Care Home: Chiswick Care Ltd

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What the care home does well The people living in the home appeared very happy and have a good relationship with the staff. The home provides a high standard of care and support to a group of people with a range of complex needs. The home works consistently and professionally with the residents in partnership with other care professionals to support them to make significant progress with their personal development. The manager and staff demonstrated a good knowledge of the people living in the service and were able to recognise their individual needs and how to respond appropriately to them. The residents are supported to develop their independent living skills in the home based on their individual needs. The residents are supported to access a range of educational and leisure activities based on their individual interests and this enables them to have participation in the local community. The manager and staff show a high level of enthusiasm and commitment to their work in the home.The home is very clean, comfortable and homely and the residents each have an attractive single bedroom. Some of the people living in the home have close contact with families and friends and this is promoted by the home. The residents` dietary needs are met with a balanced and varied selection of fresh food that meets their health needs, tastes and cultural needs. What has improved since the last inspection? All the requirements from the previous key inspection had been completed, and all recommendations from the most recent random visit were addressed, which represents significant progress. Work had been undertaken to further develop person centred care plans, involving residents and ensure that review meetings take place at least once a year. The accuracy of care plans had also been improved. There was also an improvement in the recording of people`s healthcare appointments, and recording of guidelines for `as and when` medication. Action had been taken to ensure that residents who receive DSS benefits had these paid into their bank accounts and not the company account. Staff had undertaken refresher training on epilepsy and makaton training. Further health and safety training such as moving and handling and infection control had also been undertaken. Improvements were made in the information kept on staff files to ensure that residents are protected appropriately by the home`s recruitment procedures. An analysis of the training needs of the whole staff team had also been undertaken and a training programme had been planned accordingly. An electrical installation safety check had been undertaken and the fire safety risk assessment had been completed. The home had gained Investors in People accreditation which indicates a high level of training and support for the staff team. CARE HOME ADULTS 18-65 Chiswick Care Ltd 11-13 Chiswick Road London N9 7AN Lead Inspector Susan Shamash Unannounced Inspection 6th August 2008 2:30 Chiswick Care Ltd DS0000010618.V364536.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 Chiswick Care Ltd DS0000010618.V364536.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. Chiswick Care Ltd DS0000010618.V364536.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chiswick Care Ltd Address 11-13 Chiswick Road London N9 7AN 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 8803 8002 020 8887 6664 info@chiswickcare.com Mr Bhooneswur Krite Luchmun Mrs Reeta Luchman Reeta Luchmun Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Chiswick Care Ltd DS0000010618.V364536.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. One specified service user who is over 65 years of age may remain accommodated in the home. This condition will remain until such time as the home can no longer meet his needs. 4th September 2007 Date of last inspection Brief Description of the Service: 11-13 Chiswick Road, London, N9 7AN is a care home owned and run by Chiswick Care Limited. The home is located in a residential area of North London with community resources and facilities within close proximity. Mrs Reeta Luchman is the registered manager of the home. The home has two bathrooms, a kitchen, a lounge and a large paved garden at the back of the building. Chiswick Care provides support and supervision for six adults with a learning disability and associated mental health problems. Each resident has a single bedroom. The people living in the home are supported to access community-based facilities such as libraries, sports facilities, cinemas and shops. There is a range of leisure activities provided at the home. The people living in the home make good use of public transport and services such as dial a ride. In addition to support during the day, the home has one member of staff who is awake at night to respond to the needs of the service users at night. The current range of fees in the home is from £732 - £1490 a week. The provider makes information about the service, including inspection reports, available to the people living in the home and other stakeholders. Chiswick Care Ltd DS0000010618.V364536.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced inspection took place over approximately 6 hours and went on till approximately 8.30pm. The inspection looked at how the home was performing in terms of the key National Minimum Standards for Younger Adults and the associated regulations. I was able to speak to and observe the support given to five service users who were living at the home. I also spent time talking to the manager and two members of care staff who were working in the home. I conducted a tour of the premises and looked at a range of records including residents’ care records, staff files and health and safety documentation. Information provided in the home’s Annual Quality Assurance Assessment was also taken into account as part of this inspection. What the service does well: The people living in the home appeared very happy and have a good relationship with the staff. The home provides a high standard of care and support to a group of people with a range of complex needs. The home works consistently and professionally with the residents in partnership with other care professionals to support them to make significant progress with their personal development. The manager and staff demonstrated a good knowledge of the people living in the service and were able to recognise their individual needs and how to respond appropriately to them. The residents are