Care Home: Cassini House

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What the care home does well The home provides a good standard of care and support to a group of residents with a range of very complex and challenging needs. The people who live in the home receive support for their health from a range of experienced healthcare professionals. The staff demonstrate a good knowledge of the residents and are able to recognise their individual needs. The people who live in the home are supported to maintain positive contact with their relatives and to have a full lifestyle enjoying a range of community based activities. The staff team work well together and one relative said "I have nothing but praise for the staff". What has improved since the last inspection? There have been a number of significant improvements since the last inspection in November 2007 where it was felt that the service was providing poor outcomes for the people living in the home. Most significantly the home has a permanent manager who is applying to be registered and she is supported by a recently appointed area manager who has experience of managing services for people with a learning disability. Both the manager and area manager have worked very hard to improve standards in the home. Seven new care staff have joined the team in the last six months and they have been appropriately inducted and so staffing levels are appropriate and staff are not working excessive hours. All the new staff have had the necessary recruitment checks. The care plans have been reviewed and person centred plans introduced for most of the residents. These care plans are being reviewed at regular intervals. Residents are also being protected through the improvement of the recording of medication and by the introduction of new robust systems for managing resident`s personal monies. The environment in the home has improved with new flooring, new bathroom fittings and redecoration in parts of the home. The boiler is also now working correctly. What the care home could do better: A few areas for improvement were identified for the service. In terms of the care and support to the residents it was recommended that the outstanding assessment and person centred plan is completed. There must also be a check undertaken that everyone has a record of their dental and optical appointments. The menu should be reviewed to reflect the tastes of the residents and more fresh produce should be used. Activities in the evening and weekend should be reviewed to ensure they meet everyone`s needs. The temperature of the medication cupboard should be monitored. In terms of the organisation of the home a quality assurance exercise needs to take place that seeks feedback from relatives and other care professionals in order to evaluate and improve the service. The home needs to ensure all serious incidents are notified to the Commission so they can monitor how these are being addressed. To improve health and safety the fire safety emergency plan must be reviewed. CARE HOME ADULTS 18-65 Cassini House 13 Duckett Road London N4 1BJ Lead Inspector Jane Ray Unannounced Inspection 7th May 2008 9:00 Cassini House DS0000010730.V363186.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 Cassini House DS0000010730.V363186.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. Cassini House DS0000010730.V363186.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cassini House Address 13 Duckett Road London N4 1BJ 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) 020 8340 1633 020 8340 1633 briione@yahoo.com Precious Homes Limited Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Cassini House DS0000010730.V363186.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd November 2007 Brief Description of the Service: Cassini House is owned by Precious Homes Ltd and is registered to provide residential care for six younger adults with a learning disability. The home specialises in supporting service users with autism and also residents with complex needs. Cassini House is a three-storey terrace house situated off Green Lanes, Haringey in North London. The home has six bedrooms and two bathrooms. The communal areas consist of a large lounge, a separate dining room and a kitchen. The garden area is of medium size with a paved area and access to the garden is via the dining room. The home is within easy access to local shops, restaurants, pubs, and public transport and near to Wood Green shopping city, Finsbury Park and Alexandra Park. Cassini House was registered in June 1998. The home’s stated mission is to be dedicated to creating a safe enabling environment in which individuals can experience respect, dignity and positive valuing and thereby sustain meaningful and fulfilled lives. The home also states that it seeks to provide high quality support in a residential care setting to adults with learning difficulties and challenging behaviour. This support reflects the individual residents unique needs and aspirations and cultural values, promotes autonomy and self-determination and enables the residents to lead their preferred way of life. The home charges from £990 to £2,300 per week depending on the assessed needs of each resident. A copy of this report can be obtained direct from the provider or via the CSCI website (web address can be found at page two of this report). Cassini House DS0000010730.V363186.