Care Home: Aashna House

Similar services:

• Ashlong House
• Henry Nihill House
• Birchwood
• The Infirmary
• Orchard House Nursing Home
• St Josephs Rest Home
• Red Court Nursing Home
• Spinney (The)

What the care home does well This specialist service successfully supports individuals of Asian origin that may otherwise be isolated to achieve positive outcomes and lead the lifestyle they prefer. Individual accommodation is spacious and each room has it`s own en suite, and kitchen. The scheme accommodates 37 residents, representing almost all sections of the Asian community. For the majority of residents English is not the language used for communication. This is recognised and communication in the home with staff and external professionals is good. Staff are representative of the group of residents, they share similar cultural backgrounds, and are able to talk to residents in their mother tongue with Urdu, Punjabi, Gujarati and Bengali among the many languages spoken. Islam, Sikhism, Buddhism and Hinduism are some of the religious beliefs observed, and actively celebrated in the home. Aashna House has many strengths, it has the capacity to provide for the many different cultures, practices and individual choice, up to seven different dietary preferences are catered for. Management is strong, clear leadership is given to residents and staff.. The care arrangements in the home are good, staff are responsive, they support individuals in the way they prefer. Staff provide assistance and support in a gentle and sympathetic manner, the ethos of caring and respect is fostered throughout the service. Residents told us of their experiences, the following comments are representitive, " My carers are so thoughtful, they understand my ways and know what I like and dislike", " I moved here recently, I love living here, with always someone on hand to help me when I need them", "my family do not need to worry, they know I am well cared for and that they will be kept informed if there is a need to." The service is good at promoting the health care needs of residents, individuals are supported with conditions such as diabetes, and to access to statutory and voluntary services. What has improved since the last inspection? Attention was given to making the home more comfortable and pleasant. The refurbishment of the home is almost complete, the majority of the work is now completed with new carpets fitted throughout. What the care home could do better: The care home has experienced some challenges for the past twelve months. There was a fire at the home which sadly resulted in a fatality. All other residents were assisted to evacuate the premises safely. At the time of writing this report we were not informed by the fire authority of any immediate action that needs to be taken, or of breaches in fire regulations in the home. The investigation into this fire was not concluded. We await the outcome of the investigation and will follow up with any necessary regulatory activity. The service rating has been reduced to adequate due to areas of defecit in staff recruitment and training. A number of requirements are stated in relation to staff training and development, and recruitment. The majority of mandatory staff training was not delivered to staff and remains outstanding. The service has not responded appropriately to the training needs of staff for the past eighteen months. Care officers often new to the care service need to keep their skills and knowledge up to date so that they are competent in caring for residents. Recruitment procedures are still flawed, staff are not all fully vetted before they are engaged at the home. This shortfall places vulnerable people at risk. Key inspection report Care homes for older people Name: Address: Aashna House ASRA Greater London Housing Association 2 Bates Crescent, Off Abercairn Road Streatham London SW16 5BP     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Mary Magee     Date: 0 4 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Aashna House ASRA Greater London Housing Association 2 Bates Crescent, Off Abercairn Road Streatham London SW16 5BP 0208-765-0822 02087650622 mathini@lha.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: ASRA Greater London Housing Association Limited care home 37 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: To include the current service user aged 56 years Date of last inspection Brief description of the care home Aashna House is a purpose built care home providing care and accommodation for elderly people of Asian origin. It is situated in a residential close and is within a tenminute walk of local shops and public transport. Asra Greater London Housing Association own and manage the home. It is a pleasant and spacious two-storey building with the added advantage of enclosed gardens to the rear. The home is divided into five units, each has its own dining room and kitchen. A large catering kitchen is located on the ground floor. A passenger lift is also provided. The gardens and the buildings are wheelchair accessible. The home has 31 single bedrooms and 3 double bedrooms. Each room has an abundance of space with attached kitchenette and en-suite shower facility. A CCTV is provided by the front door. Care Homes for Older People Page 4 of 33 0 37 Over 65 37 0 Brief description of the care home Fees range from £475 to £550 per week. