs of one person who uses the service staff knew they should avoid offering them pork dishes as agreed in their care plan. Pictures of the meal choices on offer each day are conspicuously displayed on an information board in the dinning area. The photographs of meals advertised for lunch on the second day of this inspection reflected the meals actually provided. Having been invited to join the people who use the service for lunch on the second day of this visit the meals served were very well presented and nutritionally well balanced. The atmosphere in the dining area during the course of the meal was extremely relaxed and congenial. We agree with the managers comments that the replacing of the large table in the dinning area with two smaller ones has enhanced the mealtime experience for the people who use the service. All food items taken out of their original packaging were found suitably labelled ,dated, and correctly stored in fridges, in accordance with basic food hygiene standards. Care Homes for Adults (18-65 years) Page 20 of 37 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience excellent quality outcomes in this area. We have made this judgement using arrange of evidence, including a visit to this service. Suitably robust arrangements are in place to ensure the people who use the service receive personal support in the way they prefer and require, and that their unique physical and emotional health care needs are continually recognised and met. People who use the use are able to take greater responsibility for managing their own medication where appropriate and are suitably protected by the services medication handling practises and policies. Evidence: Three people met who currently use the service were all suitably dressed in wellmaintained clothes that were appropriate for the time of year. One individual told us they always chose what clothes they wore each day and hairstyle. CMGs relatively new health care action plans (i.e. My health) were produced by the manager on request for the two people whose care we had decided to case track. The records set out in detail the dates and outcomes of all the appointments these Care Homes for Adults (18-65 years) Page 21 of 37 Evidence: individuals had had with various health care professionals in the past year. It was evident from entries made in the My health documents that these individual had received regular input from a number of different health care professional, including GPs, dentists, and a speech and language therapist. The manager told us that as recommended in the services previous report input had been sought from in reach psychology services twice a week and regular visits from a Community Psychiatric Nurse. During the course of this two day inspection visit staff were observed supporting people who use the service to attend appointments with their GP and a dentist. The manager told us none of the people who use the service had been involved in any major accidents since the last inspection, although one individual was admitted to hospital when staff noticed a change in their medical condition. Records kept by staff on duty at the time indicate the incident was managed in a very prompt, professional manner. No recording errors were noted on any of the medication administration records (MAR) sheets currently in use at the home. These records accurately reflected current stocks of medication held in the home on behalf of the people who use the service, including all as required PRN medication. All medicines stored in the home on behalf of the people who use the service are locked away in a metal cabinet securely attached to a wall in the office. The manager told us that since the services last inspection staff are now expected to check all medication at the end of each shift. Documentary evidence was produced on request to show that all those staff who are authorised to handle medication in the home have been suitably trained to perform this task. A representative of a well known pharmacological company regular visits the home and referred to the staffs medication handling practises as good in a recent report. In accordance with best practise the manager told us that one person who was willing and capable of taking greater responsibility for administering their own medication was being actively encouraged and supported to do so. We recommend a record of the risk framework within this individual manages their medication is developed setting out what arrangements are in place for this person to keep their medicines and how staff intend to monitor its handling. The manager confirmed that some of the people who use the service are still prescribed as required psychotropic (PRN) medication, but there use has been significantly reduced in the past year. Staff spoke with about PRN medication were very clear that it should only ever be given as a last resort and in accordance with individualised guidelines set out in services users care plans. The manager told us that Care Homes for Adults (18-65 years) Page 22 of 37 Evidence: as part of the process of trying to reduce the reliance on PRN to modify behaviours that challenge the service a GP is now involved in reviewing the use of this type of medication for one person in particular. Care Homes for Adults (18-65 years) Page 23 of 37 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes arrangements for dealing with concerns and complaints are sufficiently robust and understood by staff to ensure people who use the service feel listened too and safe. In the main the homes arrangements for ensuring the people who use the service are protected and kept safe are sufficiently robust, although more staff need to receive the providers new managing challenging behaviour training. Evidence: An easy read version of the services complaints procedures is included in the Guide and is conspicuously displayed on an information board in the lounge. One person who uses the service