Care Home: Astor House

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What the care home does well The frequency of supervision sessions required under the Standards are exceeded by this home, this ensures a well supervised work force. The Standards require at least half of the staff group to have a NVQ 2. This figure has been exceeded for the last three years. This ensures a better qualified staff group. The move to person centred planning is seen as good practice as this ensures care needs are identified from the residents` perspective. A few days before a previous inspection, the residents asked staff for a barbeque instead of the planned meal for that day. The home was flexible and accommodated this. This was not the only example of home`s willingness and ability to respond to residents` wishes in a spontaneous manner, and to change plans at the last minute in the interests of the residents. Staff attend hospital with residents and stay with those people admitted. This provides continuity and reassurance for residents, and improves the overall level of hospital care by staff being able to communicate effectively with the resident.Good practice continued. It was seen as good practice that medication training occurs annually and Additional annual training occurs in `as and when medication`, and also in diazepam usage. The residents` needs regarding terminal care and following death are met well and this Standard is exceeded for the following reasons: During these periods, relatives can visit at any time day or night if wanted by the resident; If and when no relatives are present, a staff member is available to provide a continual vigil if wanted; the home maintains contact with relatives following death of a resident; funerals have occurred at the home; The home has provided transport to assist relatives to attend funerals; and although residents have the right to die at their home, where there is a medical reason for a hospital admission at these times, the home sends staff to the hospital so that the resident does not have to be alone in their final moments. The previous report recorded that `the home gave the impression of a clean and hygienic home. The building was clean and tidy and rooms were generally free of offensive odours.` We saw that this was also the case at this unannounced inspection. As this has been seen to be the case on a number of unannounced inspections, this area can now be assessed as continuing good practice under Standard 30. The home has also received a 5 star food hygiene award. What has improved since the last inspection? A new summer house has been acquired for the residents` use. Although most staff were were previously observed to treat residents with respect and to not rush them at breakfast, one staff member was seen to hurry residents with their breakfast at the last inspection. This was not the case at this inspection and all staff were seen to give the residents as much time as they needed to eat comfortably. The new Health Plans now also contain a document referring to social care needs. This will help social care needs receive the same priority as health needs and ensure that cultural or religious needs are also considered. The home now has a new chair lift bath. CARE HOME ADULTS 18-65 Astor House 12 Oakwood Avenue Purley Surrey CR8 1AQ Lead Inspector Barry Khabbazi Key Unannounced Inspection 5th August 2008 09:00 Astor House DS0000025750.V369680.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 Astor House DS0000025750.V369680.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. Astor House DS0000025750.V369680.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Astor House Address 12 Oakwood Avenue Purley Surrey CR8 1AQ 020 8763 0267 020 8668 2471 elisabeth.murray@sabp.nhs.uk 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) Surrey and Borders Partnership NHS Trust Ms Elisabeth J Murray Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Astor House DS0000025750.V369680.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 10 12th July 2007 Date of last inspection Brief Description of the Service: Astor House is a large detached house situated in a residential road in Purley. The property is keeping with the other houses on the road. The town centre has bus and train services, a shopping centre and a Tesco superstore in addition to other services. The home has its own minibus. There are ramps to the front and back to facilitate wheelchair access to the home and rear garden. There is a lift serving the bedrooms on the first floor. Astor House has been designated as a home for more elderly service users who have a learning disability and may also have a physical disability. As the service users are over 65 years old, the inspector has advised the registered manager to apply in writing for the registration to be amended to reflect this situation. The home is therefore applying for its registration to be changed from Younger Adults to Older People. The home is reminded that it must meet Older Person Standards now. Fees for this home are from £1121.81 per week. Astor House DS0000025750.V369680.