supported to develop their independent living skills in the home based on their individual needs. The residents are supported to access a range of educational and leisure activities based on their individual interests and this enables them to have participation in the local community. The manager and staff show a high level of enthusiasm and commitment to their work in the home. Chiswick Care Ltd DS0000010618.V364536.R01.S.doc Version 5.2 Page 6 The home is very clean, comfortable and homely and the residents each have an attractive single bedroom. Some of the people living in the home have close contact with families and friends and this is promoted by the home. The residents’ dietary needs are met with a balanced and varied selection of fresh food that meets their health needs, tastes and cultural needs. What has improved since the last inspection? What they could do better: Two verified references must be provided for the identified staff member and the verification of references must be recorded on all staff files, to ensure that people living at the home are safeguarded by rigorous recruitment procedures. No pin numbers for residents’ bank accounts may be known to staff or management in the home, and records of monies kept on behalf of people Chiswick Care Ltd DS0000010618.V364536.R01.S.doc Version 5.2 Page 7 living at the home must be accurate at all times, to ensure that people living at the home are protected from financial abuse. A small number of improvements to arrangements for the home’s health and safety arrangements are needed. It is recommended that person centred plans for people living at the home should be made more accessible through the use of pictures or other formats. More accessible formats should also be considered for menus and other notices posted in the home. It is recommended that there be more choices of activities available to people living at the home at weekends in line with their choices. It is recommended that all staff should undertake training in the Mental Capacity Act 2005, and that informal supervision sessions should be recorded to evidence that staff support service users in line with best practice. 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. Chiswick Care Ltd DS0000010618.V364536.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 Chiswick Care Ltd DS0000010618.V364536.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 was inspected. People who use 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 they will be assessed and that the service can meet their needs. EVIDENCE: Three service user files were inspected including that of the most recently admitted resident to the home. Each contained a full assessment prepared by social services made available to the home prior to his admission. In addition the home had carried out their own assessment and a copy of this was available in the case notes. The manager explained that new residents have a number of visits to the home prior to moving in. The admissions process is also reflected in the statement of purpose. The staff spoken to said they had received training in meeting the needs of the people living in the home. This was reflected in their training records. As required at the previous key inspection staff had undertaken current training in supporting people with epilepsy and communicating in Makaton sign language. I also observed people using Makaton appropriately during the visit. Chiswick Care Ltd DS0000010618.V364536.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 and 9 were inspected. People who use 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 are supported to have person centred care plans which are reviewed regularly to ensure that they remain relevant. The people living in the home are supported to make decisions and choices in their daily lives, and take informed risks with appropriate support. EVIDENCE: Since the last key inspection the home has introduced a system of person centred care planning for residents. The case notes were inspected for three residents and they all had comprehensive individual assessments, which accurately reflect their current individual support needs. Each person also had individual care plan goals. These goals were clearly recorded and where possible the resident had signed to show they have understood and agreed with these goals. Where the resident is unable to sign, relatives or other representatives have been asked to sign to say they have read and agreed the goals. As recommended at the most recent random inspection visit, residents were now being supported to identify more specific areas for personal development, in addition to personal care goals. Chiswick Care Ltd DS0000010618.V364536.R01.S.doc Version 5.2 Page 11 Some work had been undertaken to introduce formats that will engage the residents further in their person centred plans. However it is recommended that person centred plans be further developed so that they are more accessible through more use of pictures or other formats such as videos. More accessible formats should also be considered for menus, the home’s brochure and other notices posted in the home. The care plan goals are reviewed on a monthly basis and are also reflected in the daily records. The residents have mostly had an annual review with their care manager. Minutes of these meetings are available and actions agreed at these meetings are being followed up and incorporated into the care plan goals. All service users had a named key worker and one person when asked knew the name of their key worker. All residents have complex behaviours. Documentation describing these behaviours enables the staff to identify when residents are distressed and what action they should take in response to this situation. The incidents of challenging behaviours are recorded separately so any issues can be identified. Some of the service users have restrictions in place, for example keeping their cigarettes in the office or placing their money in the office for safe keeping. The reasons for these restrictions are recorded in their care plans. Residents’ records included a comprehensive individual risk assessment covering all areas of potential risk and this identified what action the home would take in response to the identified risks. Throughout the inspection people were observed being consulted about decisions concerning their daily lives. This included being asked what they wanted for meals and what activities they wanted to do. I also looked at the record of the residents meetings. Issues discussed included food, leisure activities and holidays. The records show that the residents come up with lots of suggestions and that these are taken into account in the running of the home. Chiswick Care Ltd DS0000010618.V364536.