told us they would speak to the manager if they were not happy about anything at their home. The manager told us there has been one formal complaint made about the service in the past twelve months. Records showed the matter was taken seriously by CMG, fully investigated within a reasonable time-frame, and appropriate action to resolve this substantiated complaint to the complainants satisfaction. no incidents of a similar nature have occurred since the original complaint was made in 2008. Care Homes for Adults (18-65 years) Page 24 of 37 Evidence: The acting manager demonstrated a good understanding of what constituted a significant incident and abuse and was very clear which external agencies, including the police, the CSCI and the relevant local authorities, should be notified without delay about the occurrence of such an event. Staff have appropriately maintained records of all the significant incidents involving the people who use the service and continue to keep us informed about there occurrence. All the significant incidents that have occurred since the service was last inspected pertain to the challenging behaviour of some people who live at 72 Croydon Road. Care plans being case tracked both included specific guidelines to help staff prevent and deal with incidents of verbal and/or physical aggression. As required in the services previous report a copy of the London Borough of Suttons safeguarding adults protocols have now been obtained and were made available for inspection on request. The manager confirmed that there had been no allegations of abuse made or referral made to the Protection Of Vulnerable Adults since the services last inspection. Certificates of attendance showed that all the homes current staff team had received up to date training in recognising, preventing and reporting safeguarding issues. The manager told us no physical intervention techniques had been used by staff on people who use the service in the past year to deescalate a potentially dangerous situation. The manager was very clear that such techniques should only ever be used by suitably trained staff as a last report when all other strategies had failed. Staff guidance on the use of approved physical intervention techniques as a last resort needs to be made clearer in care plans and all those staff who have yet to receive CMGs new preventing and Managing Challenging Behaviour (PMCB) training must do so as soon as reasonably practicable. Care Homes for Adults (18-65 years) Page 25 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The interior decoration of the home, including its fixtures, and fittings, have been significantly improved since its last inspection ensuring the people who use it now have a much more homely and comfortable environment in which to live. The homes arrangements for controlling infection are in the main sufficiently robust to ensure the people who use the service live in a very clean and safe environment, although the new laundry room will need to be supplied with hand washing facilities to comply with environmental hygiene standards. Evidence: During a tour of the premises it was noted that all six outstanding requirements identified at the previous inspection been met in full. This included the fitting of an electromagnetic release device to the lounge door; the replacing of frosted glazing with ordinary glass in the new sensory room; fitting of new work-surfaces and cupboards in the kitchen; the provision of staff lockers; the levelling of patio slabs in the rear garden; and the relocation of laundry facilities to a purpose building attached to the side of the property. Other improvements made by the new manager to the Care Homes for Adults (18-65 years) Page 26 of 37 Evidence: interior decoration and furnishings of the home include; two new leather sofas, curtains and carpet in the lounge, two new tables and matching chairs in the dinning area, the conversion of the old quiet room into a well equipped sensory room, a large trampoline for the garden, and various ornaments, and pictures placed through all the communal areas. Two bedrooms, the kitchen and the majority of the communal areas have also been repainted in colours that the manager told us are autism friendly. The service has also had a new computer with Internet connection installed which has improved staffs ability to communicate within CMG and with outside agencies, including placing authorities and the CQC. The deputy told us the computer was also being extensively by staff to up date their knowledge and skills through E-learning courses. The house smelt fresh and was spotlessly clean on both days of this inspection. One person who uses the service told us the house is always kept clean and tidy. The manager told us that sufficient numbers of the current staff team had received infection control training. The new laundry room does not have any hand washing facilities prominently sited contrary to good infection control standards. Care Homes for Adults (18-65 years) Page 27 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have safe and appropriate support as there are enough competent, qualified staff on duty at all times. Peoples needs are also met because staff get all the training they need to carry out their duties effectively, although there remains scope to improve the services staff supervision arrangements. Evidence: Both the managers and the support workers who were on duty over the course of this inspection were observed interacting with all the people using the service in a very caring, respectful, and professional manner. Typical comments made by one person who uses the service included, staff are alright here - you can talk to them about anything and I like my key worker - shes nice. The manager told us that at least three members of staff, which may include herself, will be on duty throughout the day. At night the service has one waking and one sleeping in member of staff on