Care Home: Churchill House

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What the care home does well The home continues to maintain a positive atmosphere in which staff and service users alike mutually respect each other. There are good opportunities for stimulation and development through a range of activities such as board games, art, table tennis, badminton, bike exercises, a library and swimming (weather permitting). There is a commitment to involving service users in developing the service and in effect, their life objectives. One way of achieving this is by ensuring that each service user has a contract and an individual support plan. There is an established practice of ensuring that detailed assessments are carried out on each service user prior to them taking residence at Churchill House. Regular supervision ensures that individual staff members are motivated, and feel supported. It is good practice that training in the recording and administration of drugs is provided to all staff. The registered provider regularly and, as required by Regulation 26 of the Care Homes Regulations 2001, carries out monthly provider monitoring visits on the service. What has improved since the last inspection? What the care home could do better: Comply fully with requirements made by the Commission. Ensure that the statement of purpose is reflective of the current service provision. Review and record dates of all risk assessments. Provide training for staff in mental health and challenging behaviour. Consider ways of including service users is staff recruitment. CARE HOME ADULTS 18-65 Churchill House 48-50 Mawney Road Romford Essex RM7 7HT Lead Inspector Stanley Phipps Unannounced Inspection 1 to 5 October 2007 11:00 st th Churchill House DS0000027836.V348309.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 Churchill House DS0000027836.V348309.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. Churchill House DS0000027836.V348309.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Churchill House Address 48-50 Mawney Road Romford Essex RM7 7HT 01708 732558 01708 732558 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) Kulwant Singh Mann Mr Ramjit Nunkoo Care Home 12 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (12) of places Churchill House DS0000027836.V348309.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To include 4 named people over 65 years of age Date of last inspection 1st September 2006 Brief Description of the Service: Churchill House is a care home providing personal care and accommodation for twelve service users. This includes younger adults and 4 service users over 65 years of age, all of whom have a mental illness. The home provides a service to both men and women. The home has no passenger lift therefore the home cannot accommodate anyone with physical disabilities. The home opened in 1996 and is located in a residential area of Romford near to Romford High Street. There is car parking to the front of the building. Churchill House consists of a three-storey building that is divided into two units and annexed via an activity room. There is a large garden with a shared patio area and swimming pool. All bedrooms are single occupancy, one of which in each unit is sited on the ground floor with the rest on the second and third floors. Some bedrooms have a shower cubicle fitted in them. There is a lounge in each unit on the ground floor in which service users relax and watch television or engage in activities of their choice. One of the lounges has now become a designated smoking area. The fees range from £850 to £980 per week and a statement of purpose and service user guide is made available to service users living there. Service users have to pay for their personal effects – the prices of which are variable. They also have to bear the cost of their annual holidays, although some placing authorities actually provide funding for their clients. Churchill House DS0000027836.V348309.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out between the 1/10/07 and the 5/10/07. It was unannounced and a key inspection of the service, which meant that all the key minimum standards for ‘Younger Adults’ were assessed. Where requirements were made on non-key standards – they were also assessed. Consideration was also given to information provided in the Annual Quality Assurance Assessment (AQAA) that was submitted by the registered persons. An assessment was made of: policies and procedures, medication practice, activities, menus, records required by regulation, service users’ plans and the environment. Discussions were held with several of the staff members on duty, a number of service users and the registered manager during the course of the inspection. Interviews were held with one member of staff, the registered manager and three service users, and the inspection concluded with verbal feedback from external professionals. It was noted that there have been significant improvements in the outcomes for service users as the registered persons addressed most of the requirements from the previous inspection. Service users were receiving a good level of care and support while living at Churchill House. It must be noted that they actively contributed to the inspection process, as each individual provided written feedback to the Commission about the service. A high number of staff also provided written feedback on their experience working at Churchill House. The contributions of both groups are a good reflection of a willingness to participate in what goes on in the home, and this is positive. What the service does well: The home continues to maintain a positive atmosphere in which staff and service users alike mutually respect each other. There are good opportunities for stimulation and development through a range of activities such as board games, art, table tennis, badminton, bike exercises, a library and swimming (weather permitting). There