Care Home: Aster House

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What the care home does well This home meets all of the National Minimum Standards for Young Adults. The arrangements for admitting new people into the home are satisfactory. People are encouraged to visit and spend time in the home prior to making a decision to move in. Appropriate information is obtained about peoples needs and staff develop an individual support plan to help the person become more independent and meet their personal goals. Staff plan how they will minimise potential risks for the residents. Feedback from the people using the service, other professionals and relatives is good. The people living in the home said staff were kind, usually listened to what they had to say and acted on the information if necessary. The food provided in the home is good and all of the people spoken with on the day of the inspection said they enjoyed it. The management of medication is good. Accurate records are maintained for medication received and administered in the home. The home provides a flexible self medication programme that will enable people to take on more responsibility for managing their medication as they became more confident. People are supported to attend local colleges, specialist services for people with mental ill health and to take part in social activities in the home and community. The building is maintained to a satisfactory standard. All areas are comfortable and tidy. Fire safety equipment is serviced regularly and health and safety issues are addressed promptly. The provision of training for staff is good. There are good systems in place to support staff and all staff receive regular supervision. The people living in the home know who to speak to if they have any concerns. Complaints are recorded and are addressed promptly by the Manager. There are good systems in place to monitor the quality of care provided and to obtain feedback from the people using the service. What has improved since the last inspection? This was the first inspection of this newly established service. What the care home could do better: Areas identified at this inspection that need some improvement are as follows: Standard 1 It is recommended that the service user guide is revised to include details about the complaints procedure. Standard 6 It is recommended that the Manager ensures that reviews of the care plans should include sufficient detail so as to record the progress that has been made with the individual care plan objectives. Standard 30 It is recommended that the Manager ensures that all staff receives training on the control of infections. Standard 37 It is recommended that the Manager produces a report that analyses the quality feedback information gathered from the surveys. That an action plan is drawn up which addresses any issues that have arisen from the feedback and used to inform any new developments that could be planned for this unit. The report could be sent out to all the participants of the survey for their information. Key inspection report Care homes for adults (18-65 years) Name: Address: Aster House 141 Sunderland Road London London SE232PX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: David Halliwell     Date: 0 3 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: Aster House 141 Sunderland Road London London SE232PX Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Neraindas Nunkoo Type of registration: Number of places registered: care home 8 Ashmead Health Care Limited Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users may be accommodated is 8 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 category: Mental Disorder Code MD Date of last inspection Brief description of the care home Aster House is a detached property situated in Forest Hill, London SE 23. It is a part of the Ashmead Healthcare Ltd group of homes. Easily accessible by public transport, the property consists of 8 single rooms with ensuite facilities in a modern setting. 8 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 35 Brief description of the care home The aim is to provide for up to 8 female residents individually tailored rehabilitation plans to support independent living through individualised support and move on plans. The objective is to promote an all embracing holistic approach for the service users in a safe and homely atmosphere where all residents will be encouraged to have as high a quality of life as possible. The Manager told us that placement fees range from £950 per week for people with low needs to £1500 per week for people with high needs. Care Homes for Adults (18-65 years) Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The stars quality rating for this service is 2 stars. This means that people who use these services experience good quality outcomes. Service users said that they like to be called residents. No enforcement activity has occurred with this service. This was the first inspection since the home opened in May 2009. It was an unannounced inspection visit and was carried out over 2 days. The Inspection covered all the key standards in the National Minimum Standards. The inspection involved a review of all the agencies records and a formal interview with the Manager and the Quality Assurance Manager, with 3 support worker staff and we had discussions with 2 residents. 4 staffing files and 4 residents files were inspected as well as the policies and procedures manual for the home. Care Homes for Adults (18-65 years) Page 6 of 35 4 recommendations have been made as a result of this inspection. Feedback on the recommendations was given verbally to the Manager at the end of the inspection visit. We were impressed by the very positive commitment and hard work that has been put into setting up this home and the services it provides to people with complex mental health problems. The Manager and staff were very helpful and they are to be thanked for their assistance over the course of this inspection visit. The homes Registration Certificate with the Commission was seen displayed appropriately in the main office. The Manager told us that placement fees range from £950 per week for people with low needs to £1500 per week for people with high needs. Care Homes for Adults (18-65 years) Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: Areas identified at this inspection that need some improvement are as follows: Standard 1 It is recommended that the service user guide is revised to include details about the complaints procedure. Standard 6 It is recommended that the Manager ensures that reviews of the care plans should include sufficient detail so as to record the progress that has been made with the individual care plan objectives. Standard 30 It is recommended that the Manager ensures that all staff receives training on the control of infections. Care Homes for Adults (18-65 years) Page 8 of 35 Standard 37 It is recommended that the Manager produces a report that analyses the quality feedback information gathered from the surveys. That an action plan is drawn up which addresses any issues that have arisen from the feedback and used to inform any new developments that could be planned for this unit. The report could be sent out to all the participants of the survey for their information. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 35 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 1, 2, 5 were inspected. Standard 6 is not applicable as the home does not offer intermediate care. 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 this service. Good information is available to help prospective residents and their representatives make an informed choice about whether to use the service. People have an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. Each resident has a written contract. Evidence: Standard 1 We read the Statement of Purpose and the Service User Guide and these contain information that people receive about Aster House when considering whether they want to live there. The content provides information about the aims and objectives of the home. It tells people what support with day to day needs, social, leisure and educational opportunities and the environment they can expect to receive. Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: The service user guide needs to include information about the complaints procedure so that residents have this information to hand should they need it. It is recommended therefore that the guide is revised to include the complaints procedure. It is recognized that information is also displayed on the notice board in the house. Prospective service users have the information they need to make an informed choice about whether they wish to live here or not. Standard 2 Suitable policies are in place to ensure that the home only admits people whose needs can be met by the services provided at Aster House. Inspection of 4 residents care files indicated that for each resident an assessment of needs had been completed by both the referring clinical teams and by the homes staff. The assessments are detailed in that they look at the care and support needs, significant history, medication and specific health care support, information about the likes and dislikes of the person and their choice of social and therapeutic activities. We saw that residents assessments are regularly evaluated and updated. This shows that peoples needs are monitored and reviewed. We saw that the homes key worker staff had completed full mental health needs assessments. These were written in a person centered way and each individual had signed in agreement. There were lots of useful sections to tell staff about the persons particular needs. Each person had an up to date Enhanced Care Programme Approach (CPA) on their file. This clearly detailed their needs and any presenting risk factors. This means that prospective service users individual aspirations and needs will be assessed. Standard 5 Overall the contracts gave people clear information about the obligations of the provider and the persons responsibilities when staying in the home. Full details about any extra costs needs to be included however so that people have accurate information about any additional services they can expect to pay for. Records showed that one person paid for their taxi fares and this must therefore be included in the contract. This means that each resident has an individual written contract with the home. Standard 6 Intermediate care is not offered at the home; therefore this standard was not Care Homes for Adults (18-65 years) Page 12 of 35 Evidence: assessed. Care Homes for Adults (18-65 years) Page 13 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standard 6, 7 & 9 were inspected at this inspection. People using this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents may be assured that their assessed needs and personal goals will be reflected in their care plans. They may also be assured that they will be able to make decisions about their daily lives and be enabled to take risks as part of developing a more independent lifestyle with support, as they need it. Evidence: Standard 6 As a part of this inspection we looked at 4 of the residents care plans which had each been updated within the last six months. We saw that care plans were being reviewed on a regular basis every 2 months to ensure that any changing needs were being addressed and met. It is recommended that the Manager ensures that reviews of the care plans should include sufficient detail so as to record the progress Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: that has been made with the individual care plan objectives. Information we saw on the care plans was well written so that staff have clear guidelines on how to meet assessed needs in a way that the person prefers. We looked at some of the daily diary sheets that gave a good outline of a persons daily experiences, activities, their health and well being and any significant issues. Each person has a named key worker to support them. All of the service users have a plan of care that reflects their identified needs. Records on the residents files sampled, indicated that service users are fully involved in their individual planning meetings and supported to achieve their personal goals and aspirations. It is clear that staff work closely with each individual, their family and significant others to ensure that their preferences are responded to appropriately and the people important to them are involved with the planning of their care. Daily records are also kept which highlight progress, achievements and any activities participated in. This all means that residents know their assessed and changing needs and personal goals are reflected in their care plans. Standard 7 The Manager told us that staff work