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The overall quality rating of the service is 2 star. This means the people who use this service generally experience Good outcomes. This inspection was unannounced and started early in the day to allow the residents to be met, before they went to their day activities. The manager was interviewed, and records, policies, care plans, and the building were examined. The home is in the process of changing ownership; as a result of this the manager’s latest self-assessment {AQAA} was not available to be used to support findings in this inspection. The people who use this service refer to themselves as residents. Where communication was limited by the residents’ disability, those residents appeared relaxed and contented. Staff were seen to be supportive and responsive to residents’ needs. All of the previous Commission’s service user and relative surveys have also confirmed this view, with only positive comments about the home being received. Where shortfalls have been identified these are of a minor nature and the manager has proven committed to fully meeting all areas and exceeding them where possible. What the service does well: The frequency of supervision sessions required under the Standards are exceeded by this home, this ensures a well supervised work force. The Standards require at least half of the staff group to have a NVQ 2. This figure has been exceeded for the last three years. This ensures a better qualified staff group. The move to person centred planning is seen as good practice as this ensures care needs are identified from the residents’ perspective. A few days before a previous inspection, the residents asked staff for a barbeque instead of the planned meal for that day. The home was flexible and accommodated this. This was not the only example of home’s willingness and ability to respond to residents’ wishes in a spontaneous manner, and to change plans at the last minute in the interests of the residents. Staff attend hospital with residents and stay with those people admitted. This provides continuity and reassurance for residents, and improves the overall level of hospital care by staff being able to communicate effectively with the resident. Astor House DS0000025750.V369680.R01.S.doc Version 5.2 Page 6 Good practice continued. It was seen as good practice that medication training occurs annually and Additional annual training occurs in ‘as and when medication’, and also in diazepam usage. The residents’ needs regarding terminal care and following death are met well and this Standard is exceeded for the following reasons: During these periods, relatives can visit at any time day or night if wanted by the resident; If and when no relatives are present, a staff member is available to provide a continual vigil if wanted; the home maintains contact with relatives following death of a resident; funerals have occurred at the home; The home has provided transport to assist relatives to attend funerals; and although residents have the right to die at their home, where there is a medical reason for a hospital admission at these times, the home sends staff to the hospital so that the resident does not have to be alone in their final moments. The previous report recorded that ‘the home gave the impression of a clean and hygienic home. The building was clean and tidy and rooms were generally free of offensive odours.’ We saw that this was also the case at this unannounced inspection. As this has been seen to be the case on a number of unannounced inspections, this area can now be assessed as continuing good practice under Standard 30. The home has also received a 5 star food hygiene award. What has improved since the last inspection? A new summer house has been acquired for the residents’ use. Although most staff were were previously observed to treat residents with respect and to not rush them at breakfast, one staff member was seen to hurry residents with their breakfast at the last inspection. This was not the case at this inspection and all staff were seen to give the residents as much time as they needed to eat comfortably. The new Health Plans now also contain a document referring to social care needs. This will help social care needs receive the same priority as health needs and ensure that cultural or religious needs are also considered. The home now has a new chair lift bath. Astor House DS0000025750.V369680.R01.S.doc Version 5.2 Page 7 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. Astor House DS0000025750.V369680.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 Astor House DS0000025750.V369680.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): Standard 2: People who use this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. Potential new residents can be confident that their needs and aspirations will be assessed and recorded so that they can be met by the home. EVIDENCE: Standard 2 was assessed as met at previous inspections. The home has not had a new resident admitted via a placing authority for some years. A completely new placement will need to be made before Standard 2 can be fully re-assessed. It was therefore not possible to re-assess Standard 2 at this time. There was however a new resident that had been transferred from another home in the group. All documentation required was present for this person. Astor House DS0000025750.V369680.R01.S.doc Version 5.2 Page 10 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): Standard 6, 7, and 9: People who use this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. Residents’ needs and changing needs are assessed and recorded so that staff know and can therefore meet these needs. Residents are supported to make decisions about their lives to maximise their independence and choices. Residents are consulted on and participate in all areas of life at the home. EVIDENCE: The last report recorded that the new plans of care are now more holistic. However, they did not contain all the information required. The following requirement was therefore set to address this. The new care plans must cover all the elements required under Standard 6 or record where this information is to be found if held in other documentation. Astor House DS0000025750.V369680.R01.S.doc Version 5.2 Page 11 This had occurred by the time of this inspection with an additional social care planning sheet being added to the health action plans. This requirement is therefore now met. These documents however are being re-organised to make the information more easily accessible to staff. As this is needed the following recommendation will now be set: The manager should continue with the updating of the care plan layout to make them more accessible to staff. In addition to the health and social care planning documents above, the home has also started to develop separate person centred plans for the residents. Residents are consulted