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The inspection took place on the 7 May 2008 and was unannounced. The inspection lasted for six and a half hours and was the key annual inspection. The inspection looked at how the home was performing in terms of the key National Minimum Standards for Younger Adults and the associated regulations. The inspector was able to observe the support given to the current residents. The inspector was also able to spend time talking to the manager as well as the three care staff who were working. After the inspection the inspector also spoke to two relatives about the care provided to their sons. The inspector did a tour of the premises and also looked at a range of records including resident records, staff files and health and safety documentation. The home had provided the inspector with a completed self-assessment questionnaire (AQAA) prior to the inspection. This inspection was also part of a national thematic exercise being carried out by the Commission looking in more detail at safeguarding vulnerable adults. What the service does well: What has improved since the last inspection? There have been a number of significant improvements since the last inspection in November 2007 where it was felt that the service was providing poor outcomes for the people living in the home. Most significantly the home Cassini House DS0000010730.V363186.R01.S.doc Version 5.2 Page 6 has a permanent manager who is applying to be registered and she is supported by a recently appointed area manager who has experience of managing services for people with a learning disability. Both the manager and area manager have worked very hard to improve standards in the home. Seven new care staff have joined the team in the last six months and they have been appropriately inducted and so staffing levels are appropriate and staff are not working excessive hours. All the new staff have had the necessary recruitment checks. The care plans have been reviewed and person centred plans introduced for most of the residents. These care plans are being reviewed at regular intervals. Residents are also being protected through the improvement of the recording of medication and by the introduction of new robust systems for managing resident’s personal monies. The environment in the home has improved with new flooring, new bathroom fittings and redecoration in parts of the home. The boiler is also now working correctly. 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. Cassini House DS0000010730.V363186.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cassini House DS0000010730.V363186.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,2,3 and 5 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home can be assured that their individual needs will be assessed and that the staff have the skills and ability to meet these needs. New people moving to the service will have access to information in an appropriate format to tell them about the home. EVIDENCE: We inspected the statement of purpose and this document had been updated to provide specific information about the home and the resident group they care for. This document is clear and would be useful for care professionals and relatives who could need information about the service. In each residents case notes we were able to see that they had been given a service user guide in an appropriate pictorial format. We looked at the case notes for the four people who live in the home. They all had assessments that formed part of their individual care plans that covered their current individual needs and provided a good basis for the care plan goals. For three of the four residents this assessment had recently been Cassini House DS0000010730.V363186.R01.S.doc Version 5.2 Page 9 updated on a new person centred format, but for the final person this needed to be completed. We discussed the current needs of the people who live in the home with the manager and care staff. They have very specific individual needs linked to their learning disability, mental health, complex behaviours and autism. The staff spoken to had a very good understanding of the individual needs of the residents. In addition it was observed that the staff were supporting the residents with great skill and sensitivity. The training programme till the end of the year was also inspected and it was positive to note that training sessions are planned on mental health and autism as well as supporting people who have complex challenging behaviours. There have been no new people moving to the home since the last inspection. The manager explained that they are supporting one of the residents to develop his independent living skills to support him to move in the future. The manager also explained that a referral has been made to an advocacy service to support the resident in making choices about this possible change. The AQAA prepared by the home stated that all the residents had a completed contract between themselves and the home clearly stating what the service will provide. The four case notes that were inspected all included copies of the contract signed by a representative acting on behalf of the resident. In addition the organisation had produced a user-friendly contract explaining the rights and responsibilities of the residents and the care provider. Cassini House DS0000010730.V363186.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): Standards 6,7,8 and 9 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home can be confident that they will be supported to have an individual care plan and risk assessments. This will facilitate the residents to make choices in their daily lives. EVIDENCE: We inspected care plans for four people currently living in the home. We also spoke to the manager and care staff about the care plans. All of the people whose records were inspected had comprehensive care plans in place. These were clearly laid out and covered all aspects of each persons needs and were written using appropriate language. The care plans had all been reviewed on a monthly basis by the key-worker. All the residents had been supported to have an annual care plan review meeting with their care manager. A relative Cassini House DS0000010730.V363186.R01.S.doc Version 5.2 Page 11 spoken to as part of the inspection said, “I always attend the review meetings”. Each resident had a named key worker and co-key worker. The staff were asked about their role as a key-worker and this showed that the support they provided was very comprehensive including helping with personal shopping, attending healthcare appointments, ensuring all the residents personal care needs were met, organising leisure activities and updating care plans. The staff also showed a good understanding of each resident’s individual care plan goals. Since the last inspection the home has also developed a userfriendly person centred care planning process for all, the resident’s apart from one. One resident spoken