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We carried out this unannounced key inspection in December 2009, two visits were made to the service for the the inspection. An interpreter assisted on day one at the home when we interviewed fifteen residents, (for 33 of the 37 residents English is not the first language. We used surveys to sample from residents their experiences, surveys were sent to residents prior to the inspection, twelve of these were returned. We met with and had discussions with the registered manager, and staff members present on both days. Management and staff were cooperative and helpful and facilitated the inspection process. Five care staff were spoken to individually. A district nurse supplied us with information on the health care needs of residents. The relatives of three residents were spoken to in recent months. We spoke to a local authority reviewing officer, he had recently reviewed fifteen Care Homes for Older People Page 6 of 33 residents at the home. We also spoke to a fire officer involved in the investigation into a fire at the home. We examined a selection of records at the home relating to residents and to the premises. We also examined a selection of staff files that were sent from the head office in Leicester. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: The care home has experienced some challenges for the past twelve months. There was a fire at the home which sadly resulted in a fatality. All other residents were assisted to evacuate the premises safely. At the time of writing this report we were not informed by the fire authority of any immediate action that needs to be taken, or of breaches in fire regulations in the home. The investigation into this fire was not concluded. We await the outcome of the investigation and will follow up with any necessary regulatory activity. The service rating has been reduced to adequate due to areas of defecit in staff recruitment and training. A number of requirements are stated in relation to staff training and development, and recruitment. Care Homes for Older People Page 8 of 33 The majority of mandatory staff training was not delivered to staff and remains outstanding. The service has not responded appropriately to the training needs of staff for the past eighteen months. Care officers often new to the care service need to keep their skills and knowledge up to date so that they are competent in caring for residents. Recruitment procedures are still flawed, staff are not all fully vetted before they are engaged at the home. This shortfall places vulnerable people at risk. 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 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 Older People Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is successful at meeting the needs of elderly people of Asian origin. People have the opportunity to visit the home first before making a decision to move there to live. Admissions are not made to the home until a full needs assessment has been undertaken and the home is satisfied that it can meet the individuals s needs. Evidence: We used case tracking to evaluate the care arrangements at the home for people using the service. We selected care files two people recently admitted. On each file we viewed was a copy of the contract with the home and the name of the funding authority. The home accepts referrals from a number of local authority care management teams. Where possible applicants also complete the application form. On both files examined we found that there were copies of the pre admission assessments. The pre admission assessments completed by the manager record all essential Care Homes for Older People Page 11 of 33 Evidence: information on the individual support needs, capacities to engage contribute to care planning, and daily routines preferred. We found that additional demands have on occasions been placed on staff due to the lack of information supplied. Also events that have taken place prior to admission were not always shared with staff at the home. On occasions people have greater needs than when initially assessed. Management have learned from these events and aware of the importance of gathering as much information as possible from referring care management. The home should ensure that as much information as possible is sought in relation to the applicant so that the pre admission is well informed. The home should always ensure that the people accepted meet the relevant criteria. For each person there was also a copy of the care management assessment outlining the need for residential care in this specialist home. We spoke to fourteen of the residents via na interpreter. The majority described coming to the home to view the facilities before they made the decision to move in. Residents spoke of the benefits of living at Asian House. All those spoken were positive of living in a community where the needs of people from specific similar cultural and ethnic groups are met. The staff composition is Representative of the many religious and cultural groups. The home works hard to attract staff that understand the cultural and religious needs of the resident group as a whole. Staff members do not have English as a first language. Each care worker speaks at least two Asian languages. Care Homes for Older People Page 12 of 33 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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. Care arrangements and practices are good. The health care needs of residents are promoted. Staff are familiar with customs and the ways of the residents, they consider and respect the views of older people, promoting dignity and respect in practice. Medication procedures are safe. Evidence: We focused on the care arrangements and evaluated the care given to three residents. For each resident a written care plan was available. The plans set out clear details for staff on how the support should be provided, for example preference for time of day for shower, meals, pastimes and hobbies, lifestyle preferences such as engagement, needs associated with cultural requirements. We found that for each resident there was a record of the care and support needed in each area, also held was a copy of a comprehensive risk assessment. The home has a team of staff that are of Asian background. For thirty three of the thirty six residents English is not the first language. The staff team members have many linguistic skills, they understand the cultural and religious needs and are able to communicate well with resident. Staff are gentle and caring, we observed that they treat residents with