Care Home: Angel Home

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What the care home does well Prospective citizens are being provided with the opportunity to visit the home, and to stay overnight, before deciding whether the home is likely to meet their needs. Citizens who have been admitted to the home have been fully assessed, and can be assured that the home will endeavour to meet their individual needs and aspirations. Citizens are having their health, personal and social care needs and goals set out in an individual plan of care, with regular review taking place. Citizens are being enabled to participate fully in decisions that affect them and their day-to-day lives in the home. Citizens are being encouraged and supported to take risks and to develop an independent lifestyle. This is being reflected in detailed and comprehensive risk assessments. Citizens are being assessed regarding potential risks to their health and safety, and are enabled to take responsible risks wherever possible. Citizens are being enabled to participate fully, and to exercise choice and control in their daily routines and activities. Citizens are being encouraged to maintain contact with their family and friends, and to maintain links with the local community. Citizens` rights and responsibilities are being respected and recognised in their day-to-day lives. Citizens are being offered choice and flexibility with meal arrangements. The quality of food is wholesome, nutritious and varied, with meals being taken in a pleasant and congenial setting. The health and personal support needs of citizens are being fully met, and are being carried out in a way that maintains their right to dignity and choice. Citizens are being protected by the home`s medication policy and procedures, and by the provision of accredited medication training for all care staff. The home has an appropriate and well-publicised complaints policy and procedure in place. This assists citizens and their relatives/friends to raise any concerns that they may have.The home`s policies, procedures and practice indicate that citizens are being protected from abuse and are living in a safe environment. Citizens live in a safe, hygienic and well-maintained environment with access to appropriate and sufficient communal facilities. Citizens` rooms are safe, comfortable and pleasantly decorated, being suited to their individual needs. Citizens can be assured that their needs are being safeguarded, through staff being appropriately supported and supervised on a regular basis. Citizens are living in a home that is generally being well managed and run in their best interests, and which provides an open, positive and inclusive atmosphere. The rights and best interests of citizens are being safeguarded by the home`s record keeping. What has improved since the last inspection? The home has increased its staffing complement in line with the increase in its resident group from 4 to 7. The home has been developing a person-centred approach in planning and providing care and support for its` citizens. The home has developed a pre-appraisal self-evaluation questionnaire for staff to complete, so as to assist staff to identify their relative strengths and weaknesses. The health, safety and welfare of citizens are being appropriately protected. The home`s Fire Risk assessment has been revised and updated. The home has developed its quality assurance processes so as to demonstrate that it is obtaining widespread feedback regarding the extent to which it is supporting citizens and meeting its aims and objectives. A Development Plan does, however, need to be put in place for 2007-08. CARE HOME ADULTS 18-65 Angel Home Angel Home 43-45 Stayton Road Sutton Surrey SM1 1QY Lead Inspector Peter Stanley Unannounced Inspection 9th June 2008 09:30 Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Angel Home Address Angel Home 43-45 Stayton Road Sutton Surrey SM1 1QY 020 8715 6940 020 8647 2548 christinemouralidarane@hotmail.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Angel Home Limited Mrs Christine Mouralidarane Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 9 12th June 2007 Date of last inspection Brief Description of the Service: Angel Home is a residential care home, situated on a residential road in Sutton In 2006, the owners purchased the house next door and have converted the two semi-detached houses into an enlarged residential home. Since being reregistered on 6 November 2006, the home provides care and accommodation for up to nine service users with a learning disability. The accommodation is arranged over two floors. On the ground floor there is now an enlarged open lounge and diner. This is arranged into two separate living areas, each with its own television. There is also a kitchen, small office, and laundry room, with access via the kitchen and lounge/dining room to a garden and patio area. With the expansion of the home there are now nine bedrooms, four of which (all in the new annexe) are ensuite. There is a first floor bathroom/toilet, and a shower/toilet on the ground floor. Included in the new extension is a ground floor reception area and a small area on the first floor set aside for seeing visitors. The home has appropriate laundry facilities separate from the kitchen and the preparation of food. To the front of the building there is a small garden. There is restricted car parking near the home, although the home itself has limited parking at the back of the property. The home is within easy walking distance of Sutton town centre, where there Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 5 are shops, post office and pubs. Sutton has good transport links as it is on many bus routes and there is also a railway station that goes into London and the coast. Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This key inspection was conducted over five hours. The inspection involved discussion with the registered provider and manager, Christine Mouralidarane, and staff on duty. The inspector also met with two of the home’s residents (or “citizens”), this being the home’s preferred terminology. There are currently seven citizens, three new admissions having taken place within the last 12 months. The inspector examined staff and service user records, including assessments, risk assessments and care plans, recruitment records, and records of supervision and training. The inspector also examined documentation relating to policies and procedures, and records relating to medication, complaints, incidents and accidents, and health and safety. The inspector completed an inspection of the premises, and observed interaction between staff and those citizens who were present. The inspector case-tracked the records of 3 citizens who have been admitted within the last 12 months. Feedback was available from the home’s surveys with citizens, relatives and professionals, and from completed CSCI questionnaires, which were received from one relative, two care managers, and one reviewing officer. All 3 requirements from the previous inspection have been met. There are 4 requirements from this inspection, and 4 recommendations, one of which has been partly met from the previous inspection. The impression gained from this inspection, together with the supporting evidence, shows that The Angel provides a homely, enabling and caring environment. The home is respectful of individual needs, with citizens presenting as settled and well supported. The home has an enabling and person-centred ethos, with individuals being encouraged to develop their skills and interests and to develop their potential for independent activities and functioning. The home has a close and well-knit staff team with evidence of good support, supervision and training. All documentation examined was satisfactory and well maintained and in compliance with the national minimum care standards. The inspector would like to extend his thanks to Christine Mouralidarane for her assistance in facilitating this inspection, and also, to those staff and citizens who were present. Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 7 What the service does well: Prospective citizens are being provided with the opportunity to visit the home, and to stay overnight, before deciding whether the home is likely to meet their needs. Citizens who have been admitted to the home have been fully assessed, and can be assured that the home will endeavour to meet their individual needs and aspirations. Citizens are having their health, personal and social care needs and goals set out in an individual plan of care, with regular review taking place. Citizens are being enabled to participate fully in decisions that affect them and their day-to-day lives in the home. Citizens are being encouraged and supported to take risks and to develop an independent lifestyle. This is being reflected in detailed and comprehensive risk assessments. Citizens are being assessed regarding potential risks to their health and safety, and are enabled to take responsible risks wherever possible. Citizens are being enabled to participate fully, and to exercise choice and control in their daily routines and activities. Citizens are being encouraged to maintain contact with their family and friends, and to maintain links with the local community. Citizens’ rights and responsibilities are being respected and recognised in their day-to-day lives. Citizens are being offered choice and flexibility with meal arrangements. The quality of food is wholesome, nutritious and varied, with meals being taken in a pleasant and congenial setting. The health and personal support needs of citizens are being fully met, and are being carried out in a way that maintains their right to dignity and choice. Citizens are being protected by the home’s medication policy and procedures, and by the provision of accredited medication training for all care staff. The home has an appropriate and well-publicised complaints policy and procedure in place. This assists citizens and their relatives/friends to raise any concerns that they may have. Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 8 The home’s policies, procedures and practice indicate that citizens are being protected from abuse and are living in a safe environment. Citizens live in a safe, hygienic and well-maintained environment with access to appropriate and sufficient communal facilities. Citizens’ rooms are safe, comfortable and pleasantly decorated, being suited to their individual needs. Citizens can be assured that their needs are being safeguarded, through staff being appropriately supported and supervised on a regular basis. Citizens are living in a home that is generally being well managed and run in their best interests, and which provides an open, positive and inclusive atmosphere. The rights and best interests of citizens are being safeguarded by the home’s record keeping. What has improved since the last inspection? What they could do better: Prospective citizens are being provided with the information they require, to make an informed choice, as to whether the home is likely to be suitable in meeting their needs. However, both the Statement of Purpose and the Service Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 9 User Guide must be signed and dated to evidence that they have been reviewed and updated. Health action plans have been put in place, but require review. This should be done at least annually. Generally, citizens are being well protected by the home’s recruitment policy and procedures. However, the home must ensure that it observes correct procedures with regards to criminal records checks. Generally, citizens are having their needs well met by an effective, appropriately trained and qualified staff group. However, staff should undertake updated training regarding the needs of individuals with learning disabilities and those who present severe communication difficulties. Generally, the rights and best interests of the home’s citizens are being protected by the home’s policies and procedures. However, some of these have not been reviewed for several years and need to be reviewed and updated. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 to 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Generally, prospective citizens are being provided with the information they require, to make an informed choice, as to whether the home is likely to be suitable in meeting their needs. However, both the Statement of Purpose and the Service User Guide must be signed and dated to evidence that they have been reviewed and updated. Prospective citizens are being provided with the opportunity to visit the home, and to stay overnight, before deciding whether the home is likely to meet their needs. Citizens who have been admitted to the home have been fully assessed, and can be assured that the home will endeavour to meet their individual needs and aspirations. EVIDENCE: Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 12 The registered provider has compiled a statement of purpose outlining the aims and objectives of the home, and the facilities and services it provides. This information is given to families and professionals considering a placement at Angel Home. The information includes a copy of the contract and the latest inspection report. A copy of the Statement of Purpose and the Service Users Guide is made available to each citizen. The registered provider stated that these had been reviewed in December 2007. However, neither document has been signed and dated to evidence that they have been reviewed and updated. A requirement applies. The home only accepts referrals following an assessment completed by a care manager, and then completes its own assessment. There have been 3 new admissions since the last inspection. The inspector examined the relevant files and evidenced the presence of both care management assessments and the home’s own assessments on citizens’ files. The provider/manager has previously confirmed the process that the home follows prior to any new admission. Following the referral, a care management assessment for the person is first obtained, together with any other information. The manager or deputy manager then visits him or her in their existing home environment, and an assessment is completed. The individual is then invited to visit the home, to look around and get the “feel” of the home. A further visit, with an overnight stay, followed by another overnight or weekend visit, are then arranged, to ensure that the person is reassured regarding the proposed placement and that it is likely to meet his/her needs. Throughout this process there is consultation with the resident group regarding their views of the potential new resident. If the individual then wishes to move in, and is felt to be compatible with the residents already living in the home, then an admission date is agreed. This involves discussion with the nearest relative(s) and the care manager. An initial review is held after the first six weeks of the placement, to ascertain how well the person is settling in and whether his/her needs are being met. The individual, his/her key worker, family and care manager are invited. A decision is then made regarding whether the admission should be confirmed as a long-stay one. Following admission, each person is being issued with a contract provided by the Local Authority, and a copy of the home’s own contract, which details conditions of residence and the services to be provided by the home. Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 13 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6 to 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Citizens are having their health, personal and social care needs and goals set out in an individual plan of care, with regular review taking place. Citizens are being enabled to participate fully in decisions that affect them and their day-to-day lives in the home. Citizens are being encouraged and supported to take risks and to develop an independent lifestyle. This is being reflected in detailed and comprehensive risk assessments. Citizens are being assessed regarding potential risks to their health and safety, and are enabled to take responsible risks wherever possible. EVIDENCE: Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 14 Each citizen has an individual plan, which is signed by the individual and their key worker. This is based on the individual’s initial assessment, and subsequent review, and details their likes, dislikes, interests and experiences. Plans are reviewed and revised on a three monthly basis. Each citizen has a statutory annual review, which is attended by the care manager. The deputy manager keeps a central record of review dates. The home’s manager and the deputy manager have attended the Person Centred Planning for facilitators course run by the London Borough of Sutton and Person Centred Planning principles have gradually been incorporated into the care planning process at the home. The inspector looked at a sample of care plans. These are being internally reviewed every six months and formally reviewed every 12 months. The care plans present as being person-centred and user-friendly, with pictures and symbols being used to help facilitate understanding. The home has a real ‘family’ atmosphere. Citizens are consulted as to their preferences and choices, and participate in daily activities within and outside of the home. The inspector met two citizens, both admitted within the last 12 months. Whilst unable to engage in conversation, both presented as having settled well, and seemed calm and reassured by the staff input. In this regard, staff were observed to be facilitative in their approach, and to be positive and caring in their interactions with the two residents. The home promotes citizen involvement, and to this end, there are regular 2-monthly service user meetings, with citizens being encouraged to attend. Notes are taken of each meeting and are placed in communal areas. The inspector examined a sample of citizens’ files and evidenced the completion of risk assessments. These are initially completed prior to admission, and detail areas of potential risk, and the actions required to minimise and manage these. Risk assessments are being reviewed and updated annually or, more frequently, if circumstances require. The risk assessment format provides comprehensive information regarding the different aspects of risk that citizens encounter in their daily lives, the actions required to manage these, and the date when the risk assessment was last reviewed. Risk assessments are reviewed on a regular basis, to which the resident’s key workers are encouraged to contribute. From his discussion with the manager/provider, and the feedback obtained from questionnaires and review notes, the inspector ascertained that citizens are being encouraged to develop their independent living skills within and outside of the home, and are enabled to access public transport and community facilities wherever possible. Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 15 The inspector is satisfied that information relating to citizens is being handled appropriately. The home has a policy covering confidentiality, with files being appropriately maintained and stored in lockable filing cabinets within a small lockable office. Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 16 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11 to 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Citizens are being enabled to participate fully, and to exercise choice and control in their daily routines and activities. Citizens are being encouraged to maintain contact with their family and friends, and to maintain links with the local community. Citizens’ rights and responsibilities are being respected and recognised in their day-to-day lives. Citizens are being offered choice and flexibility with meal arrangements. The quality of food is wholesome, nutritious and varied, with meals being taken in a pleasant and congenial setting. EVIDENCE: Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 17 The inspector viewed details of daily activities and commitments, these being recorded in residents’ files. There is an individual activity plan, which is developed in consultation with each citizen and which reflects his/her interests, wishes and preferences. The home’s citizens are enabled to access local day centres where they attend a variety of sessions depending on their individual interests and goals. The weekly activities programme is dependent upon individuals’ expressed interests and wishes, and includes activities such as swimming, horse riding and woodwork at Oaks Park. The activity plan for each citizen is reviewed at their annual review meeting, and updated to reflect changes in their needs or preferences. The home’s citizens are enabled to access community facilities. These are documented in the home’s activity book and include visits to the cinema, park, pub and local shops. Citizens also attend the Gateway Club and Tuesday Club, social clubs for people with learning difficulties. These provide the opportunity for wider social contact and recreational activities. Activities in the community can be accessed by the use of public transport, community buses and the taxicard scheme. The home organises occasional outings and day trips in the summer; these have previously included a day trip to Brighton and trips to various attractions and locations. Two citizens recently went on a day excursion to Bruges, and a day trip to Bournemouth is being planned for two other citizens. Citizens are consulted individually as to their wishes regarding trips away, and are assisted to take an extended break or holiday if they so wish. The home has a visitor’s policy, and from the views expressed, family members are made welcome when they visit. The home aims to encourage residents to maintain their contact with family and friends, and to extend invitations to organised events such as summer parties and barbecues. These tend to be held at the other (sister) group home (The Rafael), which has a larger garden. Citizens are encouraged to maintain contact with others in the community, and to develop friendships outside of the home. Citizens have developed close links with those at a sister home (‘The Rafael’), visiting each other regularly, and participating in joint activities. The home has a positive ethos. Feedback received indicates that citizens feel able to exercise a considerable degree of choice in their day-to-day lives, and that there are no unnecessary restrictions on their movements. It is part of the role of the staff team to encourage citizens at the home to maintain and develop their independent living skills. Individuals are encouraged to participate fully in daily routines and activities, and to assist with household tasks such as tidying their room, doing their own laundry, preparing food, laying table, or helping out in the garden. There are regular citizens’ meetings in which there is consultation and information sharing regarding citizens’ Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 18 preferences and choices, and regarding any issues that affect their day-to-day lives. Menus cover a four-week period, offering a balanced, nutritious and varied range of food. These include fresh vegetables and fruit. The menu is based on the expressed preferences of the resident group, and is agreed on a weekly basis. A menu board is displayed at the home. Alternatives to the main meal are provided, together with a choice of drinks and snacks throughout the day. Individual dietary requirements are monitored and taken account of when planning menus. Mealtimes are flexible dependent on the timing of daily activities and commitments of residents. Citizens are encouraged to assist with food preparation if they so wish. There is a pleasant communal dining area (within the main through lounge), with a large dining table, for “citizens” to take their meals if they so wish. Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 19 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18 to 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal support needs of citizens are being fully met, and are being carried out in a way that maintains their right to dignity and choice. Health action plans have been put in place, but require review. This should be done at least annually. Citizens are being protected by the home’s medication policy and procedures, and by the provision of accredited medication training for all care staff. EVIDENCE: The home has a friendly, homely feel with a small staff team, which works in shifts of two with the resident group of seven adults. Staff observed on the inspection presented as caring and supportive, and to be interacting in a positive way with those citizens who were present. The key worker system provides the opportunity for one to one support, with each individual being allocated two designated key workers. Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 20 The inspector examined a sample of care plans and individual plans. As detailed in the plans, there is a varied range of personal support needs that are being presented. The support offered is provided according to individuals’ assessed needs, wishes and goals. Information detailed in these plans, together with feedback provided from daily logs, care review minutes, and survey data, indicates that the home is addressing and meeting citizens’ health and support needs. The staff team at the home closely monitor the health of each individual and ensure that he/she receives any treatment needed. Key workers at the home note any health concerns that may arise and seek professional advice or help where this is required. Any health appointments are recorded on residents’ files. Care plans and review notes record the type and level of support required, with residents requiring varying degrees of assistance with their personal care. Since the last inspection there have been 3 new citizens admitted to the home, two of whom have severe learning disabilities and profound communication difficulties. The care plans evidence that support is being carefully tailored so as to meet their wishes and needs. The inspector is mindful, however, that staff would benefit from undertaking some specialised training regarding the communication difficulties associated with profound levels of disability, and developing skills for improving communication. A recommendation applies. Each individual at the home has completed a health questionnaire and been assessed by a community nurse. As a result, each citizen has had a Health Action Plan (HAP) put in place. This outlines his/her health needs and wishes in regard to their health care, and is designed to involve adults with learning difficulties more fully in the process of identifying their health care needs and how these may best be met. The inspector examined a sample of HAPs and noticed that the plans had not been formally reviewed. Each HAP should be reviewed at least 12 monthly, and should involve consultation with the individual, his/her relative/representative, the GP and key health care professionals who are involved. A requirement applies. In line with the person-centred approach, the home is evidenced to be respecting individuals’ wishes and preferences, and to be setting goals that are linked to their personal development and potential for independent living. Citizens are encouraged to maintain responsibility for their own personal care, hygiene and appearance, with encouragement, prompting or assistance being given where this is required. All citizens are given the choice of the GP that they may wish to register with. The home accesses dental care at Orchard Hill NHS Centre and a private chiropodist visits the home every six weeks. Residents also attend an eye clinic at Sutton Hospital on an annual basis. A record of dental and health checks is maintained on residents’ files, and all medical appointments are recorded in a Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 21 daily log. Staff are available to support citizens for hospital appointments as and when this is required. Each citizen attends a Well Woman/Well Man clinic for an annual check-up. There is close monitoring of each individual’s weight, with weight charts being maintained for all residents. The home has access to relevant professional support so as to address any behavioural problems that may arise, and maximise citizens’ independence and quality of life. This includes the provision of advice and guidelines for dealing with challenging behaviour from the Community Team for People with Learning Disability. One citizen, who has epilepsy, attends ongoing appointments at St Heliers Hospital for his condition to be monitored, and for his medication to be kept under review. In an emergency, an urgent appointment can be obtained. As a result of the treatment received, the individual’s epilepsy has become more controlled. A seizure chart is maintained by the home, a copy of which is kept at the day centre. Staff at the home have received training in epilepsy awareness. A pharmacist supplies medication to the home on a weekly basis and deals with the returns of medication. The home now uses the blister pack system for administering medication. The home’s GP completes an annual review of citizens’ medication, which includes a review of any homely remedies being used. These are recorded on record sheets and are updated accordingly. In keeping with good practice, there is a locked metal cupboard for the secure storage of any controlled drugs. One citizen, who has exhibited challenging behaviour, has been prescribed a controlled drug (Temazepan) on very rare occasions. All staff at the home have attended an accredited medication course. Updated medication training for all staff is scheduled to take place later this year. One citizen has been risk assessed and is entrusted and enabled to administer his own medication when away from the home at weekends. The inspector examined a sample of medication records, which presented as being satisfactorily maintained. All medicines administered are recorded on MARS (Medicine Administration Record) Sheets, with a medication profile being completed for each “citizen”. A photograph of the individual is attached to the front sheet. A medication protocol is also completed, with the GP or consultant signing for each type of medication that has been prescribed. Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 22 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an appropriate and well-publicised complaints policy and procedure in place. This assists citizens and their relatives/friends to raise any concerns that they may have. The home’s policies, procedures and practice indicate that citizens are being protected from abuse and are living in a safe environment. EVIDENCE: The home has a clear complaints policy, which includes the timescales and the process of the investigation. Each citizen is provided with their own copy of the complaints policy in their bedrooms. This is written in plain English, and uses Makaton symbols. The home has a good record and has not received any complaints within the last twelve months. The home maintains a complaints log, no complaints having been recorded since May 2003. The inspector observed two citizens during the inspection. While unable to engage the individuals in conversation, both presented as settled and content in their environment, with evidence of good and trusting relationships with the staff who were present. The inspector has not been made aware of any concerns regarding citizens’ safety or welfare. Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 23 The home has a whistle blowing policy and a copy of Sutton’s Safeguarding Adults Policy and Procedures. The staff team are made aware of the home’s complaints and safeguarding adults procedures, and of the need to report any incidents. The home is able to evidence that staff (both permanent and bank staff) have attended relevant training, and that staff are supported (through induction, training and supervision) to develop their awareness and understanding of safeguarding issues. Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 24 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 to 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Citizens live in a safe, hygienic and well-maintained environment with access to appropriate and sufficient communal facilities. Citizens’ rooms are safe, comfortable and pleasantly decorated, being suited to their individual needs. EVIDENCE: Angel Home is a residential care home, situated on a residential road in Sutton In 2006 the owners purchased the house next door and have converted the two semi-detached houses into an enlarged residential home. Since being reregistered on 6 November 2006, the home provides care and accommodation for up to nine citizens with a learning disability. Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 25 The inspector completed an inspection of the premises. The home presented as being clean, hygienic and comfortable throughout, and to be providing the quality of environment, and facilities, with which to meet the needs of the resident group. The environment was observed to have a very ‘homely’ feel, with citizens presenting as settled and comfortable in their surroundings. No health and safety concerns were identified. The accommodation is arranged over two floors. On the ground floor there is an enlarged open lounge and diner. This is arranged into two separate living areas, each with its own television. There is also a kitchen, small office, and laundry room, with access via the kitchen and lounge/dining room to a garden and patio area. The home is well lit and ventilated, with domestic lighting being present throughout the home. Included in the new extension is a ground floor reception area and a small area on the first floor set aside for seeing visitors. With the expansion of the home there are now nine bedrooms, four of which (all in the new annexe) are ensuite. All bedrooms include hand washbasins. Each of the home’s citizens has a single room, which is decorated and personalised to reflect their individual taste. Each bedroom has a single bed, wardrobe, chest of drawers and a comfortable chair. Individuals personalise their rooms with posters and photographs, and with personal possessions such as television sets and audio equipment. The bedrooms are naturally ventilated and are equipped with window restrictors. The enlarged lounge and dining area presents as being pleasantly decorated and arranged, being furnished with domestic style furniture, and with homely lighting. This area is divided into two separate sections, each with its own sofa and armchairs, and television, presenting as a very homely and congenial environment. Two citizens were observed to be relaxing in the lounge on their return from the day centre, and presented as being comfortable and at ease in their environment. There is a first floor bathroom/toilet, and a shower/toilet on the ground floor. The first floor bathroom is designed to enable assisted bathing should this be required. These facilities are lockable to allow for privacy, and include an overriding device in case of emergency. The bathroom and toilet facilities presented as being clean and hygienic. With the ensuite facilities that are provided in the four new bedrooms, the facilities are assessed as being sufficient for meeting the needs of the home’s citizens. The home has appropriate laundry facilities situated in a separate lockable laundry room. The facilities are kept separate from the kitchen and the preparation of food. The home has purchased a new, more efficient washing machine that is capable of washing clothes at high temperatures. The laundry Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 26 has suitable flooring. There is a locked COSSH cupboard for cleaning agents and products that are hazardous to health. The home last had an Occupational Therapy assessment in June 2006 when it was found to have sufficient aids and adaptations to meet the present residents’ needs. There is an accessible bath on the first floor should this be required at any time. There is also a ramp in the garden, which would allow access to wheelchair users via the back garden. The home generally presented as being clean and hygienic. All staff are provided with training in infection control. The home has policies and procedures covering the disposal of clinical waste. Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 27 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 to 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Generally, citizens are having their needs well met by an effective, appropriately trained and qualified staff group. However, staff should undertake updated training regarding the needs of individuals with learning disabilities and those who present severe communication difficulties. Generally, citizens are being well protected by the home’s recruitment policy and procedures. However, the home must ensure that it observes correct procedures with regards to criminal records checks. Citizens can be assured that their needs are being safeguarded, through staff being appropriately supported and supervised on a regular basis. EVIDENCE: The home has a small staff team comprising of the manager, 10 care staff, and 3 bank staff. The staff complement covers both this home and its sister home, The Rafael (which has 3 residents). The home has a stable and appropriately Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 28 qualified staff group and does not use temporary or agency staff. Staff job descriptions are comprehensive in their content and are