through one to one discussions, contact with relatives and advocates and the home’s quality assurance programme. See also Standard 39 ‘Quality Assurance’. Access to independent advocacy/self advocacy schemes are available to the residents and we have seen that information is available within the home Risk assessments where restraints or restrictions of liberty are pre-planned are now available for all areas required. These now contain all the information required including what training or other options have been explored before a restraint or restriction of liberty is applied. Astor House DS0000025750.V369680.R01.S.doc Version 5.2 Page 12 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): Standard 12, 13, 14, 15, 16, and 17: People who use this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. Residents receive sufficient access to activities to maintain a stimulating life. Residents are regularly participating in the local community, with the aim of maximum integration and challenging discrimination. Residents are supported in maintaining appropriate relationships, so that their social lives are maximised within chosen boundaries. The daily routines and house rules do generally promote residents’ rights, to ensure equality and that all rights are enjoyed by all residents. Dietary needs are catered for and a balanced diet is provided, to ensure health and enjoyment of food. Astor House DS0000025750.V369680.R01.S.doc Version 5.2 Page 13 EVIDENCE: Basic money awareness training occurs for two of the residents during shopping trips. Access to activities is provided at the home and at the daycentres that are attended by all the residents. Access to the local community is assisted by the home having its own transport. The local pubs, parks, restaurants, cafes, church, and shops are accessed. Staff are available to support residents while accessing the community and this occurs about three times a week in summer and in the evenings as well as during the daytime and at weekends. Some residents attend local clubs. A few days before a previous inspection, four residents asked staff for a barbeque instead of the planned meal for that day. The home was flexible and accommodated this. In addition at the last inspection as the sun was shining, the plans for the day were changed to activities that would take advantage of the nice day. The manager’s willingness and ability to respond to residents’ wishes in a spontaneous manner, and to change plans at the last minute in the interests of the residents is to be commended. Residents are offered a holiday with £150 of extra staffing hours. The residents are currently required to pay for the cost of the holiday themselves. The following previous recommendation remains regarding this: Each service user should be offered a seven-day holiday paid for by the home as part of the contracted price. There is an open visitors policy and the home just ask that visitors phone to ensure their family member or friend is going to be in before they visit. Family and friends are invited to any social events held at the home as well as reviews. At Christmas the home arranged a “high tea” for friends and family. The house rules and daily routines are as flexible as possible, bearing in mind the weekday commitments of the residents. At the weekends there is more flexibility with breakfast and bedtimes. Residents are encouraged to help out with some household tasks such as clearing the table or taking out the bins. The residents are given a choice of having keys to their bedrooms and the front door of the home. The residents have not taken up this option and the reasons are recorded on their personal files. The menus are seasonal and based on the likes and dislikes of the residents. The Trust dietician visits the home on a regular basis to check the menus for nutritional value. When a resident has an alternative meal a record is kept of what they have eaten. The home has received a 5 star food hygiene award. Astor House DS0000025750.V369680.R01.S.doc Version 5.2 Page 14 The last inspection report recorded that although most staff were observed to treat residents with respect and to not rush them at breakfast, one staff member was seen to hurry residents with their breakfast at least 3 times. The following requirement was set: Staff must treat residents with dignity and respect at all times and must not rush service users with their food. This was not seen to be the case at this inspection so the requirement is currently met. However, this area will continue to be monitored. Astor House DS0000025750.V369680.R01.S.doc Version 5.2 Page 15 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): Standard 18, 19, 20 and 21: People who use this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. Residents’ personal care needs and physical and emotional health needs are met well by this home. This ensures that the residents’ physical and emotional health is well maintained and therefore the quality of life experienced is also maximised. Residents’ medication is also well managed to ensure maximised good health. The residents’ needs regarding terminal care and following death are met well and this Standard is exceeded. EVIDENCE: A union memo was posted in the residents’ dining room. The following recommendation is therefore now set: Staff information and memos must not be posted in the residents’ own dining room. This is needed to ensure the dining room remains homely and relevant to the residents and that staff fully respect their space. Astor House DS0000025750.V369680.R01.S.doc Version 5.2 Page 16 Records we examined show that all the residents at this home need assistance with their personal care. Where possible a person of the same sex offers support with personal care. Personal care is provided in private, and timings of this are also flexible, for example residents can have a bath when they are not booked in for this. At this inspecting we saw that the residents were treated with dignity and respect during assistance