duty. The deputy manager and a suport worker both Care Homes for Adults (18-65 years) Page 28 of 37 Evidence: told us these ratios were more than adequate to meet the needs and wishes of the people who currently reside at 72, Croydon Road. Duty rosters sampled at random showed the service has a flexible approach to planning staffing levels and will ensure an additional fourth member of staff will work on shift as and when required (i.e. to cover peak periods of activity). The ethnically diverse mix of the current staff team reflects the cultural heritage of the people who use the service. The manager told us she was very mindful of the age, gender, and ethnic mix of the people who use the service and always took this into account when recruiting new staff. In the past year the service has experienced unusually high levels of staff turnover, especially with regards its Senior members. The relatively new manager and her deputy told us they had not recruited any new staff since their arrival, but were currently recruiting to fill two staff vacancies. The new manager went on to say she believed the recruitment of good quality carers was the cornerstone of delivering good outcomes for the people who use the service and was very keen to ensure the right people for the job were employed. Staff training records revealed that CMG have exceeded National Minimum Standards by ensuring 100 of the services current staff team have achieved an National Vocational Qualification Level 2 or above in care.The new acting manager has reassessed all her staff teams knowledge and skills, and identify any gaps in their training on a training matrix. The matrix shows that in the main the existing staff team are suitably trained to perform their care work duties. As required in the services last report sufficient numbers of staff have now received basic food hygiene training. Other areas of practise staff are suitably trained in include, fire safety, moving and handling, first aid, safeguarding adults, medication, infection control and diabetes. The manager also told us that all suport workers were now expected to complete Elearning courses on the homes new computer and that three Senior members of staff had recently completed an autism course run by the National Autistic Society. Two members of staff spoken with at length told us they liked the new E-learning course, which enable them to up date their existing knowledge and skills in their own time. Supervision notes kept on the personal staff files of three individuals who were on shift that day revealed that they had each attended four to five supervision sessions with a Senior member of staff throughout 2008/09. The manager and her deputy both conceded that the holding of staff supervision sessions on a more frequent basis to comply with National Minimum Standards and CMGs own supervision procedures, and the maintaining of appropriate records regarding the outcome of these meetings was an area of practise that could be improved. The new manager also told us that no ones overall work performance had been appraised since her arrival, but was able to Care Homes for Adults (18-65 years) Page 29 of 37 Evidence: produce documentary evidence on request that showed arrangements had already been made to rectify this shortfall by the end of April 2009. Progress made to achieve the aforementioned objectives will be assessed at the services next inspection. Minutes taken at staff meetings revealed they were being held on a bi-monthly basis. The last three meetings were all well attended by staff and had covered a wide variety of relevant topics, including safeguarding issues, person centred care planning, medication handling practises, E-learning, staff rotas, and time keeping. The manager told us she has recently introduced additional staff meetings just for Senior staff. Care Homes for Adults (18-65 years) Page 30 of 37 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience excellent quality outcomes in this area. We have made this judgement using arrange of evidence, including a visit to this service. The people who use the service benefit from living in a home that is now being extremely well run by a very experienced and competent new management team. The quality assurance systems that are in place ensures the views of the people who use the service and their representatives underpin all self-monitoring and future developments of the home. Health and safety arrangements are sufficiently robust to safeguard the welfare of the people who use the service, their guests, and staff. Evidence: Margaret Mohammed, the homes new acting manager, and her deputy, have both been in operational day to day control of 72, Croydon since may 2008. It was evident from the comments made by one person who uses the service and several members Care Homes for Adults (18-65 years) Page 31 of 37 Evidence: of staff that people like the relatively new management teams leadership style. Typical comments included, i like the new manager - i would talk to her first if i was unhappy, both the managers are very approachable and work well together as a team, the new manager has certainly turned the place around - its now a much better place to work and i think the people who live here are happier and the manager is definitely firm, but is also fair. It was evident from comments made by a number of staff that the new manager is committed to ensuring her staff team take greater responsibility for running the service and as a consequence a number of staff have been delegated specific roles, including fire safety officer, and a communications champion. The services AQAA states the new manager was previously registered by us as the manager of another CMG care home and is in the process of applying to be the registered manager of 72, Croydon Road. The manager has nearly 10 years of experience working with adults with learning disabilities and is suitably qualified having achieved her registered