Care Home: Arnold House

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CARE HOME ADULTS 18-65 Arnold House 154 Shooters Hill Rd Blackheath London SE3 8RP Lead Inspector Miss Rosemary Blenkinsopp Key Unannounced Inspection 17th and 26th January 2009 10:30 Arnold House DS0000006753.V373110.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 Arnold House DS0000006753.V373110.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. Arnold House DS0000006753.V373110.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Arnold House Address 154 Shooters Hill Rd Blackheath London SE3 8RP 020 8319 4084 020 8319 8752 greenwichoffice@milburycare.com www.voyagecare.com Milbury Care Services Ltd 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) Mr Olufemi Adeyemi Akinwale Care Home 23 Category(ies) of Learning disability (23) registration, with number of places Arnold House DS0000006753.V373110.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 with nursing (CRH - N) 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: 23 2nd February 2007. Date of last inspection Brief Description of the Service: Arnold House is one of a group if six homes for adults with a learning disability, who are resident in the London Borough of Greenwich. It is managed by Milbury Care Services Limited, and has links with the Greenwich Community Learning Disabilities Team. The home is registered for twenty-three residents, and eight named individuals are over the age of 65. The home is a modern, two-storey building divided into four flats, two on each floor. The flats have interconnecting doors between the lounge areas, and these are open during the day to allow the residents to socialise. Each flat functions as a separate unit with its own Home leader, staff group, communal facilities and front door. Each flat contains five bedrooms, a bathroom, shower room, laundry, kitchen and ‘quiet room’. There is a large communal garden to the rear, and a drive at the front with parking for several cars. The home is close to a parade of shops, and buses run past the door towards the shopping centres of Lewisham and Woolwich. A single storey building attached to the home contains the administrative offices for Milbury Care Services, and a large room that is used for staff meetings, social events and training purposes. The weekly fees are £ 426 .00 this excludes toiletries, hairdressing, activities Arnold House DS0000006753.V373110.R01.S.doc Version 5.2 Page 5 and holidays. Arnold House DS0000006753.V373110.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of the service is 2 star. This means the people who use this service experience good. The inspection was conducted over two one day periods. The first visit was a Saturday, which allowed us to spend time with residents and staff observing interaction activities and meeting visitors. Periods of observation were undertaken in two flats. The second visit was by appointment and the manager facilitated this site visit. Prior to the inspection the manager had completed the AQAA and forwarded this to the CSCI. Nineteen comment cards were returned prior to the inspection including seven from residents, two from health professionals and ten staff. During the visit the inspector met with staff and several residents. Positive comments were included in the comment cards and these are included under relevant sections of the report. Staff were interviewed as part of the site visit. All of the information obtained from the sources identified above has been incorporated into this report. A selection of documents were inspected including care plans, staff personnel files as well as health and safety records. Feedback was provided to the manager at the end of the inspection. Other information which has been considered when producing this report and rating, is the information supplied and obtained throughout the year including Regulation 37 reports and complaints. What the service does well: The home has retained a very stable staff team, which for learning disability residents is essential to provide consistency in care, as change often prompts deterioration in behaviour. Staff in the home were knowledgeable about their key residents and the care and support they needed. Information received from members of the visiting multi disciplinary team – was positive in respect of the service provided, staff approach and attitude to residents. Arnold House DS0000006753.V373110.R01.S.doc Version 5.2 Page 7 The environment is well maintained which is difficult with this type of client and particularly the amount of equipment in use. Bedrooms were very personalised and reflective of resident’s personal tastes. What has improved since the last inspection? 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. Arnold House DS0000006753.V373110.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Arnold House DS0000006753.V373110.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The pre-admissions procedures provide residents with a range of information, including visits to the service, to assist their decision making process, and enable them to decide whether the service is right for them. Staff are provided with comprehensive information on which they can base an initial care plan and address resident’s needs. EVIDENCE: The home was in the process of undertaking assessment procedures for a potential new admission. The assessment process is a lengthy one and involves obtaining information from all parties involved with that resident and includes multidisciplinary team members. The prospective resident is invited for several pre admission visits to enable them to meet other resident’s staff and familiarize themselves with the service. This also provides an opportunity for staff to meet the resident. Relatives are invited to be involved with the process to assist the resident to settle as well as providing valuable information about them. Arnold House DS0000006753.V373110.R01.S.doc Version 5.2 Page 10 Within the files seen the assessment information was comprehensive including multidisciplinary team reports, the Community Care Assessment and specialist information such as a report from a sensory assessment undertaken. The manager would undertake an assessment once the referral from the Community Learning Disability Team had been received. It is from this source that all referrals are made there is no direct referral system to this service. There is a close working relationships