Care Home: Apna Ghar

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What the care home does well The provider/manager is receptive to advice and suggestions made and demonstrates an eagerness to put right any matters requiring attention. The home provides a vital and specialist service in a homely environment to three Asian residents. The residents are appreciative of the cultural and spiritual support they receive at the home. Comments include "We like living here", "It`s just like home" and "Everything is available in Apna Ghar". What has improved since the last inspection? Recommendations made following the last visit to the home have now been complied with. Almost all the staff are now trained to NVQ level II care, which should ensure they are appropriately qualified to support the residents in living their lives to the full. What the care home could do better: The home should continue with its policies and procedures review to ensure they are fully compliant with current legislation and good practice. The medicine storage should be reviewed to ensure the efficacy of some medicines is not compromised, leading to possible ineffective treatment for residents. To ensure effective audit trails are in place with regard to healthcare needs, some care documentation needs to be reviewed and enhanced. CARE HOME ADULTS 18-65 Apna Ghar 1 Kingswood Road Gillingham Kent ME7 1EA Lead Inspector Elizabeth Baker Unannounced Inspection 20 February 2008 09:55 Apna Ghar DS0000028849.V359135.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 Apna Ghar DS0000028849.V359135.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. Apna Ghar DS0000028849.V359135.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Apna Ghar Address 1 Kingswood Road Gillingham Kent ME7 1EA 01634 850445 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) Mrs Nilofer Englefield vacant Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (2), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (1) Apna Ghar DS0000028849.V359135.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One (1) Person over 65 with Mental health Difficulties. Two (2) People with Mental Health Difficulties. 26th February 2007 Date of last inspection Brief Description of the Service: Apna Ghar is a small privately run home situated a few minutes walk from the centre of Gillingham and the train station. It has easy access for all local amenities. The home comprises of a semi-detached property on a corner plot with homely accommodation situated over two floors. It offers 24 hour care for people with mental health difficulties of ethnic minority and this is reflected in the care and support provided by the management and small stable staff team. Current fees range from £400 to £425 per week according to assessed personal need. Additional charges are payable for taxis, toiletries, holidays and satellite/cable TV. Activities currently include yoga, board games, Asian art programmes, overseas trips and external trips to Asian Cultural Shows, Asian Musical Shows and trips to London Cinemas to see Asian films. A copy of the latest inspection report is available on request at the home. Apna Ghar DS0000028849.V359135.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This is the first key unannounced visit to the home for the inspection period 2007/08. Allocated inspector Elizabeth Baker carried out the visit on 20 February 2008. The visit lasted about three and a half hours. As well as briefly touring the home, the visit consisted of talking with two residents. One of the residents was later interviewed in private. At the time of the visit the provider/manager was on duty. Verbal feedback of the visit was provided to the provider/manager during and at the end of the visit. At the time of compiling the report, in support of the visit, the Commission received survey forms about the service from the three residents. At the Commission’s request the provider/manager completed and returned the home’s first Annual Quality Assurance Assessment (AQAA). Some of the information gathered from these sources has been incorporated into the report. The home continues to run at full occupancy. What the service does well: What has improved since the last inspection? Recommendations made following the last visit to the home have now been complied with. Almost all the staff are now trained to NVQ level II care, which should ensure they are appropriately qualified to support the residents in living their lives to the full. Apna Ghar DS0000028849.V359135.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Apna Ghar DS0000028849.V359135.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Apna Ghar DS0000028849.V359135.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Residents who use the service experience good outcomes. This judgement has been made using a range of evidence including a site visit to this service. Residents know Apna Ghar will support their goals and aspirations. EVIDENCE: The three residents have lived at the home for a number of years and intend to do so for the foreseeable future. Therefore it was not possible to ascertain precisely the process for pre-admission assessment purposes. However appropriate assessment information was in place within the residents’ files examined. Care Programme Approach (CPA) care plans, risk assessments and background information was available. Apna Ghar DS0000028849.V359135.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Residents who use the service experience good outcomes. This judgement has been made using a range of evidence including a site visit to this service. Residents are enabled and supported in living an independent life as is possible. EVIDENCE: The resident’s files inspected contained CPA documentation, contracts, risk assessments and other supporting documents. The CPAs are reviewed six monthly. This is undertaken by the respective care co-ordinators, with input from the residents and staff. Relatives are invited to attend the reviews. To supplement the current CPAs the provider/manager has just commenced introducing additional care plan components. This should enhance the current system in that for a resident with diabetes there was no clear care plan for this condition, although information was available but kept in different places. Bringing all this information together should provide a better audit trail of all care provided to reflect current assessed needs of residents. The care records inspected contained risk assessments. However the current format does not allow for clear evidence of reviews having taken place. Having this information Apna Ghar DS0000028849.V359135.R01.S.doc Version 5.2 Page 10 would help the home in evidencing all risks are appropriately reviewed, if an investigation was required to be carried out. Good daily statements are recorded providing a detailed picture of residents’ quality of day and experiences. All residents are independent and self-caring, with minimal support required from staff. Two of the residents maintain their own finances and a local authority is the appointee for the other resident. Residents were seen going about their daily routines in a relaxed but purposeful manner. Apna Ghar DS0000028849.V359135.