dignity and respect. We Care Homes for Older People Page 13 of 33 Evidence: heard from residents and families too, the feedback was that staff at this home are good at promoting individual rights and promoting dignity and respect. The service records the preferred language of the individual. Records were available of the care given every day, also of the state of well being of the resident. We found that risk assessments are reviewed less frequently that recommended, also care plans too. The home should ensure that monthly reviews take place of care plans and risks assessments. Residents are registered with a new GP practice, they find the service good. Examples were seen of how residents are enabled to keep their independence. Individuals with diabetes are supported to manage their conditions, staff supervise residents with blood sugar monitoring with records kept in individuals rooms. The district nurse visits the home daily to administer insulin to those requiring it. From her we received positive comments on how staff support residents. We heard from the nurse how residents are supported with promoting good health care. None of the residents have pressure sores, one resident has a leg ulcer, it is dressed by the nurse in accordance with recommendations. A placement review took place for one of the residents recently admitted. We heard from the resident how suitable the placement is. She finds that the home delivers all the support she needs. She said staff support and encourage me, I find it is a great place to live. A local authority reviewing officer completed reviews for a large number (10)of residents at the home recently. He told us that he met with relatives and residents as he completed statutory reviews. The outcome of the reviews concluded that the home was meeting the needs of the residents. We heard from him that the service had prepared well for the reviews, he had received all the documentation needed for each resident, and that details supplied were up to date. The home also supplies in individual bedrooms to each resident a copy of the care plan and the risk assessment. In addition to copies supplied to residents there is additional information held in the office. There are procedures to ensure that people using the service are informed of their rights to confidentiality. All fifteen residents spoken to told us of their experiences, they say they find that the care arrangements are good. We examined the medication procedures. Medication is administered by senior staff members that are trained and competent. Our findings are that staff are doing a good job. Communication with the staff is good, staff at the home can interpret for residents where English is not a first language and this enables resident good access to statutory services. At staff hand overs all information relative to each resident is reported to the staff team. Appropriate referrals take place by staff where there is any need for health professional advice. Medication is reviewed regularly by the GP. Medication is administered by senior and competent staff. All staff have received training in administering medication and competency levels have been assessed. Care Homes for Older People Page 14 of 33 Evidence: A pharmacist dispenses and delivers medication. The medication administration procedures were observed to be good. We found one error for a medication administered once per week. The MAR sheet for one week contained no signature to denote that the medicine was administered. All medication administered should be acknowledged on the MAR sheet. Care workers work in pairs when administering medication, with care worker assisting the senior carer. MAR sheets (2)were observed to be accurate with no errors observed. Care Homes for Older People Page 15 of 33 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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. Provision is made to cater for the many dietary requirements of residents and serve wholesome meals that people enjoy. At Aashna House individual lifestyles and personal preferences are respected and satisfied, and recreational interests are appropriately considered. Individuals are supported to pursue their choices of activities, and enagage in activities that they enjoy. Religious needs are met with consideration given to enabling residents to pursue and worship. Evidence: Residents enjoy life at the home, they find that the home meets their expectations and lifestyle preferences. Residents receive encouragement and are supported to make informed choices of their daily lifestyle. Participation in daily activities, outings and visits are promoted but individual choices to remain in their own rooms and follow their pursuits are respected. Each resident has a television in their own room with a variety of Asian channels to choose from. The home displays photographs are displayed of many group outings people participate in. The majority of activities available are religion orientated, this we found meets with residents preferences. The majority of the residents told of previous history, with the majority focusing their life on families and nearest relatives. Religious observances are important to residents. Care Homes for Older People Page 16 of 33 Evidence: Festivals including Diwali, Christmas,and Eid are celebrated in the lounge. The home employs staff that share the same religious beliefs and practices, and on occasions these staff take the lead on cultural and religious celebrations. Both staff and residents lead on scripture reading and chanting. Yoga classes are one of the activities enjoyed by the majority and that contribute to the overall well being of residents. The residents enjoy the spacious individual accommodation and make use of this. They welcome family and friends into their home, the bedrooms with kitchens and sitting areas enable them entertain in the privacy of their own homes. Residents frequently choose not to engage in many group activities, this is often a previous