hard to enable residents to make decisions about their lives and that they provide assistance as it is needed. We saw that residents have full involvement in their needs assessment and care planning and we were told by residents who we spoke to that they are always involved and encouraged to make their own decisions. Both the Manager and residents told us that there are regular 2 - 3 monthly house meetings with residents and that relevant issues are discussed concerning all aspects of life in the home and in relation to individual needs. We saw minutes of these meetings that evidenced this statement. The Manager told us that all residents manage their own finances and that the home does not do so. This all means that residents are enabled to make decisions about their lives with assistance as needed. Standard 9 The staff we spoke with showed an awareness of risks posed to people living at the home, their vulnerability and described ways in which they help them. All Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: care plans contained clear risk reflecting activities that people take part in so that staff and residents can make efforts to minimise risk and promote peoples safety. These covered the full range of assessed risks and matched the needs of each person. Risk plans had been reviewed at timely intervals and where needs had changed. There are good systems in place for monitoring each residents physical well being. Care plans are reviewed to ensure that staff take further action to meet resident support needs. It is clear that residents are more able to undertake community and home activities that contain a level of risk and that may help them achieve greater levels of independence. Management systems were seen to be in place that would reduce the risk. Community risk assessments were seen to be in place and were appropriate for the individual residents. Any restrictions were explained in detail and reviews were evident. This all means that residents are being supported to take risks as a part of developing a more independent life style. Care Homes for Adults (18-65 years) Page 16 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 12, 13, 15, 16 & 17 were inspected at this inspection. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Residents are able to take part in age and culturally appropriate activities and are to a reasonable extent involved in local activities. Residents have appropriate relationships and their rights and responsibilities in their daily lives are recognised and respected by the staff in the unit. Residents are offered a healthy diet and they are assisted in learning cooking and food preparation skills. Evidence: Standards 12 & 13 Records and observation showed that residents are offered choices Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: of activities and are supported to engage in their preferred interests and hobbies. Activity plans are flexible so that daily programmes can alter if residents wish to do something different. The home does not have its own transport but service users regularly use public transport services including bus and trains. Residents told us that they like to go out and some of the community activities mentioned included swimming, social clubs, bingo, trips to local pubs and restaurants. The home also has an activities officer who we spoke to. She told us about some of the activities that are offered in house to the residents. This included entertainment facilities such as television, videos, a music system, art and craft activities and jigsaws, computer and board games. Meetings are held monthly for the residents. Minutes showed that residents have opportunities for discussing and planning activities and they spoke favourably to us about these events and it was clear that their views have an influence on the way the activities and outings are organised and the way the home is run. The Manager told us that all the residents have been registered to vote and residents also told us that they had been registered to vote. This all means that residents are able to take part in age and culturally appropriate activities and that where they want to be residents may enjoy being a part of the local community. Standard 15 The Manager told us that residents do keep in regular contact with their families and friends. Staff encourage the residents to keep and maintain contacts with family and friends so that residents benefit from having appropriate relationships. There is a visitors room in the house that can be used by visitors who wish to see their relatives in the house. Standard 16 Policies seen by us to be established within the unit ensure that residents rights to privacy, respect and dignity are respected. Residents who were interviewed also confirmed that they felt staff respected these rights. Residents said that they have a key to their own bedrooms, their mail is unopened, their preferred form of address is used by staff and staff do knock on their doors before entering. We observed staff to be interacting with residents in a friendly and respectful manner. Standard 17 With regards to meals and meal times there is a planned and varied 4 week menu which residents told us they enjoy. We saw the planned menu for the Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: week ahead, the food choices selected show that a nutritional range of food is offered to residents. The Manager told us that specific needs are catered for and alternative choices are provided. Residents are able to state their preferences when the menus are planned and there are discussions about this at the residents meetings. The Manager told us that on one day each week residents plan and cook a meal for the house. The residents that we spoke to told us that they very much enjoy this activity. We could see from the menu that the food chosen by residents to prepare and cook were both varied and interesting. The Manager told us that the home does not use a dietician in assisting with the menus but that if there was need they would do so. This all means that residents are offered a healthy diet and that they enjoy their meals and mealtimes. Care Homes for Adults (18-65 years) Page 19 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 18, 19, & 20 were inspected at this inspection. People using this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users may be assured that they will receive personal