with feeding and moving. The residents choose their own clothes and staff support service users with shopping for personal items of clothing or toiletries where required. The residents are registered with a local G.P. They are able to access community health facilities such as opticians, chiropodist and district nurses as required. Residents are supported to attend outpatient appointments and other medical appointments as required. Medication profiles and medication administration record sheets were seen in records sampled. Medication is kept securely in a locked metal cabinet fixed to the wall. The Trust has a policy on the administration of medication and also provides accredited training in this area. Medicine admistration sheets were in order. It is seen as good practice that staff attend hospital with residents and stay with those admitted. This provides continuity and re-assurance for residents, and improves the overall level of hospital care by staff being able to communicate effectively with the resident. It is seen as good practice that medication training occurs annually and additional annual training occurs in ‘as and when medication’, and also in diazepam usage. The residents’ wishes regarding terminal care have now been sought and recorded. This Standard is exceeded for the following reasons: During these periods, relatives can visit at any time day or night if wanted by the resident, the home maintains contact with relatives following death of a resident, funerals have occurred at the home, the home has provided transport to assist relatives to attend funerals. Although resident’s have the right to die at their home, where there is a medical reason for a hospital admission at these times, the home sends staff to the hospital so that the resident does not have to be alone in their final moments. Paliative care training is being sought. Astor House DS0000025750.V369680.R01.S.doc Version 5.2 Page 17 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): Standard 22 and 23: People who use this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. The home manages complaints well so that residents feel their concerns are listened to, and the complaints procedure is now more accessible. The home’s policies and procedures relevant to this Standard currently promote protecting residents from abuse. EVIDENCE: The home has a complaints procedure that meets all the elements of this Standard including a minimum response time of less than 28 days, details of the Commission and this is now also available in more accessible formats. The home has a copy of Croydon’s Vulnerable Adults Policy and training in this area is mandatory. The last announced inspection report recorded that the home has a “Responding to Aggression and Violence” policy and procedure, which states that physical restraint, should only be used as a last resort and should be recorded. A new corporate Whistle Blowing Policy and a local Wills Policy has been devised and staff were aware of these. Astor House DS0000025750.V369680.R01.S.doc Version 5.2 Page 18 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): Standard 24 26, and 30: People who use this service experience adequate quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. The environment and furniture generally meet the residents’ needs, and the environment promotes the residents’ well being. Although residents’ bedrooms generally promote independence one bedroom has some access issues that need to be addressed to fully promote independence. The home is particularly hygienic and clean, homely and comfortable, This environment therefore facilitates the residents’ health and emotional wellbeing. EVIDENCE: Astor House DS0000025750.V369680.R01.S.doc Version 5.2 Page 19 The home is a detached house situated in a residential area in Purley close to transport links. The home is decorated and furnished in a domestic style. There is a ramp providing access to the front of the home and is a garden to the rear that has level access. Maintenance for the home is provided on an as required basis by the Trust Works department. We saw that the overall condition and décor of the home was reasonable. A new summerhouse has been acquired since the last inspection. We saw that the residents’ rooms were individually decorated and rooms had been individualised by the residents. The bedrooms on the first floor are accessed via a passenger lift, which has been adapted for temporary use in the event of a fire. We saw that the access to one resident’s room is limited by the position of the bed. Damage to the edge of the wall where the resident has to squeeze through was evidence of the severity of the limitation to access. This resident also wishes to have the position of the bed moved to improve access and this should be acted upon. The following new requirement is set to address this: Bedroom 1 must be made accessible to the resident using it. All bedrooms need redecoration but one in particular has a more urgent need to be redecorated. The following recommendation is now set to address this: Bedroom 9 should be redecorated The home has two accessible baths, and has three separate toilets. At this inspection we saw that one of the baths has recently been replaced with a new model. The previous reports all recorded that ‘the home gave the impression of a clean and hygienic home. The building was clean and tidy and rooms were generally free of offensive odours.’ As we have seen this to be the case on a number of unannounced inspections, this area can now be assessed as continuing good practice under Standard 30. The home has also received a 5 star food hygiene award. Astor House DS0000025750.V369680.R01.S.doc Version 5.2 Page 20 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): Standard 32, 34, 35, and 36: People who use this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. The residents are supported by appropriately qualified staff, which raises the quality of staff and their practices. This standard is exceeded. The home’s recruitment procedures protect the residents through vigorous staff vetting. Although there has been progress in implementing the induction training programme, there have been no new staff to undertake the induction, which limits our ability to fully assess the effectiveness of this process. Staff are well supervised to ensure that they receive appropriate training and perform in a manner conducive to the residents’ well being. This Standard is exceeded. EVIDENCE: Astor House DS0000025750.V369680.R01.S.doc Version 5.2 Page 21 There are 17.45 Full Time Equivalent Staff. The Standards require at least half of the staff group to have a NVQ 2. This home has exceeded that figure for the last three years and therefore this Standard is exceeded. All elements of Schedule 2 {staff files} are now kept securely on site and are available for inspection. This includes CRB checks, references and records of staff disciplinary action. There have been no new staff since the last inspection where staff files were examined {see October 2005 inspection report for details}. At that time all the information required was present and this Standard was met. As no new staff had started staff recruitment files were not re-examined at this inspection. All staff undertake a comprehensive induction. This does not currently meet the topics and timescales required to be covered in the first six weeks induction and following six month foundation training as specified within Sector Skills Council workforce training targets. As no new staff have been recruited to test this system fully a recommendation only will be set at this time as follows: All new staff recruited should undertake a six weeks and six month foundation training to Sector Skills Council workforce training targets. Standard 36 requires at least 6 Staff supervision sessions per year. Staff supervision sessions were exceeded in frequency this year by almost double. This Standard is therefore exceeded. This ensures a well supervised workforce. Astor House DS0000025750.V369680.R01.S.doc Version 5.2 Page 22 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): Standard 37, 39, and 42: People who use this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. The home is managed by an experienced and well qualified manager who ensures a quality service. There is a quality assurance system, which involves the residents and provides a way for them to measure improvements in quality for themselves. The home promotes the health and safety of the residents, so that practices and the environment do not place their health and safety at risk. EVIDENCE: Astor House DS0000025750.V369680.R01.S.doc Version 5.2 Page 23 The home has a registered manager who is a qualified first level nurse and has over twenty-five years experience of working with people with learning disabilities. As well as a nursing qualification the manager also has a Certificate In Management Studies and has the Registered Managers Award. The last inspection report recorded that although progress had been made with implementing a quality assurance system and an annual development plan, with both involving residents, the results of the user/relatives satisfaction surveys need to be incorporated into the annual development plan that is open to the residents, to fully involve the residents and allow measurement of achievement in improving quality. The views of the residents have been acquired and an annual development plan designed. The information need now only be transferred to the annual development plan on an annual basis and fed back to the residents. The following recommendation regarding this remains in place: The information from service user surveys should now be transferred to the new annual development plan where appropriate. We saw that all of the health and safety policies and procedures relevant to this Standard were present. Moving and Handling, Fire Safety, First Aid, Food Hygiene, Infection Control, and Handling and Disposal of Clinical Waste policies are all also included in staff induction. Control Of Substances Hazardous to Health policies and data sheets are also present and all these items are locked in the storage cupboard. We saw that all of the procedures and testing of systems required were also present. These included for example, fire fighting equipment testing, Portable Appliance Testing, and gas testing. It has since been confirmed that the home is on mains only and does not have a tank. There is therefore no need for bacterial analysis or cleaning of the cold water tank. Astor House DS0000025750.V369680.R01.S.doc Version 5.2 Page 24 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 2 27 x 28 x 29 x 30 4 STAFFING Standard No Score 31 x 32 4 33 x 34 3 35 3 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 4 3 x 3 x x 3 x Astor House DS0000025750.V369680.R01.S.doc Version 5.2 Page 25 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. Standard YA26 Regulation 12(4)b Requirement Bedroom 1 must be made accessible to the resident using it. Timescale for action 01/09/09 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. 2. 3. 4 5. 6, Refer to Standard YA6 YA14 YA18 YA26 YA35 YA39 Good Practice Recommendations The manager should continue with the updating of the care plan layout to make them more accessible to staff. Each service user should be offered a seven-day holiday paid for by the home as part of the contracted price. Staff information and memos must not be posted in the residents’ own dining room. Bedroom 9 should be redecorated All new staff recruited should undertake a six weeks and six month foundation training to Sector Skills Council workforce training targets. The information from service user surveys should now be transferred to the new Annual Development plan where appropriate. Astor House DS0000025750.V369680.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Astor House DS0000025750.V369680.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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