is a commitment to involving service users in developing the service and in effect, their life objectives. One way of achieving this is by ensuring that each service user has a contract and an individual support plan. There is an established practice of ensuring that detailed assessments are carried out on each service user prior to them taking residence at Churchill House. Regular supervision ensures that individual staff members are motivated, and feel supported. Churchill House DS0000027836.V348309.R01.S.doc Version 5.2 Page 6 It is good practice that training in the recording and administration of drugs is provided to all staff. The registered provider regularly and, as required by Regulation 26 of the Care Homes Regulations 2001, carries out monthly provider monitoring visits on the service. What has improved since the last inspection? The service user guide has been updated – a copy of which has been given to service users. Risk assessments were more updated, although in some cases this could not be evidenced. ‘Infringement of Rights’ forms are now widely used across the home and they were specific to individual service users. The health care needs of service users are more pertinently record to include the outcomes when, interventions are made by external professionals e.g. the dentist. Up to ninety per cent of the staff have received ’safeguarding adults’ training with clear plans in place for newly–recruited staff to undertake it. Re-decoration works have been carried out in line with the requirements of the last inspection. Fifty percent of the staff team have completed their NVQ Level 2 in Care, two of which have commenced their level 4. Six staff are in progress, two of which are near completion. Up to seventy-five percent of the staff team have undertaken a basic first aid course, with plans in place for the remainder to have this training. Most of the staff have attended their training in fire prevention, with the exception of the most recently recruited individual. Plans are in place to expedite this at the soonest opportunity. Plans are in place for staff that did not previously undertake infection control training, to have this by December 2007. With the exception of two, all staff have completed training in COSHH and health and safety. Six staff members have also completed their Food Hygiene training and four were due to go on in October 2007. Up to seven staff members have attended a literacy course. Churchill House DS0000027836.V348309.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. Churchill House DS0000027836.V348309.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 Churchill House DS0000027836.V348309.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): (1,2) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Service users have some level of updated information to enable them to make an informed decision about living in the home. The area of weakness remains in the statement of purpose. Pre-admission assessments undertaken by the home provides a solid platform for meeting the needs of service users. EVIDENCE: It was noted that in response to the previous inspection report, that the registered persons took action and updated the service user guide. This meant that service users have some level of information that reflected the current position of the home, in relation to what is provided there. While prospective service users have the benefit of visiting the home to get a taste of what happens at Churchill House, there was no evidence that the statement of purpose held current information about the home. As a matter of fact this document had a reference date of 2003, which makes it outdated. Prospective service users and their relatives must have updated information about the services provided at Churchill House. The previous requirement is therefore repeated in this report. There were no recent admissions to the home since the last inspection and it was clear that detailed assessments had been carried out on all previous admissions to the home. A part of this process, assessment information is obtained from placing authorities, which helps to get as full a picture as possible of the needs of the prospective individual. All potential service users Churchill House DS0000027836.V348309.R01.S.doc Version 5.2 Page 10 could ‘test-drive’ the home in the process of considering its suitability to meet their needs. The assessment of need is linked to an individual service user plan and risk assessment, to enable staff and service users to follow and measure the outcomes for each individual living in the home. There was god evidence to indicate that service users and their relatives form an integral part of the process of admission. Churchill House DS0000027836.V348309.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (6,7,9) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Service users benefit from having individual plans detailing how their needs are to be met. Improved systems ensure that they are empowered to make decisions about their lives, which includes how risks are taken in achieving greater levels of independence. This could be enhanced by ensuring that all risk assessments carry review dates on them. EVIDENCE: There was evidence that service user plans were developed in conjunction with service users and based on their needs. From case tracking three service users currently living in the home, it was clear that although the service user plans were used as working tools. They were also reviewed more frequently than what is recommended in the national minimum standards for younger adults, which is positive. It should be noted that they were reviewed annually with the involvement of external professionals. There was also evidence that Care Program Approach (CPA) reviews were carried out with and for service users, the most recent – held in October 2007. All service users spoken to were aware of their individual plan