managers award. In the past year the manager has attended CMGs own financial management training and had one formal supervision session with her line (area) manager. The manager told us she feels well supported by her deputy manager on a daily basis and her line (area) manager who is always contactable by phone to offer advice, and by other managers of CMG care homes in the area. It is custom and practise for CMG home managers who are within close proximity to one another to carry out monthly inspections of neighbouring services, which Margaret told us she believed was an extremely effective way of sharing best practise ideas and identifying poor ones. Documentary evidence in the for of Regulation 26 reports were produced on request by the manager which indicated another manager of a CMG care home in the area was continuing to carry out unannounced inspections of the 72, Croydon Road each month. In addition to these monthly reports the service has also recently received a comprehensive internal audit undertaken by CMGs relatively new quality assurance team. The outcome of the quality assurance reviews mentioned above were in the main very complimentary about the standard of care provided by the service. The manager told us all the minor shortfalls identified in these reports have been acknowledged and action taken to resolve them. The homes fire records revealed that the fire alarm system continues to be tested on a weekly basis and fire drills undertaken at regular intervals. The vast majority of the staff team and the peole who use the service had participated in at least one of the services last three fire drills. One person who uses the service and a suport worker spoken with about the services fire evacuation procedures were both very clear where Care Homes for Adults (18-65 years) Page 32 of 37 Evidence: all the homes fire exits where and fire assembly points. During a tour of the premises it was positively noted that fire safety notices were conspicuously displayed throughout the house and were available in easily understood pictorial formats. A copy of the services most recently up dated fire safety risk assessment of the building was also produced on request. The member of staff delegated the task of appropriately maintaining the services health and safety records demonstrated a good understanding of their role and responsibilities in this area. During a tour of the premises we noted two first aid boxes, which were both well equipped and conveniently located in the kitchen and office. The manager told us a third first aid box is always kept in the services peole carrier ti enable staff to deal with emergencies whilst accessing the wider community. The temperature of hot water emanating from both a first floor bath and an en-suite shower facility in a service users bedroom were found to be below a safe 43 degrees Celsius when tested in the afternoon on the second day of the inspection. Based on assessed risk - all the services radiators have been suitably covered to minimise the likelihood of any of the people who use the service being burnt. The member of staff responsible for health and safety in the home was able to provide us with certificates of worthiness that showed us suitably qualified professionals had tested the services gas installations, portable electoral appliances, fire alarm system, and extinguishers in the last 12 months in line with recommended best practise guidelines. Care Homes for Adults (18-65 years) Page 33 of 37 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 34 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 23 13 Preventing and managing challenging behaviour training must be provided for all the care staff that work with people who use the service. This training will ensure all staff have the necessary knowledge and skills to prevent and effectively deal with incidents of challenging behaviour in a way that keeps the people who use the service safe. The new laundry room must be supplied with a wash hand basin. This will keep the people who use the service safe by minimising the risk of infection spreading in the home. 01/06/2009 2 30 13 01/05/2009 Care Homes for Adults (18-65 years) Page 35 of 37 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 All staff who work at the service should be suitably trained in the use of Makaton and any other specialist methods of communication used by the people who live at the home. This will ensure the staff can communicate effectively with all the people who use the service and thus meet their needs. When one to one sessions between the people who use the service and their designated keyworkers are held each month the outcome of these meetings should be clearly recorded. This will enable anyone authorised to inspect these minutes to determine whether or not suitable arrangements are in place to enable the people who use the service to be consulted, and participate in all aspects of life at the home. A record of the risk framework people who manage their own medication operate within, including what arrangements are in place for them to keep their medication safe and how staff intend to monitor its handling, should be appropriately maintained and made available for inspection on request. All staff who work with people that have been assessed as having behaviours that challenge the service should have access to more detailed guidelines regarding the appropriate use of approved physical intervention techniques as a last report. The way in which senior staff carry out supervisions and record the outcome of these sessions should be reviewed because at present they are not being held at frequent enough intervals (i.e. At least once every two months). This will ensure the people who use the service have their needs met by suitably trained and well supported care staff. 2 7 3 20 4 23 5 36 Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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