lifestyle choice that is continued into retirement. From speaking to fifteen residents it is evident that individual lifestyle choices not to engage in activities is respected. We received some comments suggesting that activity programme could be developed further. A recommendation is made to pursue the introduction of more activities. We observed meals served at the home, these appeared good, residents were pleased with the dishes served when we were present. We were informed by the manager that there is a choice of two meals daily. Regular food committee meetingss are held three monthly to discuss menus. Healthy eating is promoted. Residents are encouraged to eat the variety of vegetables and fresh fruit and try the many different dishes available in Asian cuisine. A list is held in the kitchen of individual dietary needs and preferential requirements, particular needs such as diabetic, and salt free, spice free dishes are provided for. We toured the kitchen. our findings are that kitchen staff take the necessary precautions to promote the health of residents, and monitor the temperatures of cooked food. Of the many Asian dishes served these range from Bangladeshi, Sri Lankan, Madras, Mauritian, Punjabi. Different dishes within this group that have to be prepared include those that are oil free, salt free, spice free. Residents generally find the meals good but on this visit we had at least nine negative comments on the food served on occasions. Some of the residents spoke of the food not always meeting expectations and that it is not according to taste of the majority. The menu we viewed included some non Asian food, which residents commented on. We enquired about the menu and the introduction of the changes.The manager told us that two dishes were the preference of particular residents. We found that the majoirty of residents were unhappy about the introduction of such dishes. A recommendation is made. Residents are weighed regularly; appropriate referrals are made to health professionals if there are nutritional disorders. Food supplements are also given as necessary if residents require them. Residents have televisions in their own bedrooms, a variety of Asian channels are available to watch. We found that the majority of residents like to remain in their own rooms, watch television, and entertain relatives. Residents we spoke to told us that Care Homes for Older People Page 17 of 33 Evidence: they also continue with the yoga exercises in the comfort of their own homes . We found that usually in the afternoon residents like to meet with neighbours and socialise in the lounge. Small religious services take place in the lounge according to celebartions. Residents are encouraged to take in their own personal possessions to personalise their rooms. All the bedrooms viewed were personalised with religious effects and photographs of family. Residents are encouraged to attend religious ceremonies in the communities and volunteers are also encouraged and invited to undertake religious activities with residents and to participate in social and recreational activities. Care Homes for Older People Page 18 of 33 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has an effective complaints system where residents feel confident in raising issues or concerns. Robust procedures are in place at the home for responding to suspicions of abuse or neglect. Staff are vigilant and knowledgeable on safeguarding procedures but training requirements leave them unfamiliar with changes to legislation that include awareness of the deprivation of liberties. The recruitment procedures have shortfalls and have the potential to place vulnerable older people at risk from care staff not being fully vetted. Evidence: Complaint policies are in place, these are translated in other languages for the residents to understand. Complaint log sheets are available in the office to log complaints. Residents and staffs are encouraged to make complaints to improve our services. Complaint policies and procedures are given at admission and are included in the information pack. The number of complaints recorded was ten , however many of these were minor issues raised by residents. All according to records seen were addressed appropriately. Copies are accessible to all residents. We met with staff individually, staff have a good awareness of safeguarding procedures, Staff lack an understanding about the Mental Capacity Act , deprivation of liberty, and safeguarding training is overdue. The home has experienced incidents with a family member that necessitated notifying relevant authorities and the instigation of legal procedures. Appropriate arrangements Care Homes for Older People Page 19 of 33 Evidence: are now in place to enable supervised contact between the resident and the relative. Staff are alert to the vigilance required. Staff received training in safeguarding policies and procedures in 2007. None of this was renewed in 2009. New staff also require more advanced training on safeguarding procedures. Care Homes for Older People Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, 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. 