and each had a relationship with their key worker. In discussion with individual service users, Churchill House DS0000027836.V348309.R01.S.doc Version 5.2 Page 12 they demonstrated a firm understanding of what their plans contained and the purpose of it. In the cases seen, service users signed them off. The service user plans contained both long- term and short-term goals and systems were in place to enable service users to have one to one sessions with their key workers regarding their care. This is positive. There was an improvement in ensuring that service users were empowered in making decisions about their lives. The registered persons in response to the previous inspection report, now engages with individuals in preparing an infringement of rights form, where a restriction is agreed as part of their individual plan. An example of this is where an individual needs support in managing his cigarettes and voluntarily gives up the control for staff to make them available to him/her at agreed times. Service users spoken to were quite pleased about this. This is positive. Service users are encouraged to take reasonable risks and to this end risk assessments are linked to each identified need. A risk management plan is in place to keep each risk to a minimum, without overly restricting the independence of the individual. It was noted that in many cases they were reviewed and evidence of this was provided. However, there were some cases in which the dates of the review could not be established. This needs to improve, whether or not there were actual changes to the risk assessment document. It was, however, noted that as part of the risk management process more service users were undertaking activities outside the home. Churchill House DS0000027836.V348309.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (11,12,13,15,16,17) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Service users participate in their community while enjoying various levels of activities and, are able to maintain and develop social and personal networks of their choosing. They are supported to exercise their rights, which are respected and promoted by staff in the home. Service users also enjoy meals that meet their cultural and nutritional needs. EVIDENCE: There were several examples of service users having opportunities for personal development. This arises out of several forums such as individual assessments, service user meetings, bi-annual service user surveys and one to one sessions. It must be stated that regardless of the age range of the service user group, each individual is given an opportunity to reach their desired potential. Examples could be found of service users undergoing training in information technology, undertaking sheltered employment and attending day centres. In speaking to the individual that attends the sheltered employment he commented; ” I love what I do and the opportunities I get here. One day I hope I am able to move on to independent living”. Churchill House DS0000027836.V348309.R01.S.doc Version 5.2 Page 14 Despite the reward he receives for the work he puts out, he sees it as an important part of his development, which is positive. It must be noted that the staff play an integral role in enabling and supporting individuals to achieve their goals. Another individual that attends the Shaw Trust twice weekly spoke positively of his experiences of doing maths, computers and craftwork and would like to someday engage in paid employment even if on a small scale. Service users were at different levels of functioning and indeed at different stages of their life, however there was evidence of individuals engaging in social, skills –oriented, and in some cases spiritual development. This is positive and the registered persons are exploring more ways of increasing this further. This is a strong area of the home’s operations. Service users enjoy a wide range of activities that was reflective of not only of their culture, but also their individual interests. This ranges from a wide selection of in-house activities e.g. swimming, personal shopping, DVD evenings (coordinated by a service user), coffee mornings in the community, art, and badminton to name a few. Externally there was evidence that service users go on day trips to places like Hastings and Southend–on-Sea. Up to eight service users visited the Zoo on the 20/8/07. Pictures of these events were displayed on the walls of the home and most service users were extremely pleased with the opportunities provided to them, notwithstanding the fact they went on an annual holiday. Plans were in place for a gardening project and to build a club house in the rear garden. This is a strong area of the homes operations. It was also clear that service users were using the local library, banks, cinemas, shopping areas including the local market, and again staff facilitated this process by offering varying levels of support based on assessed needs. Service users were using the community to attend their various appointments and most were quite familiar with the resources available to them. In achieving this it was that various forms of transport facilities were used, which demonstrated their levels integration into the community. Family links are also encouraged in the home and the registered manager sees this as an area that he would like to develop further. Although the inspector did not meet with relatives during the course of the inspection, there was evidence that relatives were in contact and in some cases involved in the care of their loved ones. One service user spoke of calling his aunt regularly, while another spoke of his friends that he goes out and meets in the community. The use of the ‘infringement of rights’ form referred to earlier in this report is an example of the level of awareness of promoting service users’ rights in the home. Staff interviewed demonstrated a good understanding of the home’s ethos and the