to during the inspection said, “I sometimes look at my care plan especially the picture at the front”. The use of photos and pictures makes the format far more accessible. The care plans were comprehensive and clearly acted as a focus for the support and care given to the residents as well as offered opportunities for further personal development. We read the risk assessments for the same four people who live in the home. It was possible to see that an effort had been made to identify areas of personal risk and look at how this can be managed without placing unnecessary restrictions on people. The risk assessments had been prepared using one main format that was clear and easy to follow. It was also possible to observe the actions from the risk assessments being implemented in the home, such as supporting people in the kitchen and these clearly helped to maintain the safety of the residents. Each person living in the home had individual behavioural guidelines as part of their individual profile, assessment and care plan and these were clearly written and gave appropriate guidance to the staff. The four residents assessments and care plans clearly stated what arrangements were in place to support them to manage their personal finances including who acts as their appointee and how they can access their monies. We observed the three people living in the home and their interaction with the staff. It was positive to note that they were being facilitated to make choices including when they wished to get up or move around the home, when they were ready to eat and in some cases what they wanted to eat or drink. The staff were observed to be very aware of both verbal and non-verbal communication. They were also able to describe how they facilitate choices by for example holding up two items of clothing to enable the resident to indicate their preference. The residents are also supported to hold a monthly residents meeting. This uses an agenda that encourages a range of issues relating to the home to be considered. Actions agreed at the meeting are recorded. Cassini House DS0000010730.V363186.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): Standards 11,12,13,14,15,16 and 17 were inspected. People using this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home are supported to develop their daily living skills and are also enabled to follow their own routine. The home has made progress in supporting the residents to enjoy a good range of activities during the daytime but evening and weekend leisure activities need further development. Residents are offered a healthy diet but this would be enhanced further by the use of more fresh produce. EVIDENCE: We were able to observe during the inspection that, the people living in the home were being supported by staff to develop their independent living skills in line with their individual needs. For example one person was being supported by staff to prepare his own breakfast and one other person was Cassini House DS0000010730.V363186.R01.S.doc Version 5.2 Page 13 being helped to prepare a hot drink. The development of independent living skills was also reflected in the residents care plans. Here it could be seen that there was a strong focus on developing greater independence by developing skills to manage their own personal hygiene or improve domestic skills. I spoke to the staff and looked at the resident’s activity programmes to get an understanding about the activities that are taking place. The senior explained that three of the people currently living in the home go to specialist day centres five days a week, one person goes to a supported employment service and does gardening and the other two residents take part in activities organised by the home. It was observed that the residents make good use of public transport and have a freedom pass. One resident also has his own mobility scooter. The records of leisure activities showed that the people living in the home were accessing community based leisure activities regularly such as shopping, cinema, restaurants, local parks and bowling. One member of staff said that as a key-worker she is helping one resident go swimming twice a week. Some residents attend a local evening social club and the evening before the inspection some residents had been to a barbecue at the house next door. On the day of the inspection the three residents who were at home went out for lunch and then one went with his key-worker to the bank. The staff were also asked about activities at the weekend. They explained that several of the residents visit relatives and the others are offered leisure activities. One relative said, “the weekends bother me as less seems to happen”. This needs to be monitored by the manager to ensure sufficient opportunities to participate in activities are available at the weekend. One of the residents enjoys riding a bike and it was observed that bikes are available for both himself and the staff who accompany him. The relative however said that the staff do not go out regularly with him and that she feels he would enjoy more physical activities in the evenings. In terms of holidays the manager explained that some of the residents had enjoyed a long weekend break earlier in the year and other residents had been away with their relatives. Future holidays are being discussed at the residents meetings. The AQAA identified that the residents have different ethnic and cultural backgrounds. One person is a practising Muslim and the home have discussed this with his relatives and ensure he eats halal meat. The family however take him to pray at the mosque. The other residents do not attend a place of worship and their wishes and those of their relatives have been addressed in their assessment. The manager explained that most of the people living in the home have close contact with their relatives, who either come to visit them or they are supported to go home. One relative spoken to during the inspection said that she felt that communication was good between herself and the staff in the home. Another relative said that a communication book had been organised so Cassini House DS0000010730.V363186.R01.S.doc Version 5.2 Page 