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. Residents live in a pleasant well maintained premises. Individual accommodation is spacious, this is complimented by a range of shared communal facilities. Residents have access to safe indoor and outdoor communal facilities. Evidence: We toured the premises, and viewed all communal areas and twenty bedrooms. This two storey premises are well designed. Location is convenient for public transport, it is situated in a quiet close with enclosed well-maintained gardens. Gardens are accessible to wheelchair users and offer pleasant surroundings for residents to meditate and relax. A passenger lift is available. A large comfortable lounge is available and used by residents daily. The lounge decor and articles on display reflect the diversity of the group of residents. On display are many art and religious objects that reflect Asian culture and religions. We found that many of the residents enjoy watching on the large television a variety of Asian channels in the lounge. Each resident has a television in their own bedroom, with the same selection of channels to choose from. A large part of the planned maintenance programme had been completed. The carpet was recently repalced throughout the ground floor. The communal lounge was repainted. The communal kitchen for the communal lounge has broken kitchen units that need to be replaced, and window sill requires attention and redecorating. A requirement is stated. The home is divided into five homely units, each with own dining room area. Dining rooms are used by residents and they use Care Homes for Older People Page 21 of 33 Evidence: them to socialise, many choose to sit with friends after meals enjoying a chat. Since the last inspection the home has continued with a decorating programme and a number of dining rooms bedrooms were decorated Individual bedrooms twenty were viewed, the rooms are comfortable and pleasant. Residents display many possessions including religious effects that give a homely touch. All bedrooms are ensuited, they also contain small kitchenettes. The walk in shower facilities available in all rooms enable good access to people with mobility difficulties. Hand rails are fitted to corridors to assist those that need help with walking. The premises throughout were clean and are odour free. The maintenance records viewed confirmed that water temperatures in shower and bathrooms are regularly monitored. Rooms we found were well ventilated. Records were aslo supplied of how attention is given to servicing and maintenance of hot water systems and lighting. The home has emergency lighting that is services alongside the fire panels. The post of maintenance person was vacant when we visited. We found that the main kitchen was clean, one filter screen was repalced recently. Care Homes for Older People Page 22 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People find that appropriate numbers of staff are available on duty in the daytime to respond to the needs of residents. Staff are NVQ qualified. The organisation is not responding appropriately to the training and development needs of care staff. It has allowed training to lapse, and not invested in staff training and development for the past eighteen months. Recruitment procedures are not sufficiently robust, shortfalls are still experienced in vetting procedures which place residents at risk. Evidence: We examined staffing rotas for September, November and December 2009. In the morning there five care officers on duty plus one senior care officers, in the afternoon are four care officers plus one senior. This was consistent with the numbers found on both days of our visit. Conversations with residents, and relatives recently raised some concerns about the staffing levels. We feel that daytime staffing levels are appropriate. At night on duty are two night care officers plus one senior officer on sleep over duties. We recommend that a review of night time staffing levels take place, and that this considers the needs of the current residents. According to the AQAA, the manager told us too that all newly recruited care staff receive induction, the induction according to reports received meets Sector Skills workforce training targets. However the evidence of this as well as of foundation programme is not available, there are no certificates available of induction training completed on staff Care Homes for Older People Page 23 of 33 Evidence: files, or on the training matrix supplied. The manager must ensure that the induction and foundation training given to new staff meets the Skills for care standards, evidence of this training for newly recruited staff must be supplied to CQC. There was evidence on the files that the new staff completed probationary periods to demonstrate that they are suitably skilled and competent for the role, performance was also monitored closely during this period with periods of extension given as deemed necessary. The home has experienced a number of changes in the past year which has impacted on the service, a number of the permanent mainly senior care officers have been absent, some long term. Bank and agency staff have covered the vacant posts, this has resulted in less consistency in the service. All regular permanent care officers are NVQ qualified, (14). However a number of vacancies experienced at the home are covered by bank and agency staff, the range of skills for the agency staff engaged are not recorded. Agency and bank staff are employed more at weekends, this period appears to experience relatively high sickness levels. The vacant posts should be recruited to as early as possible. All staff are clear regarding their role and what is expected of them. People using the service report that staff working with them know what they are meant to do, and that they meet their individual needs in a way that they prefer. Compliments were received from residents about the caliber of staff employed but commented on bank and agency staff engaged. All fifteen residents spoken to praised long serving staff for their contribution to making life better for those living at the home. The strength in this service is due to the fact that staff share similar cultural backgrounds, communicate well and can speak in a language understood by residents. On the negative side staff despite sharing cultural ethnic backgrounds have little experience of living in London,and require a significant investment in training and development. Training provision has slipped considerably in the past eighteen months. At the last key inspection we had some concerns and made a requireemnt about staff training. Since 2007 the training provision was minimal. The mandatory training requires updating, changes within the organisation took place at head office. We found that there is no specific training