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 who use 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 to have full and active lifestyles that reflect their interests both within and outside of the home, and offer opportunities for the development of new skills. They enjoy contact with their relatives and friends and are provided with a balanced and nutritious diet. EVIDENCE: Residents told me that they access a range of activities based on their individual choices and interests. Some people attend a day service whilst others enjoy going to college for gardening, computer art, numeracy and literacy. The possibility of supported employment is being looked into for one person, and one person has been referred for art therapy. Some residents go to a men’s drop in within the local area, attend an art class and go out to two or three evening clubs for people with a learning disability. In addition the daily records show that residents enjoy lots of leisure activities including meals out, shopping, swimming, massages, going to the cinema, bowling and sporting activities such as football and badminton. Chiswick Care Ltd DS0000010618.V364536.R01.S.doc Version 5.2 Page 13 Staff advised that one resident plays in a football team and this involves regular training as well as matches. Daily records indicated that there are fewer activities available to residents over the weekends, and it is recommended that there should be more choices of activities available to people living at the home at weekends in line with their choices. The manager noted that one person had a phobia of going out when they first moved to the home, however they now went out frequently without difficulty, and the home is commended for the support provided to this person. Another resident had moved from the home into a more independent setting with support from staff at the home. The people in the home choose to practice their religion according to their individual wishes. One person likes to go to church every week and is a practicing Catholic, another celebrates Muslim festivals with relatives and another resident occasionally goes to church with their parents. One resident is supported to watch Indian movies in line with their cultural preferences. Holidays are arranged for people living at the home, including a trip to Cornwall last year, for which photographs were available. Residents told me that they had enjoyed this trip a great deal, and the manager advised that they were in the process of planning a holiday for this year, this was confirmed in the most recent resident meeting minutes. One staff member had taken residents on a day trip to the Isle of Wight in April 2008, and residents confirmed that they had enjoyed the trip. The residents were observed helping with domestic activities such as tidying their rooms and clearing up after meals. There is a rota for the people so they know what assistance they need to give. One resident confirmed the rota is followed and that they also offer to help with shopping from the local shop. The manager explained that most of the residents have contact with their families and friends. They are made welcome in the home or residents are supported to go to their family homes. One person living in the home had a friend over during the inspection, and told me that visitors are made welcome to the home, and they are also able to go out and see friends when they wish to. During the inspection I noted that routines in the home remain very flexible. One resident told me that they like to stay up later at night watching films, and each resident has their own bedroom and front door key. There was a friendly atmosphere in the home with the staff chatting to the residents and residents also supporting each other. One person told me that they felt as if they were part of a big family at the home. Chiswick Care Ltd DS0000010618.V364536.R01.S.doc Version 5.2 Page 14 A variety of fresh fruit and vegetables were available in the home. The menu for the week was inspected and this offered a healthy and varied diet. The manager explained that two of the residents generally choose not to eat pork for religious reasons. Two people commented on how much they enjoyed the food, and others were observed to eat well and seemed satisfied with food provided. Chiswick Care Ltd DS0000010618.V364536.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 who use 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 receive a high standard of personal care and are assisted to access healthcare appointments to get the support that they need. Medication systems within the homes are well organised to ensure that people’s medication needs are met. EVIDENCE: I observed during the inspection that the people living in the home were given support with their personal care based as needed, in a way that respected their dignity. The residents were well dressed and groomed and advised that they chose their own clothes. Residents were observed participating in domestic activities in the home including cleaning their bedrooms and helping with the washing up. Their individual care plans also included how they were being supported to develop these independent living skills. Chiswick Care Ltd DS0000010618.V364536.R01.S.doc Version 5.2 Page 16 The records of healthcare checks were inspected for three residents and these were clear and up to date. Records indicated that they had been supported to see their GPs regularly, and had recent optical and dental checks as appropriate. In the case of one resident who does not have a regular dental check, as this requires sedation, this was recorded within their individual risk assessment as recommended at the previous inspection. In addition the residents receive input for their specialist healthcare needs including psychiatry, dietician and audiology clinics accessed for specialist advice. All the people living in the home are supported to check their weight on a monthly basis. The home uses a blister pack monitored dosage medication system. The medication administration records were inspected and were completed correctly. The medication entering the home is recorded appropriately on the medication administration record. There is a separate record for medication returned to the pharmacist. The medication available was correct. Training records were also inspected for four staff members with certificates showing that three of them had completed medication training as appropriate, and the other did not administer medication. As required at a previous inspection, the resident who has PRN medication now has clear guidelines available stating when this should be administered, prepared by the consultant psychiatrist. Chiswick Care Ltd DS0000010618.V364536.