between the home and the multi disciplinary team in order that assessment is as smooth as possible for the new resident and those already living in the home. Once admitted residents have allocated key workers and advocacy procedures implemented to ensure their well-being is looked after. Comments within the residents comment cards indicated that they were involved with decision on placement and they had had an opportunity to sample the service prior to admission. Information on the service is available in pictorial formats. The Service Users’ Guide is in large print with pictorial aids. Residents are issued with service agreements outlining what will be provided for them. In one contract seen there was the signature of the manager although none for the resident or the advocate. Where it is not possible for the resident to sign then their advocate or next of kin should be involved and sign the document to afford the resident protection. Arnold House DS0000006753.V373110.R01.S.doc Version 5.2 Page 11 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. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The information in care plans enables the staff to plan and deliver the care. Residents are enabled to make decisions on how they live their lives . Risk assessments ensure residents are safe to engage in all activities of daily living. EVIDENCE: Each resident has an individual plan of care. The care plans are in the process of being reviewed to include more comprehensive information and have supporting risk assessment for all elements of daily living. Care plans were randomly inspected. The new care plans will, when completed provided comprehensive detail on the care to be given. Reassessment of individuals needs and the introduction of new support plans will take some time not only to implement, but to ensure staff are familiar with their use. Those care plans viewed included personal details including a description and photo of the Arnold House DS0000006753.V373110.R01.S.doc Version 5.2 Page 12 resident, comprehensive information on likes and dislikes, not only food preferences but activities, daily routines interests and hobbies. All of this information will inform a personal and individual care plan which staff can address. The daily records were to a reasonable standard although they need to have full signatures instead of initials signed. Information relating to wishes in the event of death were recorded detailing preferences funeral director and anything specific that was known. Residents in this home have different levels of ability some are able to go out unaccompanied whilst others need staff support. Risk assessments cover all aspects of the activities of daily living these reflect the support required to minimise harm. Residents are allocated key workers who coordinate their care. The key worker would work closely with the resident forming a good relationship and have a comprehensive knowledge of their needs. Changes to their care and support would be where possible discussed with the resident and the family. Residents have assistance with personal care met by staff in the service. Male and female staff are employed to address gender issues. It was evident staff promoted independence enabling residents not fostering dependence by doing for them. Their approach varied depending on the resident’s ability and level of communication. One comment included in a survey received from a health professional was as follows: There is a high level of awareness of clients needs. Staff are responsive and always comply with professional advice “. Another one commented “staff are responsive and welcoming”. Arnold House DS0000006753.V373110.R01.S.doc Version 5.2 Page 13 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. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Residents are well supported with all activities of daily living to maximise personal development and enhance rehabilitation for more independent living. Open visiting promotes and encourages residents to maintain social networks. EVIDENCE: It was clear during the time spent within the flats that residents were enabled to be as independent as possible with choices promoted. Staff in this facility know the residents very well their likes, dislikes and address their support individually. Within comment cards received from residents the following comments were made Arnold House DS0000006753.V373110.R01.S.doc Version 5.2 Page 14 “I get asked what I would like to wear and decide on a bath or a shower”, “I like watching TV and used to like making a cup of tea but not now ‘cos of ill health. “ Very happy – like coming back home for me “. “I go to church every Sunday and have trips out _ my bedroom is nicely decorated”. During the Saturday visit several of the residents were watching TV in the lounge areas. Some were going out – one man returned at lunchtime he is able to go out unaccompanied and said that he visits many places. Another resident has a job cleaning in another home he enjoys it and this further increases his independence. The following was included in the AQAA: “Service users have individual activity plans; they are supported to attend colleges - i.e. adult education centres, day centres, social night clubs. Support with different activities i.e. exercise group, voluntary jobs, going on holidays, have budgetary planning with some service users, maintain good relationship with local community and church. Support service users to attend church as they wish and having church home group regularly. Support service users to be politically aware and vote, enjoy having regular parties i.e. celebrating individual birthdays, support service users to develop and maintain relationship, ensure that service users enjoy chosen balanced diet. Suitably trained staff are provided. They dressed and groomed to individual preferences and taste”. The fridges and freezers well full of varied good quality foodstuffs. Fresh fruit and vegetables were available and we were advised that the home focuses on healthy eating with fresh produce included. Menus to reflect individual dietary and cultural needs and preference, during the lunchtime it was observed that many variations on the menu were provided to residents. Drinks were supplied during and after the main meal. The menu seen did not include a written choice although this was evident, staff and residents confirmed this to be the case. Three residents with whom we spoke