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Residents who use the service experience good outcomes. This judgement has been made using a range of evidence including a site visit to this service. Links with the community are good and support and enrich residents’ social, occupation and development opportunities. Residents benefit from a wide variety of lifestyle choices and with appropriate staff support where needed. EVIDENCE: Residents regularly attend venues, which are important to them. This includes the Sikh and Hindu Temples, cinemas to watch Asian films, cultural and religious festivals, and a day centre. Where possible, residents are supported in making home visits. Two residents have just attended a one-day computer awareness course and action is now being taken to facilitate computer training provided by the nearby Adult Education centre for one of the residents. Two of the residents visit the nearby library to read Asian papers and magazines. The home had endeavoured to have these delivered to the home, but the number required did not make it viable for the newsagent to provide them. Two of the residents enjoyed an overseas holiday last year and it is proposed Apna Ghar DS0000028849.V359135.R01.S.doc Version 5.2 Page 12 that this will be repeated. The resident spoken with said residents go to bed and get up when they want to. Residents are involved in deciding the daily menus and assist in the shopping and preparation of meals. Meals are appropriate for resident’s cultural preferences. The home’s routines are flexible enabling residents to practice their spiritual needs, which are very important to them. Apna Ghar DS0000028849.V359135.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Residents who use the service experience good outcomes. This judgement has been made using a range of evidence including a site visit to this service. Residents receive personal support in accordance with their needs, wishes and preferences and can feel confident they are fully supported with their healthcare needs. EVIDENCE: The three residents are independent and require minimal prompting and support, although staff are available to provide encouragement where there is a need. Residents are supported in attending appointments and consultations with health care professionals. Care records inspected contained evidence of residents being supported by the home in obtaining more health checks and appointments than were originally offered by the healthcare professionals. This is good practice. The two residents seen were dressed appropriately to the level of detail where this is important to them. Manicure, pedicure and Apna Ghar DS0000028849.V359135.R01.S.doc Version 5.2 Page 14 make-up sessions are provided so residents feel appropriately presented for some of their religious festivals. Three medicine administration record (MAR) charts were inspected. The charts evidenced medicines are being administered. However it was identified on this visit that when a change to the prescriber’s administration instructions is made, the handwritten revised instruction does not contain details of who authorised the change, who made the change and the date the change was made. Medicines are kept in a lockable metal cupboard in an area, which could possibly affect the efficacy of some medicines with regard to temperature and humidity. Advice about medicine storage is included in the Royal Pharmaceutical Society of Great Britain’s publication The Handling of Medicines in Social Care. This is available from the Society’s website. Additional information about medicine management is also available from the Commission’s website. Patient information leaflets are retained and used for reference purposes. This is good practice and provides care staff with vital information and indications of possible side effects. Indeed one such incident has recently been brought to the attention of a GP resulting in the resident receiving more medical monitoring. Apna Ghar DS0000028849.V359135.R01.S.doc Version 5.2 Page 15 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. Residents who use the service experience good outcomes. This judgement has been made using a range of evidence including a site visit to this service. Residents can be sure their concerns are listened to and acted upon. EVIDENCE: The returned AQAA document indicates the home has not received any complaints about the service in the last 12 months. The Commission has not received any complaints about the service. Although care staff were not available for interview on this occasion, the training schedule supplied at the time of the visit identified all staff had received adult abuse training. The provider/manager said the home has a current copy of the county’s multiagency Adult Protection policies and procedures. All three returned resident surveys indicated the respondents knew how to make a complaint and who to speak to if they were not happy. The care records seen included a copy of the home’s complaints procedure. Apna Ghar DS0000028849.V359135.R01.S.doc Version 5.2 Page 16 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 and 30. Residents who use the service experience good outcomes. This judgement has been made using a range of evidence including a site visit to this service. The standard of the environment is good providing residents with a homely and comfortable place to live. EVIDENCE: The provider/manager ensures the home is kept in a good decorative order. The home is warm, clean, tidy and odour free. All residents have a single bedroom located on the first floor. The bedrooms are appropriately furnished and decorated. The AQAA indicates the home has an infection control policy. All three residents are independent and self-caring. Through discussion it was identified that home does not have a copy of the guidelines published by Kent Health Protection Unit specifically for care homes. Contact details were provided to the manager. Having a current copy of the guidelines may assist the home in developing current infection control policies further, particularly if any of the residents required more personal hygiene support in the future. Last year the home had visits from representatives of the Environmental Health Department and Kent Fire and Rescue Service. The manager/provider Apna Ghar DS0000028849.V359135.R01.S.doc Version 5.2 Page 17 reported that these agencies were satisfied with the home’s practices and systems. Apna Ghar DS0000028849.V359135.