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 who use 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 the correct training and procedures are in place to address their concerns about the home and protect them from the risk of being abused. EVIDENCE: The manager explained that the home has not received any complaints since the previous inspection. The complaints policy is displayed for the people users to access as required, and people living at the home told me that they felt able to speak to the manager about their concerns. The manager and staff on duty explained that the staff had all had adult protection training. This was confirmed by the records of staff training for four members of staff, although one staff member would benefit from some refresher training. The home has an adult protection procedure that has been checked on a previous inspection and is satisfactory. Staff have received training on how to support people who have complex behaviours and this training was felt to be very helpful. Chiswick Care Ltd DS0000010618.V364536.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): Standards 24 and 30 were inspected. People who use 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 benefit from an environment that is clean, comfortable and maintained to a high standard of decoration for their comfort. EVIDENCE: I conducted a tour of the home and looked at all four of the bedrooms as one person did not want me to visit their bedroom. The home was clean and tidy throughout. Each person’s bedroom was well furnished and appeared comfortable and personalized. People living at the home told me that they were happy with the environment, and satisfied with the furnishings provided to them in their bedrooms. The communal space consists of a large lounge and dining area and a separate kitchen. These were also well furnished and comfortable. There are adequate bathing facilities with a bathroom on each floor. The home has a laundry on the first floor. All the equipment in the home was observed to be in good working order. Chiswick Care Ltd DS0000010618.V364536.R01.S.doc Version 5.2 Page 19 The garden area was maintained to a high standard, and I saw residents sitting outside during the visit. As recommended by a staff member, the fitting of a dimmer switch in an identified person’s bedroom should be considered, so that they can be supported during the night without disturbing their sleep. Chiswick Care Ltd DS0000010618.V364536.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): Standards 32, 34, 35 and 36 were inspected. People who use 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 by a stable team of staff who have completed appropriate recruitment checks and training, and are supervised to support them in line with best practice. EVIDENCE: At the time of the inspection there were eleven care staff employed in the home including the manager. The staffing structure consists of the manager, senior carers and a team of carers. During the day there are between two and three staff working depending on the activities taking place. This time is divided into an early and late shift from 8am to 10pm. At night there is one waking and one sleeping in member of staff on duty. The rota was inspected and clearly showed who is working. Four staff member’s records were inspected. These included application forms, identity documents, two written references and CRB disclosures. Staff contracts and evidence of the right to work in the UK were also available. However references were not on file for a newly employed staff member, who assists the manager with paperwork. This must be addressed without delay, Chiswick Care Ltd DS0000010618.V364536.R01.S.doc Version 5.2 Page 21 and the verification of references should be recorded on all staff files, to ensure that people living at the home are safeguarded by rigorous recruitment procedures. Staff team meetings had been taking place every two months. The records of these meetings were inspected and show a range of issues relating to the operation of the home and the care of residents are discussed. In the Annual Quality Assurance Assessment the manager advised that ten care staff have completed their NVQ level 2 in care, and the most recently recruited staff member will be undertaking this qualification. The home is commended for this practice which exceeds the National Minimum Standards for staff qualifications. Certificates for this training were available in the staff training records. Training records for the more recently recruited staff included an internal induction checklist and showed that staff had completed the induction booklet that is in line with the TOPPS guidelines. A record of training needs for the staff team had been completed. This identified the training to be undertaken this year. Staff members confirmed that they had recently undertaken training and that it was useful in their work with people living at the home. It is recommended that all staff should undertake training in the Mental Capacity Act 2005, and how this is relevant to their role in supporting people living at the home. The supervision records were also inspected for the four staff, and records indicated that staff receive good quality individual supervision on a regular basis. Staff members spoken to confirmed this. It is recommended that informal supervision sessions should be recorded to evidence that staff support people in line with best practice. Chiswick Care Ltd DS0000010618.V364536.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): Standards 37, 39, 41 and 42 were inspected. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People can be confident that the home is overseen by an experienced manager who works hard to meet the requirements and recommendations of the CSCI. Their health and safety is well protected, however they could be better protected in support with their finances. EVIDENCE: All the requirements from the previous key inspection had been completed, and all recommendations from the most recent random visit were addressed, which represents significant progress. The home has a registered manager who in conjunction with her husband is also the owner of the home. The manager has the appropriate skills and experience and has also completed the NVQ level 4 in management of care. Chiswick Care Ltd DS0000010618.V364536.R01.S.doc Version 5.2 Page 23 Prior to the last inspection the home had completed a quality assurance exercise including asking service users, relatives, care professionals and other stakeholders who know the home to complete questionnaires asking for feedback. The manager advised that an action point indicated from the feedback was addressed. Regular staff and resident meetings are held at the home during which consultation is also undertaken. The manager advised that the home had obtained Investors in People certification and was working towards a Skills Pledge award. They were recently contacted by Kent University to participate in a survey about quality assurance. The finance records were inspected for three residents where the home manager acts as the appointee. As required at the previous inspection action had been taken to ensure that residents have their DSS benefits paid into their own personal accounts instead of the company account. However I was concerned to learn that pin numbers for residents’ bank accounts were known to the manager. The difficulties encountered in finding a different system for assisting residents to access their monies were discussed. However new arrangement must be put in place so that no staff have access to residents pin numbers, even if this necessitates transferring people’s bank accounts to building societies that still operate a book system. Some minor discrepancies due to lack of change were found with records of monies kept for safekeeping on behalf of people living at the home. However these must be kept accurate at all times, with discrepancies due to insufficient change available clearly recorded at the time of each transaction, to ensure that people living at the home are protected from financial abuse. Accident and incident reports were recorded appropriately in the home. Fire safety measures are in place with records showing that weekly fire alarm checks and monthly fire drills are undertaken. However the fire call point tested each week must be varied to ensure that each call point is tested on a regular basis. The fire alarm and extinguishers had received recent servicing and records were available to confirm this had taken place. The home also has an emergency plan and fire safety risk assessment as required, with action taken to address issues from the previous key inspection. Staff training records were inspected indicating that they had undertaken training covering fire safety, first aid, food hygiene, moving and handling and infection control. Certificates were also in place to confirm the gas and electrical wiring systems and the portable electrical appliances had been tested and serviced and there was a current insurance certificate displayed in the home. However there was no current certificate for Legionella testing of the home’s water systems. Chiswick Care Ltd DS0000010618.V364536.R01.S.doc Version 5.2 Page 24 The temperatures of one refrigerator and freezer were being tested on a daily basis to ensure that these remain within the appropriate range, however there were two refrigerators and freezers being used within the home, therefore all of these appliances must be tested daily. Chiswick Care Ltd DS0000010618.V364536.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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 3 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 4 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X 2 3 X Chiswick Care Ltd DS0000010618.V364536.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 YA34 Regulation 17(2) Sched 4 (6c) Requirement Timescale for action 12/09/08 2. YA41 17(2) Sched 4 (9) 3. YA42 13(4) 23(4cv) The registered persons must ensure that two verified references are kept on the identified staff member’s file and that the verification of references is recorded on all staff files, to ensure that people living at the home are safeguarded by rigorous recruitment procedures. The registered persons must 10/10/08 ensure that no pin numbers for residents’ bank accounts are known to staff or management in the home, and that records of monies kept on behalf of people living at the home are accurate at all times, with discrepancies due to insufficient change available clearly recorded at the time of each transaction, to ensure that people living at the home are protected from financial abuse. The registered persons must 26/09/08 ensure that the following health and safety issues are addressed: The temperatures of both refrigerators and both freezers in the home must be recorded on a Chiswick Care Ltd DS0000010618.V364536.R01.S.doc Version 5.2 Page 27 daily basis, and monitored to ensure that these remain within the appropriate range, The fire call point tested each week must be varied to ensure that each call point is tested on a regular basis, And a current certificate for Legionella testing must be obtained for the home, to ensure the health and safety of people living and working at 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. Refer to Standard YA6 Good Practice Recommendations It is recommended that person centred plans for people living at the home should be made more accessible through the use of pictures or other formats. More accessible formats should also be considered for menus, brochures and other information relevant to people living at the home. It is recommended that there should be more choices of activities available to people living at the home at weekends in line with their choices. It is recommended that a dimmer switch be fitted in an identified person’s bedroom so that they can be supported during the night without disturbing their sleep. It is recommended that all staff should undertake training in the Mental Capacity Act 2005, and how this is relevant to their role in supporting people living at the home. It is recommended that informal supervision sessions should be recorded to evidence that staff support people users in line with best practice. 2. 3. 4. 5. YA14 YA24 YA35 YA36 Chiswick Care Ltd DS0000010618.V364536.R01.S.doc Version 5.2 Page 28 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 Chiswick Care Ltd DS0000010618.V364536.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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