did comment that they liked the Chinese take away food, which is something the home organises for them regularly. Currently there are no residents who are able to make their own meals or drinks. Residents are supported to develop and maintain personal relationships within and outside the house. Residents are able to engage in activities of their choice both within the house and outside in the wider community. Residents advised us that they took part in a range of activities. They told us about their holidays abroad including America, France, Spain as well as UK breaks. Activities including attending day centres, local events visiting family and friends were referred to by residents. Birthdays are celebrated with a Arnold House DS0000006753.V373110.R01.S.doc Version 5.2 Page 15 party where relatives and friends are invited. There had been such a celebration recently the resident told us. There is a local church, which some residents attend. One resident stated that they had been in other Milbury services although liked it here. He said that he attends a day centre five days a week and has many friends there both staff and other residents. The majority of residents have their own telephone, which enables them to contact family and friends. Visiting is open and encouraged. Many visitors had been to visit their relative over Christmas. The home has it’s own mini bus with allocated drivers this makes it easier for outing instead of reliance on public transport which can be unreliable. Arnold House DS0000006753.V373110.R01.S.doc Version 5.2 Page 16 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. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Health care is provided through the local community, which promotes resident’s rehabilitation and engagement with services. Medications are safely managed by staff that are trained and proficient to do so. EVIDENCE: The facility has residents aged between 50 years and 87 years with varying degrees of ability. It was clearly evident during staff interviews and the periods of observation that staff had a good undertstanding and knowledge of residents needs. They were fully aware of how to address the personal care and support they required. The staff were observed do this in a caring an sensitive manner whilst promoting independance. The home has a team of qualified nurses who are qualified in different areas general nursing as well as learning disability this provides a good skill mix from which to address resident’s needs. In addition staff have first aid training and there is always a first aid trained staff on duty. The community learning disability team work closely with service and support them when necessary. Arnold House DS0000006753.V373110.R01.S.doc Version 5.2 Page 17 Residents are supported to access where possible services in the community. Five residents attend local optical services other have domiciliary services visiting. The GP surgery is opposite the home and any medical issues would be referred through them. Within the files there was evidence of specialist services for residents such as breast screening. In the “health referral file”, there was records relating to healthcare input. Within the daily events more information on health care appointments was included. One comment made within a staff comment card was the poor service that residents receive whilst in hospital particularly learning disability resident. The comment card suggested that Arnold House should take this up and champion the cause. This was referred to the manager. The medications were inspected with the assistance of the deputy manager during the first site visit. Only qualified nurses administer the medication. There are policies and procedures produced through the company on safe storage and administration of medication. During the site visit there was no one who was self medicating. No controlled drugs were in use. Medications received in to the home were recorded and those returned were detailed in a specific book signed by the staff and the receiving pharmacist. The medication charts were untidy with old charts retained in the file. Medication charts should be maintained in an orderly manner to reduce any margin for error. In the medication file there was a list of all staff administering medication, which included their signature, initials and full name. The medication charts had allergies omitted in some cases, and amendments made to medications on the chart, were without a confirmation signature. In addition those medications, which are hand transcribed, need to have two staff signatures to confirm that the record is accurate. Some “ as required”, medications were without written instructions namely a maximum amount, reason for administration and duration on the drug chart so staff have clear guidance on administrating such medications. There were written instructions for some as required medications although one was dated 2004. PRN medications need to be kept under review and an annual review is recommended. During the second visit the medication omissions as detailed above had been addressed. The supplying pharmacist provides medication training and external courses through Greenwich College provided. Staff confirmed that this training was provided with regular updates. Reference drug manuals were on site for staff to check medication queries. Arnold House DS0000006753.V373110.R01.S.doc Version 5.2 Page 18 Arnold House DS0000006753.V373110.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23.People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Complaints information is available for residents, staff and visitors to access. Complaints are taken seriously and responded to appropriately. Staff had a working knowledge and understanding of adult protection and whistle blowing, which provides safeguards to residents. Regular updating is required in these areas, to ensure that they are familiar with current guidance and contact points. EVIDENCE: The service has policies and procedures relating to complaints whistle blowing abuse and a charter of rights, the policies are kept under review to reflect changes in legislation and good practice guidelines. Staff are able to access policies and procedure at any time and these are covered during the induction period. Information on whistle blowing was also on display in the office. Information on how to complain is made available within several of the documents produced by the company and