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Residents who use the service experience good outcomes. This judgement has been made using a range of evidence including a site visit to this service. Residents’ care, social and emotional needs are promoted by a stable workforce in such numbers that meet their needs. EVIDENCE: Apart from one carer, all staff are now trained to NVQ level II in care. This is good practice and should ensure residents receive appropriate care and support. Since the last visit a schedule is now maintained of staff’s current training. A review of this during the site visit identified staff had received training on subjects including health and safety, first aid, adult abuse and infection control. However it was noted that there has been no training to reflect the new Mental Capacity Act, which came fully into force from October 2007. As the home is registered for mental disorder, it is important this matter is addressed. The home employs a small stable workforce reflecting the needs of the current residents. There have been no new appointments since the last visit. No ancillary staff are employed and domestic duties are carried out by care staff and or with input from the residents. During the day the home is manned by at least one awake member of staff and for certain periods two members of Apna Ghar DS0000028849.V359135.R01.S.doc Version 5.2 Page 19 staff are rostered. One sleep-in member of staff covers night duty. The arrangement is adequate for the current needs of the three residents. Following a recommendation made at the last visit, the home’s employment application form has been amended to include the comment that gaps in employment histories must be recorded. As the provider/manager is eager to fully comply with regulation it was suggested the provider/manager accesses the Commission’s website to obtain a copy of the two InFocus documents issued in 2006, and published to assist services in the development of recruitment procedures and practices. The documents in question are called Safe and Sound? Checking the suitability of new care staff in regulated social care services and Better safe than sorry – Improving the system that safeguards adults living in care homes. Staff are provided with a copy of the General Social Care Council’s code of conduct. In addition to English versions, versions have also been obtained in Hindi and Urdu, to reflect the backgrounds of current staff and residents. This is good practice. Induction records were seen in the records inspected. The provider/manager shadows new staff for a month as part of the home’s induction practice. It was suggested the home checks the Skills for Care website to ensure current induction arrangements reflect what is now expected of care home employees. Apna Ghar DS0000028849.V359135.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Residents who use the service experience good outcomes. This judgement has been made using a range of evidence including a site visit to this service. Residents’ benefit from a well run home. EVIDENCE: The provider/manager has run the home for a number of years, is appropriately qualified and possesses the knowledge and experience of the home necessary to fulfil her role. The home is run in the best interests of residents. “House” meetings were introduced so residents could voice their views and opinions of the service. But this turned out to be less successful than first thought. Residents prefer to meet regularly with the provider/manager on a one to one basis so they can discuss any issues they may have. Recorded evidence was seen that residents are asked for their views on how they feel the service has improved their quality of life. Surveys are available for healthcare professionals to complete Apna Ghar DS0000028849.V359135.R01.S.doc Version 5.2 Page 21 when they visit the home. Residents were seen coming and going freely during the visit. The provider/manager discusses the contents of inspection reports with the residents to seek their views on how they felt the visit went and how the home is doing. All three residents are independent and fully mobile, so lifting and moving and handling equipment is not currently required. Two fire safety officers visited the home last year. Following advice given, the home produced a fire risk assessment. A follow up visit by the officers identified the document was appropriate for this particular home. Following clarification of a number of AQAA points during the visit, it was established that the home’s equipment is serviced/maintained as recommended by the manufacturer or other regulatory bodies. Apna Ghar DS0000028849.V359135.R01.S.doc Version 5.2 Page 22 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 X 2 3 3 X 4 X 5 X 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 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 4 X 3 X X 3 X Apna Ghar DS0000028849.V359135.R01.S.doc Version 5.2 Page 23 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard YA6 YA9 YA20 YA34 YA35 Good Practice Recommendations It is strongly recommended that care plan components are composed and be available to reflect all current assessed needs, including diabetes. Risk assessment formats should be reviewed to allow for clear recording of reviews. It is strongly recommended that medicine storage facilities be reviewed to ensure the efficacy of medicines is not compromised, due to heat and humidity. It is recommended that the manager fulfil the stated intention of reviewing recruitment documentation and records to ensure full compliance with regulation. It is strongly recommended that all staff receive Mental Capacity Act training. Apna Ghar DS0000028849.V359135.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Apna Ghar DS0000028849.V359135.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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