14 that staff can record any events that have taken place and her son will bring this book home with him, but the staff don’t always complete this record. One of the residents has a family friend who he speaks to on the phone. An arrangement has been made for her to visit the home and take him out. We were able to observe during the inspection that the people living in the home were able to follow a routine of their choice and that people get up at different times according to their individual wishes and needs. It was very positive to note that the residents were supported in a very person centred and individual manner. We saw the menu used in the home and this offered a nutritional menu. It was however observed that the food was very traditional English and might not represent the choices of the residents. The manager said that they were about to review the menus and offer more variety. We also saw that there was fruit and vegetables available in the home but that the meat being used was frozen and in most cases was processed. The staff were able to describe how they support the residents to eat a diet based on their individual needs for example encouraging healthy portion sizes. Cassini House DS0000010730.V363186.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): Standards 18,19 and 20 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home are supported in a manner that protects their privacy and dignity. Each person is supported to access professional healthcare input based on their individual needs although some primary healthcare checks need to be updated. EVIDENCE: We observed during the inspection that the staff were supporting the people living in the home to receive personal care in a manner that preserved their privacy and dignity. It was observed that all the residents were appropriately dressed and that their clothing was very suitable for the weather and the activities they were attending. The manager and care staff explained about how relatives take some of the residents shopping for clothes and key-workers support other residents. All the residents were also well groomed in terms of their personal care including haircuts. One relative did however comment that her son had his hair shaved rather than having it cut at the hairdressers. Cassini House DS0000010730.V363186.R01.S.doc Version 5.2 Page 16 We looked at the healthcare records for the four people living in the home. They had all been supported to access a range of healthcare professionals including the GP, psychiatrist, community psychiatric nurse and other appointments according to their individual needs. One resident has a hearing impairment and had been supported to access an audiology appointment. Unfortunately he had refused to attend the appointment to fit a hearing aid but the staff were trying to encourage him to attend at an alternative time. One resident had no record of a dental check and two others had no record of an optical check although the staff thought they had attended an appointment. Immediately after the inspection the manager booked all outstanding appointments and the home now needs to ensure that these checks are recorded with any information on the outcomes of the appointment. All the residents are having their weight checked on a monthly basis or more regularly according to their individual needs. We looked at the medication, administration records and staff training records. The home uses the Boots blister pack system. Since the last inspection the home has purchased a new medication cupboard. The medication administration records show clearly when medication is received in the home or returned to the pharmacist so a clear audit trail is available. The medication administration records were completed correctly. Each resident had a profile and these appeared accurate and reflected the medication on the medication administration record. Where the resident takes “as required” medication there is a protocol in place stating when this should be administered. Each resident also has a list of homely remedies they can take and this has been approved with the GP. Since the last inspection the manager has revised the information for each resident giving clear guidelines on how medication should be managed during regular home visits. The training records were inspected and all of the staff had completed the medication training. The home manager is completing a monthly audit and these records were observed. In addition the pharmacist from Boots visited the home in January to check the medication system. It was noted that the temperature of the medication cupboard needs to be monitored. Cassini House DS0000010730.V363186.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): Standards 22 and 23 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home have access to an appropriate complaints procedure. Procedures and training on safeguarding vulnerable adults are in place to protect the residents. New systems are being implemented to ensure residents personal monies are being managed appropriately. EVIDENCE: The AQAA stated that there have been no written complaints since the last inspection. The organisation has two complaints procedures, one designed for the service users and the other for relatives and care professionals. Both these documents are clear and can be found in the service user guide. The home has a format available to record any complaints that are received and just after the inspection introduced a new format to record the outcome of the complaint and the date the complaint is resolved. The staff spoken to during the inspection understood how to respond appropriately to any complaints received. There has been one adult protection issue since the last inspection where one resident had some personal monies stolen. The police have not yet concluded the investigation and nobody has been charged. The home used the local safeguarding vulnerable adult procedures appropriately. Copies of the Cassini House DS0000010730.V363186.R01.S.doc Version 5.2 Page 18 organisations procedures and social service procedures are available in the home. A user-friendly policy has also been prepared for the residents to help