these are available to residents, staff and others involved with the service. Staff who met with us were knowledgeable about what abuse was, and the action to take. They understood what whistle blowing was as well, and on both of the topics they stated that they had received training during induction and Arnold House DS0000006753.V373110.R01.S.doc Version 5.2 Page 20 updates afterwards. Other training that staff stated they had received included that on Independent Advocacy. This would be beneficial, as impartial advocacy is needed to protect some residents. Staff themselves felt able to raise any issue with the management team and when they had they had been supported and listened to. Comments in residents comment cards indicated that they would refer complaints to staff on site “The Chief Male Nurse “being referred to in one. Other avenues for raising concerns were relatives, staff in the service, and those external to the service, such as day centre staff. There is a specific book for the recording of complaints and the information that needed to be recorded was - details of the compliant, date, action taken, result and responses. There were no entries since November 2005. The manager stated that the service received very few complaints. It is important that any complaint, no matter how trivial is recorded to demonstrate that an open and honest culture prevails within the home. There was a large amount of correspondence complimenting the service. The following informationw as extracted from the AQAA : “All residents and their families are provided with an accessible version of letting us know what you think policy. In addition residents are each provided with help cards. The manager said that there is provision of an accessible version of the POVA policy for relatives, residents, and staff use. In addition there is a copy of the Local Authority POVA policy in the service. Staff induction includes training of these procedures. Arnold House DS0000006753.V373110.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The environment is maintained to a good standard, homely, clean and hazard free. Residents have sufficient space in their bedrooms to personalise them to their own specifications. Comfortable communal areas provide space for socialising and relaxation. EVIDENCE: A tour of the home was undertaken to include individual bedroom areas as well as communal and office space. At the last site visit two requirements were made relating to the central heating system and protection of the pipe work. Since that visit the boiler has been replaced and this has also addressed the issues of the pipe work. The following was included in the AQAA information: Arnold House DS0000006753.V373110.R01.S.doc Version 5.2 Page 22 “There has been decoration of bedrooms, lounge, toilets, new furniture have been purchased. The front and back garden are well maintained. New flooring has been put in two flats, new shower room installed. Two rooms have been designated as smoking areas for residents. A new handyman, to look after the environment, has been employed”. During the tour bedrooms were personalised and to a good standard. It was evident that care and attention had been paid when these were refurbished; colour coordinated bed linen curtains and soft furnishing indicated this. All bedrooms were individually decorated with residents choosing colours, fabrics and where possible furniture and fittings. Within one comment card, received from staff, there was reference to the need for repairs to be addressed quickly in particular equipment such as laundry and dishwashing equipment was cited. During the tour it was noticed that the laundry areas were in need of repair with items such as drawer fronts missing swing bin lids absent and general disarray. All equipment looked at, was however in working order. This was in sharp contrast to all other areas of the home, which were clean tidy and very homely. Arnold House DS0000006753.V373110.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Staff are subject to robust recruitment procedures, which affords protection to residents. Staff are provided in sufficient numbers to meet resident’s needs. Staff receive training on the mandatory topics as well as those, which are related to the current resident population, this ensures that staff are competent and capable to care for residents. EVIDENCE: The home is well staffed with qualified nurses, support workers and administration support. Thirty-five staff are employed throughout the service. The home uses very little agency as it has a good supply of bank staff that are used. Many of the staff have been in post for several years and this is a benefit for the residents who have a consistent staff team who know their needs. Within the staff team there are male and female staff and fourteen nationalities. This allows residents to have care provided by staff of the same gender and culture that may then go on to become key workers. Arnold House DS0000006753.V373110.R01.S.doc Version 5.2 Page 24 There is one domestic employed and a handyman. It is recommended that with the increased age of residents and a reduction in their ability to maintain their own bedrooms an increase in domestic hours may be required in future, and this should be kept under review. Within staff comment cards the good level of support was frequently commented upon, particularly that received from the manager. The comment cards also indicated that supervision was carried out and this was an open and frank discussion between the two parties. The home has links with Greenwich University and through this has students who are on placement. There are usually two at any one time this being the maximum the facility can accommodate. The students work in a supernumerary capacity and received support not only from the staff in the home but through their college tutors. We met with one student. She was enjoying her placement and said that this was an area where once she qualified would like to work in. She felt that she had received good support and that the residents received good care and were enabled to live fulfilling lives. Other staff on duty met with us. Some staff had worked at other homes ran by the same organisation. All had been in post for a number of years. They confirmed that they received good support and training, which was provided both internally and externally. The mandatory subjects were covered during induction and at regular