support in the way they prefer and require, they may also be assured that their physical and healthcare needs will be appropriately met. Service users are protected by the homes policies and procedures for dealing with medicines. Evidence: Standard 18 The Manager explained that residents can choose when they get up each morning. The residents we interviewed at this inspection said that they do choose when to go to bed, when to have a bath, what they wish to wear and what activities they do during the day. The Manager told us that residents do have a choice of their allocated key worker Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: should they so wish. Residents that we spoke to did not raise any concerns with us about their key workers in fact their comments reflected a positive view of key work support. This means that residents receive personal support in the way they prefer and require. The Manager said that residents at Aster House continue to receive regular input from their Community Psychiatric Nurses and from other professionals in their clinical teams. Standard 19 With regards to the health care of the residents the Manager informed us that all residents are supported to keep well through accessing appropriate healthcare support. All residents are signed up with local GP surgeries and some are registered with local dentists. The Manager told us that annual health checks take place at the GP surgeries and residents attend there. The Manager said that whether or not a resident uses the dentist is left up to the residents own decision but staff will encourage residents to use this service if required. Residents who we spoke to said that they go to see their GPs as and when necessary. The Manager told us that if residents need to use either a chiropodist or an optician then staff would assist them to do so. This all means that residents physical and emotional health needs are being met. Standard 20 The Manager told us that all the permanent staff administer medication to the residents and that staff have received appropriate training to do with the safe handling of medicines. Staff when interviewed also said that they had received medication training and had found it helpful. There was certificated evidence available that confirmed this training had been given. The Manager informed us that at present none of the residents self-administer all of their medications, although some residents do administer some medications with supervision. Inspection of the records showed us that where this is done a risk assessment had been carried out so as to minimise any potential risks to the resident. An inspection of the medication records MAR sheets was undertaken together with the Manager. Photographs of the residents were attached to all of the MAR sheets, which helps to ensure that staff administers medications to the right resident. We did a spot audit check on the stock control system and this proved satisfactory with the levels of medications being as stated on the control sheets. Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: A check on the storage facilities for the medication was seen to be appropriate. Care Homes for Adults (18-65 years) Page 22 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 22 & 23 were inspected at this inspection. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Arrangements for complaints and protection from abuse are well managed and ensure that service users feel listened to and safe. Evidence: Standard 22 We saw a clear and properly structured complaints procedure that enables residents and other people to make a complaint or compliment. A proper record book is in place that is used to record any complaints made. All of the 3 complaints that had been received since May 2009 had been dealt with appropriately and as per the agencies policy. The complaints procedure contains all of the relevant and necessary information and is readily available to the people who live there, their relatives and other visitors. No particular trends or themes emerged fro these complaints and all were resolved satisfactorily. Residents who we spoke to said that they are aware of who to go to if they feel unhappy and are provided with the necessary support to air their views or concerns. We have recommended earlier in this report that a copy of the complaints procedure is Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: now included in the service user guide. Standard 23 Residents are protected from abuse by a range of methods including the policy on protecting vulnerable adults; the principles of care that the Manager enforces and by the regular training of staff. We checked the training records and saw certificated evidence that all the staff had attended appropriate training on safeguarding and protecting vulnerable adults. The homes procedures for the reporting allegations of abuse were available for inspection and staff were aware of these procedures. No allegations of abuse have been drawn to the attention of the Commission since the home opened. The Manager is reminded that any allegations of abuse or any serious incidents must be reported to the Commission via Regulation 37 reports. Staff recruitment includes checking criminal records (CRB) and the Protection of Vulnerable Adults Act (POVA) list. The Manager told us that the agencies policy links in with that of the local authority the London Borough of Lewisham. As indicated earlier in this report, the Manager told us that all residents manage their own financial affairs or have a family member or representative to do so. This all means that residents are being protected from abuse, neglect or self harm. Care Homes for Adults (18-65 years) Page 24 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 24 & 30 were inspected. People using this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents at Aster House live in a homely, comfortable and safe environment. The home is also clean and hygienic. Evidence: Standard 24 As a part of this inspection we looked at all areas of the home to assess the quality of the environment and decor. Aster House is nicely decorated and well maintained with a welcoming atmosphere, and made comfortable with homely communal spaces. The decor, fixtures and fittings are in good order with furniture to suit residents needs. We saw records to show that staff carry out a monthly check around the home to identify if any