and development programme for care staff. According to the training matrix supplied much of the training and development is overdue including Safeguarding training. The service must make sure that staff employed at the home receive training appropriate to the work they are to perform. The importance of knowing, understanding and responding appropriately to cultural issues is a factor in the delivery of a good service. Observations made throughout the day were that staff are gentle and patient in their approach, they value and respect people. They have attributes that are necessary for their role. Staff work with individuals at the pace that the resident likes. The ethos of caring and respecting people is demonstrated in working practice, residents know their wishes are Care Homes for Older People Page 24 of 33 Evidence: respected. Staff understand religious needs and where particular customs such as fasting takes place. When speaking to the staff group and to members of staff individually (4) the inspector found that staff are enjoying their role. Communication at change of shift remains good. Residents files are taken to hand overs and the welfare of each resident is discussed in detail. Important information is shared such as residents that have health concerns. While observing recruitment procedures we found that four new care officer staff have commenced employment at the home since the last inspection of October 2007, one of these staff members is no longer in employment there. The recruitment procedures for all four of the new staff were examined. Files were not available on day one, these were copied and sent from the head office in Leicester for our viewing. The recruitment procedures we found are still not satisfactory, in several areas we found shortfalls. Application forms we found were not fully completed for all four care officer staff, gaps were found in employment history. Two of the references viewed did not have any stamp or letter head to demonstrate authenticity, periods of some previous employment were very brief. Confirmation of emigration status was present for staff members as well as contracts of employment. CRB disclosures were present for all four staff. The disclosure sought for one staff member was a standard disclosure and did not have a POVA check completed. It was evident from viewing the disclosure that that a POVA check was not requested, it was not identified that the POVA check was absent . This was also an area of shortfall highlighted at the previous inspection for another staff member. Some staff had previously worked at the home via an agency placement and commenced employment when engaged by the home using the previous disclosure. For one staff member many months had lapsed before a new record was received from the CRB. It was unclear if the delay was the result of a late application or due to the a bureau delay. Overall it demonstrtaed that recruitment procedures are not robust enough in safeguarding vulnerable residents. A requirement stated in the last inspection report is restated in relation to recruitment. Full and satisfactory information must be received for all new staff before they commence work. Enhanced disclosures with POVA checks are required for all staff engaged. Care Homes for Older People Page 25 of 33 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home benefits from the presence of a capable and competent manager. Staff receive supervision and encouragement that supports and promotes good practice. Record keeping is good. Individuals financial interests are protected, these are supported by sound and effective financial procedures. Evidence: The home is run by a manager that is qualified and competent, the good leadership skills displayed gives clear direction to staff and residents. This was evident through the very challenging period following a fire at the home. The manager helped to restore calm and confidence in the service. The manager demonstrates through formal qualification, robust operational systems her experience and ability that she is highly competent in a range of areas. We heard from the manager that the shortfalls in staff training and development are a result of organisational changes, the training programme was affected as a result of non allocation of resources for this cause. The obligation of recognizing and fulfilling staff training and development should be Care Homes for Older People Page 26 of 33 Evidence: provided for within resources and budgeted for. The registered manager has an obligation to oversee that staff are trained for the role they perform.. Staff records are held that confirm regular supervision takes place, staff say that they are are supervised and supported. Regular team meetings take place. Working practices are closely observed, any issues of unacceptable practice are identified and addressed promptly. The service has on occasions not kept local authority informed of significant events, this is now resolved. A good relationship is now maintained between the home and health and social care professionals. Record keeping is generally good at the home. The home has excellent procedures in place at the home to protect the financial interests of residents. Office administration combined with standards of record keeping is good. We viewed the systems to support two residents that require support to manage their money safely. The administrator operates effective systems by maintaining accurate up to date records of all financial transactions, we noted that a clear audit trail is held. Individuals are assisted to have bank accounts into which personal allowances are paid, these are held in safekeeping at the office. We viewed the accidents and incident reports. We are kept informed of all notifiable incidents at the home. It is recommended that an easily accessible log is maintained for each month of any accident or incident that occurs We found that the AQAA provided a list of policies and procedures in place, evidence of review