intervals. Those subjects, which were relevant to residents needs, were also provided including LDAF therapeutic breakaway interventions, challenging behaviour and communication. Staff had completed or were completing NVQ training. Training is recorded through a computer programme and reminder updates prompt the manager for refreshers. The company employ a training co ordinator who sources training material. Staff were extremely knowledgeable about their key residents knowing not only what support they needed but also their family networks and other specific information relevant to the resident. Comments received from staff included “a very nice place to work- I am very happy “. Another staff said, “team leaders are easy to talk to and confidentiality is maintained”. This makes staff feel protected should they need to raise any issue. Another staff commented “best job I have ever had- you get very attached to the residents”. Recruitment files evidenced that robust recruitment procedures were in place application forms; identity checks, CRB and POVA checks as well as references were retained for staff members. Self-declaration of health is required should any concerns identified then a referral to occupational heath for full health screening is made. The company undertakes equal opportunities monitoring. Arnold House DS0000006753.V373110.R01.S.doc Version 5.2 Page 25 Staff are subject to probation periods and interviews are conducted at specific intervals to establish how the employee is settling and managing the work. Arnold House DS0000006753.V373110.R01.S.doc Version 5.2 Page 26 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. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home is managed by an experienced individual supported by other managers in the company and senior personnel of Milbury. Health and safety measures provide residents with a safe home for them to live in. Quality assurance measures include the views of resident’s relative’s staff and other parties involved in the home to further develop a better service. EVIDENCE: The manager of this service is a qualified nurse and has been in post since 1999 and previously in the company for five years. He is wholly supernumerary to ensure the smooth running of the service. His deputy has two days a week Arnold House DS0000006753.V373110.R01.S.doc Version 5.2 Page 27 where he is also supernumerary to assist in management issues. This is good practice. Qualified nurses and the regisitered manager are very experienced and have many different professional qualifications ncluding RMNH, RMN, RGN and RMA. There are staff trained to address moving and handling. The facility is registered with the University of Greenwich and there is a long established relationship The university undertakes audits of the establishment to ensure it is approprite for student placements. The last audit was 2008 and this was good. The organistation have a number of quality assurance measures in place although records for internal auditing were limited . The Regulation 26 reports on site were not the most recent these ,those seen referred to April June and July 2008, we were advised that more recent ones were at Head Office. A copy of the reoprt should be retained on site following a Regulation 26 visist. Staff meetings were said to be held regulaly by the manager although only two sets of minutes were available 20/1/09 and 10/8/08 a significant gap. Again only two resident meeting minutes could be located November and July 08 and these were limited in their content. These records form the basis for quality auditing and would help inform this. Residents finances were checked with the assistance of the adminstrator. All residents have an individual bank account. A £21.15 personal allowance is paid weekly to each one. A balance sheet for transactions is in place for each resident. Reciepts are retained and two staff check and confirm the transaction by way of their signature. Finiancial audits are undertaken by the Operations Manager. Health and safety issues are addresed by way of regular servicing on equipment in the building. In addition the handyman is available for repairs and staff are vigilant around potential hazards. Certificates seen, showed electrical, water and fire equipment had been checked. Lifting quipment as well as the lift had LOLER inspections The gas certificate was current. The environment was safe with COSHH products safely stored , hot water at a safe temperature and other potential hazards made safe . Weekly fire alarm testing had some gaps in the records which were said to have occurred due to annual leave. This must be addressed. Fire drills had been carried out in January 09, October, May April and January 08 . There was a Fire Risk asesment which had been reviewed November 08. Extuigishers had been seviced February 08. There was a fire policy in place. Staff were knowledgeable of what to do in the event of fire and about health and safety generally . Arnold House DS0000006753.V373110.R01.S.doc Version 5.2 Page 28 Pleae see requirements 1 and 2. Arnold House DS0000006753.V373110.R01.S.doc Version 5.2 Page 29 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 3No 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 X 3 X 2 X X 3 X Arnold House DS0000006753.V373110.R01.S.doc Version 5.2 Page 30 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. 1 YA39 Standard Regulation 24 Requirement The Registered Person must ensure that quality assurance measure include the views of all those involved and living in the service to underpin the annual review of the service. Timescale for action 30/03/09 2. YA42 23 The Registered Person must ensure that fire alarms are checked and recorded weekly to ensure that the system is safe. 09/03/09 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 YA19 Good Practice Recommendations It is recommended that the new health-monitoring sheet be completed and maintained by key workers for all residents, to ensure that all aspects of their health needs are being regularly monitored. DS0000006753.V373110.R01.S.doc Version 5.2 Page 31 Arnold House 2. YA39 It is recommended that questionnaires designed to elicit the views of service users are designed with service users in mind, and are more accessible to them. Arnold House DS0000006753.V373110.R01.S.doc Version 5.2 Page 32 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. 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