linked to achieving citizens’ goals, as set out in their individual care plans. Staff work closely as a team, and possess relevant qualifications and training. Staff communicate routinely, and have regular two monthly meetings. Staff are being encouraged to develop their knowledge and skills and to obtain NVQ care qualifications. The manager confirmed that, of the 10 members of staff, all have now obtained an NVQ Level 2, while 3 (including the manager and deputy manager) have obtained an NVQ Level 3. The manager stated that 2 other staff are presently studying for their NVQ Level 3. One staff member is currently undertaking training as a qualified nurse. The manager/provider is an NVQ Level 3 qualified assessor and has completed studies leading to the award of the Registered Manager’s Award and NVQ Level 4. The home is evidenced to have the numbers of staff on duty with which to meet the needs of the residents. With the increase in the resident group from 4 to 7, there are now 3 members of staff on duty at any one time, apart from the hours on weekdays when residents attend their day activities. There is one waking staff member throughout the night, with back-up being available from either the manager or deputy manager, one of whom is on-call if required. The duty rota was examined and evidenced to include 3 on at all times during the day on weekdays, when residents are around, and throughout weekends. The inspector evidenced that citizens are being protected by the home’s recruitment procedures and practices. 5 new staff (including 3 bank staff) have been recruited since the last inspection. The inspector examined the relevant staff files and found that all employment and identity checks had been satisfactorily completed . The home is generally completing criminal records checks, but in two cases no CRB certificate had been received. One of these has yet to commence employment, while the other has had a POVA check and is working under supervision. The inspector made it clear that no-one can commence employment at the home without a CRB. The manager stated that the individual concerned has completed all other checks (including a POVA check) and that steps had been taken to have the person supervised at all times by an experienced staff member. Subject to the assurances received, the inspector agreed to sanction the appointment on this occasion. However, the manager must, in future, seek the approval of the inspector (in writing) for permission to start the staff member. This is discretionary and is subject to all the other checks having been completed, and assurances given as to the ongoing supervision of the staff member, and the prevention of any one-to-one contact within the resident group. Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 29 New members of staff complete an induction programme. This covers various subjects including health and safety, fire drills, and introductions to service users and other staff. The induction programmes are signed, dated and kept on staff files. The home has an ongoing training programme, a copy of which was shown to the inspector. A record is kept of the training which each staff member undertakes. This includes training in medication, vulnerable adults protection, mental health and learning disability, and courses in food hygiene, infection control, health and safety and first aid. The inspector was advised that training in epilepsy awareness is scheduled for 17 June, and that staff are on LB Sutton’s waiting-list for updated training in medication and safeguarding adults. Infection control training is also planned for all staff. It is also hoped to roll out training in Person Centred Planning to all staff in the longer term. There have been 3 new admissions to the home, two of whom present profound difficulties with communication. The inspector identified the need for updated training regarding the care and support needs of people with learning difficulties. And for updated training regarding the communication needs of people who experience difficulties with communication. Recommendations apply. The inspector spoke with two support workers who were on duty. The feedback received indicated that staff feel that they are being well supported and that they are receiving regular supervision and training. One support worker, who has worked in the home for a year, said that she had learned a great deal in the time that she had been there, and that she had been able to develop her understanding of the needs of this client group. All staff agree a supervision contract, which they sign. There is regular twomonthly supervision, with supervision records detailing issues discussed and actions agreed. Staff also receive an annual appraisal (called a “Performance Review”). Following a recommendation from the last inspection, the process has been developed with a pre-assessment self-evaluation questionnaire having been introduced. The manager felt that this had proved helpful in enabling staff to identify their strengths and weaknesses, and that it had assisted in highlighting those areas where further support or training could be of benefit. Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 30 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 31 37 to 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Citizens are living in a home that is generally being well managed and run in their best interests, and which provides an open, positive and inclusive atmosphere. The home has been developing its quality assurance processes so as to demonstrate that it is obtaining widespread feedback regarding the extent to which it is supporting citizens and meeting its aims and objectives. A Development Plan does, however, need to be put in place for 2007-08. Generally, the rights and best interests of the home’s citizens are being protected by the home’s policies and procedures However, some of these have not been reviewed for several years and need to be reviewed and updated. The rights and best interests of citizens are being safeguarded by the home’s record keeping. The health, safety and welfare of citizens are being appropriately protected. The home’s Fire Risk assessment has been revised and updated. EVIDENCE: The registered provider and manager, Mrs Christine Mouralidarane, has had extensive management