dates. The home has experienced a fire in a residents flat, the fire resulted in the death of a resident. All other residents were assisted to evacuate safely, and are now well and back at the home. We spoke to a Representative of the fire authority, we did not receive any concerns about the evacuation procedures On our first visit records of servicing and maintenance of fire fighting equipment were not available, these were held elsewhere in connection with the investigation. We were told by the manager that the service has recognised an area for further review, at the time of writing this report the board of trustees were reviewing that policies and procedures in relation to health and safety of items taken to the home by residents We will not comment on the records other than confirm our findings. On second visit we examined records of servicing and maintenance of the building and equipment. The homes recent fire risk assessment was examined. These confirmed that essential servicing and maintenance are carried out. We also found that evacuation procedures are conducted in accordance with fire risk assessment. Records were examined that confirmed that electrical equipment supplied by the service is tested annually. A review is taking place within the organisation of these procedures, and of equipment supplied by residents /relatives. Health and safety checks are completed for the premises on a regular basis. lists are held with responses recorded. Some adaptions were in progress during our inspection. A new smoke detection system was being fitted in all bedrooms, we were told that this is fitted directly to the fire alarm panel. According to the manager the previous system connected to the nurses call system. The CCTV placed at the front of the premises has Care Homes for Older People Page 27 of 33 Evidence: been repaired. On documentation viewed there are records held to demonstrate the following, Fire drills are undertaken in accordance with recommendations; also the testing of fire fighting equipment takes place as required. Notifications are made to relevant bodies in accordance with regulation. All incidents or incidents are recorded. The viewed recent copies of Regulation 26 visit reports. The home has continued to develop the service in the best interest of residents but need to make sure that staff receive the required training. Residents have regular unit/group meetings, surveys are conducted too with family welcome too. Regular reviews are held of residents progress, the outcome for residents is positive.. The opinions of residents are taken into account, residents say they are listened to. Performance issues are addressed. Audits have been completed of the home, these identified any shortfalls in the upkeep of the premises, also staffing provision, finances. More development to the quality assurance system is needed, focusing on staff skills and development. Care Homes for Older People Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 23 The communal kitchen for the communal lounge has broken kitchen units that need to be replaced, and window sills in lounge requires attention. To ensure that the home is retained in good order, and offers a homely pleasant environment for residents provides a homely 31/03/2010 2 19 23 Attention is needed to areas 31/03/2010 of the ground floor corridor. As a result of leaks from overhead shower system the wall was damaged. This area needs redecorating. To keep the home in a good state of repairs 3 29 19 The manager must ensure that recruitment procedures are rigorous. No person to be employed at the home unless they are fit to do so, and that it has obtained in 26/02/2010 Care Homes for Older People Page 30 of 33 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 respect of the employee information and documentation as specified in Schedule 3. To Safeguard vulnerable residents 4 30 18 The service must make sure 26/02/2010 that staff employed at the home receive training appropriate to the work they are to perform. Staff training must be kept up to date. To make sure staff are skilled and knolwledgable for their role. 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 3 The home should ensure that as much information as possible is sought in relation to the applicant including previous history, so that the pre admission is well informed. The home should always ensure that the people accepted meet the relevant criteria and the conditions of registration. The home should ensure that monthly reviews take place of care plans and risks assessments. Records hould be made on MAR sheets of all medication administered. It is recommended that consideration is given to developing the activities programme further. It is recommended that consideration is given to retaining Page 31 of 33 2 3 4 5 7 10 12 15 Care Homes for Older People 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 Asian cuisine, personal preferences by some individuals for English dishes should not impact on the menu for the whole of the resident group. 6 18 Arrangements must be made to update the staff team on safeguarding policies and procedures. New staff and agency staff should receive training on the protection of vulnerable adults. It is recommended that a review of staffing levels for nightt take place, numbers should reflect the needs and number of residents. It is recommended that vacant posts are recruited as early as possible to promote consistency in the staff team. The service should ensure that the quality assurance system focuses on the skills and expertise within the staff team, this to be linked to training profiles for each staff member. It is recommended that an easily accessible log is maintained for each month of any accident or incident that occurs Health and safety policies and procedures of the home in relation to equipment supplied by residents should be reviewed. (This was under discussion by board f trustees) 7 27 8 9 28 33 10 37 11 38 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!