them think about how they can keep safe. I looked at the staff training records and these show that some of the staff had received safeguarding vulnerable adult training and further training is booked for the rest of the team. We spoke to the care staff about the safeguarding adults procedure and they all displayed a good knowledge of the procedures and the importance to speaking to the manager about issues that arise. In addition safeguarding is discussed as part of the staff induction and in ongoing supervisions. We also looked at the training records to see if the staff had been trained on how to appropriately support people who have complex challenging behaviours. These show that some staff have received this training and further training is booked on breakaway techniques from recently appointed staff. This helps to ensure that staff respond appropriately to residents if they are distressed. We checked the personal finances for three residents including their cash record, cash and receipts. Two of these people are supported by the manager to manage their finances. The third person is supported by a relative and the home just helps them to manage some spending money. Where people are supported by the manager they have their own post office or building society account. In the home there is an individual finance record for each person and his cash is held in a lockable filing cabinet. All expenditure is recorded and receipts are available. The manager also had a record of each persons balance in their savings account. The record of expenditure was inspected and money had been spent appropriately and receipts were available. The only person with access to the monies is the manager or area manager. A small float is made available for the care staff to access as required. The manager explained that she is supporting residents to change from having a cash card with a pin number, to using a passbook to access their monies so that residents can go to the post office with other staff rather than just herself as she is the only person with details of the pin numbers. Cassini House DS0000010730.V363186.R01.S.doc Version 5.2 Page 19 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): Standards 24 and 30 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people who use this service can usually feel confident that they are living in a well maintained home. The home is kept clean and hygienic and is largely a pleasant environment for the people who live here. EVIDENCE: The home is a converted three story domestic premises that remains generally well decorated, well maintained and which continues to provide an overall pleasant environment to meet the current service users needs. Since the last inspection a number of improvements have taken place including repairing the lounge floor, replacing flooring on the first floor landing and in the bathroom and toilet, replacing bathroom fittings and carrying out some Cassini House DS0000010730.V363186.R01.S.doc Version 5.2 Page 20 redecoration in the home. A new sofa in the lounge has been provided. One relative commented on how she was “very pleased with the improvements that have taken place”. The house has satisfactory laundry facilities and storage for chemical cleaning materials. The home was seen to be clean and tidy during the inspection. Residents had been supported to make their bedrooms homely and personalised. Flowers had been bought to plant in the garden. Cassini House DS0000010730.V363186.R01.S.doc Version 5.2 Page 21 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): Standards 32,33,34,35 and 36 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Recently recruited staff means there are now enough staff available to meet the needs of the people living in the home. The staff are receiving relevant training and are supported by regular supervision sessions. This enables them to work to a high standard and deliver good care. EVIDENCE: One relative commented that her main concern over the last year had been “the lack of staff”. We checked the rota for the home and this showed that there is a team of thirteen staff working in the service. The staffing structure consists of the manager, team leader, two senior carers and a team of carers. During the day there are two or three staff on duty depending on how many residents will be in the home and at night there is one waking member of staff and another sleeping in. The manager is shown as being supernumerary on the rota. Since the last inspection seven carers have joined the team, which represent a very significant staff turnover. According to the rota the staff were Cassini House DS0000010730.V363186.R01.S.doc Version 5.2 Page 22 not working long hours and the staff spoken to during the inspection also confirmed that their hours of work are not excessive and they are not doing lots of additional hours in other services. The inspector is however aware that whilst staffing issues have improved, this has been a serious matter of concern in the past year and needs to be carefully monitored. The manager and care staff explained that staff team meetings take place on a monthly basis. The record of these meetings was inspected and it could be seen that they discuss a range of operational issues. The staff spoken to said that the team was working well together and that there was a open communication between team members. They also felt confident to raise any concerns with the manager. The AQAA prepared by the home stated that three staff are working towards and NVQ level 4 including the manager and four staff are working towards an NVQ level 2 or 3. There are more than 50 of the staff team who are studying towards an NVQ in care. We looked at the recruitment records for the whole staff team including all the staff who had started working at the home since the previous inspection. It was found that all the staff had two references, ID, POVA check and a CRB disclosure. The staff had completed and signed contracts of employment. One did not have evidence of current permission to work in the UK. We inspected the training records. We looked at the induction records for all the staff and they all had a completed the skills for