repairs or improvements are needed. A repairs/ maintenance report form is used to highlight any areas within the premises that need attention. Some of the residents were happy to show us their bedrooms. Each one was furnished comfortably and reflected their individual lifestyles, interests and tastes. House rules Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: do not allow people to smoke in their bedrooms and there are designated rooms in the house for the smokers. We saw up to date risk assessments that cover the potential risks for each individual resident. General maintenance throughout the home was seen to be good. The home has a large rear garden and this is mainly laid to lawn with a shrub border and some small trees. It is nicely enclosed and affords the residents some privacy. The home was seen to be clean and no odours were noted. This means that residents do live in a homely and comfortable environment. Standard 30 The home has an infection control procedure in place. A review of 4 of the homes staffing files and other training information indicated that only 1 member of these 4 staff have received training to do with infection control in February 2008. It is recommended that the Manager ensures that all staff receives this basic training. This is seen as important so that staff know the required standards and what measures and controls need to be in place to achieve the standards. As has already been stated, at the time of this inspection the home was seen to be clean and tidy, hygienic and free from offensive odours. Systems are in place to ensure that the spread of infection is controlled and minimised. Laundry facilities are sited so that soiled articles are not being carried through the kitchen and hand washing facilities are appropriately provided to ensure staff can use them where appropriate. This helps to ensure the protection of the residents health and to ensure that the home is clean and hygienic. Care Homes for Adults (18-65 years) Page 26 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 32, 34, 35 & 36 were inspected. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by competent and qualified staff. Staff are being provided with the necessary induction and training with which to competently perform their work duties. They are being protected and kept safe by the use of appropriate recruitment policy and procedures. Records are being maintained as required. Staff are also supervised appropriately and this also benefits residents in terms of the support they receive. Evidence: Standard 32 We inspected a range of the homes staffing records and 4 staffing files were inspected including a recently appointed member of staff, the others having been chosen at random. The Manager told us that all the staff group hold an NVQ qualification or equivalent and at this inspection certificated evidence was available for inspection. Inspection of the staffing files indicated that 2 of the care staff have achieved their level 3 NVQs. Staff interviewed confirmed that they hold their NVQ qualifications. Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: This all means that residents are supported by competent and suitably qualified staff. Standard 34 Inspection of the records show that Aster House does have in place appropriate polices and procedures. 4 staff files were checked at random. These contained all of the required legal checks and documentation which shows that the home takes care to recruit staff correctly. Two references were on each file, a completed CRB check, health declaration, proof of identity and records of interview notes. Employment contracts were seen on each of the staff files we inspected. All this helps to ensure that the well being, health and security of service users is being protected by the agencies policies and procedures on recruitment and selection of staff. Standard 35 The Manager has put in place a programme of induction for all new staff based on the TOPPS standards. This covers staff roles and responsibilities, and key policies and procedures. Induction is ongoing for up to 4 - 6 weeks with observation, shadowing from an experienced staff member and ongoing assessment. The Manager told us that the staff induction training does include fire, manual handling, food hygiene and health and safety. With regards to staff competency it is important that all staff are familiar with the homes policies and procedures. The Manager told us that he ensures that all staff are asked to review the key policies and procedures for the home at the induction stage and then when policies and procedures are updated in the future these will be discussed individually with each member of staff in their supervision sessions. They should then sign to say that for each individual key policy and procedure that they have read and understood it and had the chance to discuss it with their supervisor. The Manager explained that there is an extensive training programme provided for the staff group. Certificated evidence was seen on the 4 staffing files inspected that confirmed these staff had attended the following training courses: 1. Medication administration, 2. 1st Aid, 3. Infection control, 4. Health and safety, 5. Fire safety, 6. Manual handling, 7. Food hygiene, 8. POVA, 9. Effective communication, 10. Risk assessment, 11. Mental Health awareness, 12. The Mental Capacity Act, 13. Challenging behaviour, 14. Creating a therapeutic environment. Staff who we spoke to said they found the training useful in helping them to undertake their roles in the home more effectively. Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: This all means that residents individual needs are being met by appropriately trained staff. Standard 36 4 staff files were inspected in relation to staff supervision and records were seen to show that this takes place on a regular basis. Staff interviewed said that their supervision happens every 6 - 8 weeks. Staff are asked to sign their supervision records as was evidenced by the inspection of these records and staff confirmed that they find this support very helpful and that they are given a copy of the minutes for their information. Staff spoken to said that the following issues are discussed at their supervision sessions as a standard format: Key work with residents Training needs Personal issues. The Manager told us that he will carry out all annual appraisals of staff competencies. Staff told us that they felt well supported in the home and felt that the management team were helpful when they had concerns or problems arising in their work. Residents should be able to benefit from well-supported and supervised staff. Care Homes for Adults (18-65 years) Page 29 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This service is well managed. The views of the residents are sought and they underpin all self monitoring, review and development by the home. The home provides a stable environment where people are listened to, they feel safe and their views are respected. Evidence: Standard 37 Aster House was registered with the Commission in May 2009 and the Manager was registered at the same time. The Registered Manager has had 12 years experience acting in management roles prior to becoming the Manager at Aster House. His qualifications include the RGN; RMN; RMND and the Registered Managers Award. These qualifications are particularly relevant to the client group at Aster House and the Managers previous experience and his evident commitment stand him in good stead to building an excellent service for both residents and staff at Aster House. This means that residents benefit from a well run home. Care Homes for Adults (18-65 years) Page 30 of 35 Evidence: Standard 39 The Manager explained to us about the quality assurance processes being used within the unit to ensure that residents views underpin all self-monitoring, review and development by the unit. A variety of feedback questionnaires are being used to gain feedback (on issues to do with the quality of services provided at Aster House) from the residents, staff, multidisciplinary professionals from the clinical teams and from visitors to the home. We saw the completed and returned survey forms that were sent out at the end of 2009. Feedback was positive in its detail from all the groups. It is recommended that the Manager now produces a report that analyses the information gathered and that an action plan is drawn up that addresses any issues that have arisen from the feedback and used to inform any new developments that could be planned for this unit. The report could be sent out to all the participants of the survey for their information, it could also be integrated into the homes annual development plan that the Manager showed us at this inspection. Quality checks could also be made on the recruitment procedures used to employ staff and from an analysis of any complaints that have been received over the year. Quality checks could also include an annual management audit that reviews all health and safety issues, statutory and legal issues, the effective implementation of the homes policies and procedures, the environment and the building, staff and employment issues and training issues. This means that residents can be confident their views underpin all self monitoring, review and development undertaken by the home. Standard 42 We were shown by the Manager risk assessments for the building and for several different services in the building such as kitchen equipment, cooking and food preparation utensils; use of electrical appliances and other relevant areas where potential risks may occur for residents. There is also a fire risk assessment recently carried out by the Manager and a fire emergency plan in place. The Manager told us that new staff receive some training at induction to do with the homes fire equipment and fire safety; food hygiene and infection control. The London Fire Brigade carried out a full check of this home in March 2009 at which Care Homes for Adults (18-65 years) Page 31 of 35 Evidence: some issues of concern were raised. These have been addressed by the Manager and the London Fire Brigade have revisited the home to check on progress and have stated that they are now satisfied with the resolution of the issues they had previously raised. Environmental Health have also carried out an inspection on 25.6.09 within the home and as a result have awarded it 4 stars which is a very good rating. The Manager showed us the policies and procedures manual that includes polices on health and safety, risk assessment, moving and handling and fire risk awareness. The Manager has developed a very useful matrix for checks on the homes essential services and the certificated checks on these services. This helps to see at a glance whether the appropriate checks have been carried out and when they next need to be done. Certificates were seen by us for the following services that are installed in the home, certificates which state that these systems have been checked by appropriate professionals since the last inspection were found to be satisfactory and fit for purpose. 1. Boiler / gas 2. Electrical system check 3. Fire alarms 4. Emergency lighting system 5. Fire fighting equipment 6. Water check for legionella organisms 7. Portable electrical equipment Inspection of the fridges and freezers in the home showed us that food is being appropriately stored, labelled and dated. We were shown records that indicate fridge and freezer temperatures are being recorded appropriately. The building was seen to have appropriate security measures in place and at the time of this inspection there were no fire doors wedged open. This all means that the health, safety and welfare of residents and staff are being promoted and protected. Care Homes for Adults (18-65 years) Page 32 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 33 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 1 6 It is recommended that the service user guide is revised to include details about the complaints procedure. It is recommended that the Manager ensures that reviews of the care plans should include sufficient detail so as to record the progress that has been made with the individual care plan objectives. It is recommended that the Manager ensures that all staff receives training on the control of infections. It is recommended that the Manager produces a report that analyses the quality feedback information gathered from the surveys. That an action plan is drawn up which addresses any issues that have arisen from the feedback and used to inform any new developments that could be planned for this unit. The report could be sent out to all the participants of the survey for their information. 3 4 30 39 Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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