experience in the residential care sector. Mrs Mouralidarane has worked for 12 years with people with learning difficulties, and has developed relevant knowledge, skills and management experience. She has also had extensive previous experience of working with the elderly in care homes. Mrs Mouralidarane has an NVQ Level 3 and is a qualified NVQ Assessor. In December 2007, the manager completed her studies leading to the award of the Registered Manager’s Award and NVQ Level 4. From the evidence of this and the previous inspection, it would appear that the home is being managed in a caring, competent and professional way. The atmosphere in this small group home is evidenced as being open, positive and inclusive, with citizens presenting as settled, well supported and cared for, and able to exercise choice and develop their interests and abilities. A personcentred approach is much in evidence in the drawing up of individual care plans and activity schedules. Staff receive appropriate training and support, and present as being caring and knowledgeable in carrying out their duties. Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 32 The home has been continuing to develop its quality assurance processes. Questionnaires are completed with all the home’s citizens on a six-monthly basis, and there is regular canvassing of views both individually, by the key workers, and collectively, at citizens’ meetings. The questionnaire is a very user-friendly format, using pictures and symbols, and covers a range of subjects relating to their day-to-day lives in the home. Feedback from relatives and friends, and from care managers, is provided at annual reviews. There were two requirements from the last inspection, which have both been met. The home has developed a questionnaire for distribution to relatives and friends, and another questionnaire for visiting professionals and care managers to complete. The inspector viewed a sample of completed questionnaires. A Development Plan for 2006-07 has been completed. The home has also been collating the feedback which it has been receiving over the last 12 month period, but still needs to put a Development Plan in place for 2007-08. A requirement applies. The rights and best interests of citizens are being safeguarded by the home’s record keeping, with generally comprehensive, up to date and accurate records being maintained. The inspector viewed a wide range of records and documentation. Staff and service user files were found to be well maintained and well structured. Confidentiality is being protected with files being located in lockable cabinets within a separate lockable office. Following a recommendation from the last inspection, a checklist of all policies and procedures has been put in place. However, specific dates when policies and procedures were last reviewed still need to be put in place. On inspection, it was found that several of the home’s policies have not been reviewed for some years and need to be reviewed and updated as a priority. A requirement applies. The inspector completed health and safety checks with updated certification having been provided for fire inspection, and the emergency call system (6/12/07), gas (21/9/07), electrical installation (16/8/06) and portable electrical appliances (7/7/07), food hygiene and environmental health (13/5/08) and legionella (30/10/07). There are daily fridge/freezer and oven temperature checks, and daily water temperature checks, these being recorded in relevant logs. The home maintains weekly checks on all electrical and other equipment in the home, and last completed a Health & Safety audit on 2/10/07. Following a requirement from the last inspection, the Fire Risk assessment was updated on 6/8/07. Fire alarm checks are being completed weekly, together with regular weekly checks of emergency call alarms. Fire drills are being carried out on a regular weekly basis, and include 3 monthly drills at night. No health and safety concerns were identified. Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 33 Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 34 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 2 2 3 3 X Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 35 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 6 Requirement Information. The home must ensure that the Statement of Purpose and Service User Guide are signed and dated, so as to evidence when these documents have last been reviewed and updated. 2 YA6 12 (1) & (2) Health Action Plans. The home must ensure that the health care needs of residents, as detailed in their Health Action Plans, are being annually reviewed and updated. 3 YA39 24(1)a) &(b),(2)&(3) Quality assurance. A Development Plan, for the year 2007-08, must be put in place. A copy of the Development Plan should be forwarded to the CSCI. 31/12/08 31/07/08 Timescale for action 30/06/08 Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 36 4 YA40 12(1) Review of Policies and Procedures In order to protect the safety and best interests of residents, the home must ensure that all of its policies and procedures are kept under review, and updated where necessary. Those that have not been reviewed for some years must be prioritised for review. 31/12/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA35 Good Practice Recommendations Training. All staff at the home should undertake updated training regarding the care and support needs of people with learning difficulties. 2 YA35 Training. All staff at the home should undertake updated training regarding the communication needs of people who experience difficulties with communication. 3 YA41 Review of Policies and Procedures. The inspector recommends that a checklist of all policies and procedures is put in place. This should detail the date when each policy and procedure was last reviewed, and note whether or not each one has been revised. Partly met. While a checklist has been developed, specific dates as to when policies and procedures were last reviewed should be Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 37 entered. Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Angel Home DS0000007204.V364793.R01.S.doc Version 5.2 Page 39 - 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. 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