care induction programme and a record was available. The staff confirmed that this induction had taken place over a week and that they had also shadowed other staff during this period. One staff member commented that she felt “well prepared for the job”. The member of staff had an individual training record and most had been supported to complete a training needs assessment. An ongoing programme of training had been booked till the end of the year covering all mandatory training as well as specific training to support staff to work effectively with the residents they support. The staff said that the training they had received was a good standard and very useful for their work. We looked at the supervision records. All the staff had received regular individual supervision. The format used for supervision is appropriate and includes a record of any action agreed. Cassini House DS0000010730.V363186.R01.S.doc Version 5.2 Page 23 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): Standards 37,39 and 42 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. A permanent manager who can provide effective leadership is now in place and is completing the registration process. Health and safety measures are in place to safeguard the people living in the home. The quality improvement system in the home would benefit from seeking the views of relatives and other stakeholders. EVIDENCE: In the last year there have been five different managers for this service and this has caused instability and anxiety for all involved. The current manager Cassini House DS0000010730.V363186.R01.S.doc Version 5.2 Page 24 who has considerable skills and experience has made many improvements since she came into post in January 2008. She has applied for registration but confusion has arisen about the company name and this needs to be clarified as part of the registration process. A new area manager has also come into post and is providing support to the manager. The inspector also met this person during the inspection. Whilst the standard of management in the home was good at the time of the inspection the inspector is also keen to ensure that improvements in this area are maintained consistently for the future. The area manager explained that a quality assurance system is in place including her monitoring visits to the home and the manager completing a weekly audit. The company has questionnaires to seek the views of relatives and other care professionals as part of a quality improvement exercise but these still need to be distributed. The manager explained that a relatives meeting is taking place and this would be a good opportunity to seek their views on how the home can be improved. The Regulation 26 visits to the home had taken place regularly in the last three months and the reports were available in the home. It was however noted that one serious incident where the resident had been admitted to the hospital had not been reported to the Commission. In terms of fire safety we looked at the fire safety risk assessment and this was now complete. The service has an emergency plan but this needs updating to reflect current fire brigade guidance. The fire alarm and fire extinguishers had been serviced. The fire alarm records show the alarm is checked weekly and the fire drills have been taking place three monthly. Fire safety training has been completed for most of the staff and further training is taking place for the new staff. The AQAA showed that all the health and safety maintenance checks had taken place. The boiler is now working properly according to the AQAA and staff spoken to during the inspection. The staff training records show that the staff have either completed or are booked to attend most of the health and safety training including food hygiene, moving and handling, first aid and infection control. Cassini House DS0000010730.V363186.R01.S.doc Version 5.2 Page 25 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 3 2 2 3 3 4 x 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 x LIFESTYLES Standard No Score 11 3 12 3 13 2 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 x 2 x x 2 x Cassini House DS0000010730.V363186.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO 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 YA2 Regulation 15(2) Requirement The registered person must complete an assessment for the final resident so that there is a record of his current support needs. The registered person must complete a person centred plan for the final resident. The registered person must review the menu to provide a greater variety of food and more fresh produce must be used to make the food as nutritious as possible. The registered persons shall ensure that an application to register a manager for the home is completed without delay. The registered person must ensure the homes quality assurance system includes sending questionnaires to relatives and other stakeholders so they can provide feedback. The registered person must ensure all serious incidents are notified to the Commission. The registered person must ensure the fire emergency plan is updated to maintain fire safety DS0000010730.V363186.R01.S.doc Timescale for action 31/05/08 2. 3. YA6 YA17 15(2) 16(2)(i) 31/05/08 15/06/08 4. YA37 8&9 31/07/08 5. YA39 24 (1) (a) & (b) 30/06/08 6. 7. YA39 37 23(4) 31/05/08 15/06/08 YA42 Cassini House Version 5.2 Page 27 in the home. 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. Refer to Standard YA13 YA15 YA18 YA20 Good Practice Recommendations The activities in the evening and at the weekend must be reviewed to ensure they meet the needs of all the residents. Agreed means of communication with relatives should be maintained. The preferences of the resident with regard to haircuts should be respected. The temperature of the medication storage area should be monitored and recorded on a daily basis. Cassini House DS0000010730.V363186.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection London Regional Contact Team 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 Cassini House DS0000010730.V363186.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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