General Social Care Council’s code of conduct in relation to promoting service users’ rights. Ninety–eight per cent of the feedback received from service users indicated that their wishes are reflected as part of their goal setting and many they were quite pleased with this. Information on advocacy Churchill House DS0000027836.V348309.R01.S.doc Version 5.2 Page 15 was widely available to service users and there was evidence that this had been taken up. There was also evidence that a service user engaged the use of a solicitor and this is positive. Meals were observed during the course of the inspection and they were observed to be varied, nutritious and in line with service users’ needs and choice. Menu planning is done weekly, which informs the shopping. Each individual is allowed to have a day when their preferred menu is prepared and this seems to work quite well as service users were very positive about this. Mealtimes were cosy and staff were observed having a meal with them. Service users are also encouraged to prepare meals as part of their skill development and to this end they also take turns in the kitchen chores. This is detailed in their individual weekly activity planner. There were adequate supplies of fruit and fresh vegetables as were snacks and refreshments. Service users also take part in the shopping and plans were in place to enable them to engage in a healthier lifestyle through their choice of diets. One service user really enjoys the opportunity to prepare meals and he was quoted as saying; “I look forward to doing the meals as it gives me great pleasure to show off my skills”. Churchill House DS0000027836.V348309.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (18,19,20) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Service users enjoy personal support in a manner that is best suited to them. Good arrangements are in place to provide for their physical and emotional health needs, which is enhanced by the staffing input and support with medication. EVIDENCE: From the interviews conducted with service users, it was confirmed that they were happy with the way in which staff provided personal support to them. This is coordinated through the key-worker system used in the home. Service users are supported to wear their individual style of dress, which was consistent with their choice, culture and personality. This was evident throughout the course of the visit. There are opportunities for same gender care if this was required, as there is good mix of male and female staff. Throughout the course of the visit staff interventions with service users were of a high and professional level, which is positive. Written and verbal feedback received from them, confirmed this. It was clear however that appropriate interventions were made to ensure that emotional and psychological support is provided to service users as and when this is required. This was evident earlier in the year when an individual required quite a bit of support. It is a fact that service users heave remained Churchill House DS0000027836.V348309.R01.S.doc Version 5.2 Page 17 fairly stable in the home for long periods, as there has been only one readmission to hospital in the last seven years. This is a testament to quality of inputs by the management and staff in the home. External professionals spoken to, confirmed that the staffing input in relation to the specialist needs of service users was of a very high standard. There was clear improvements noted in the way that health visits were recorded in the home as it was fairly easy to audit trail from the point of first intervention to the desired outcome. As a result all healthcare appointments were clearly documented. More importantly, staff in promoting healthier living with service users, ensured that issues of relapses in their mental health were identified early, and interventions appropriately made to minimise distress to service users. There was also evidence of behavioural plans that were in place where behaviours were either unacceptable or undesirable. Medication practices were examined and found to be of a good standard. Up to two service users were handling their medication with little support from staff and this had a positive impact on their self-esteem and independence. Staff supporting service users with medication had training to so do and this ensures safer practices in the handling of medication. An updated British National Formulary was in place as a reference point for staff and this is good practice. A medication policy was in place to guide staff that were responsible for supporting service users with their medication and medication storage and recording was of a good standard. Churchill House DS0000027836.V348309.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (22,23) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Service users and their relatives are assured that when complaints are raised – that they would be acted upon. Sound arrangements are now in place to ensure that service users are safeguarded from abuse. EVIDENCE: A comprehensive complaints procedure remained in place and is available to staff, service users and their relatives. Staff interviewed, demonstrated an awareness of the need to support service users – should they wish to make a complaint. In discussion with five service users, they knew who they could complain to and felt able to express their dissatisfaction about any aspect of the service, which is positive. There are several forums for service to raise their complaints, which included, informally to any individual, in key work sessions, formally, through the complaints/compliments box and in service user meetings. Ninety-nine per cent of the written feedback received from service users indicated that they felt able to complain at Churchill House. A key improvement in the provision training for staff now gives greater protection from abuse to service users. Staff interviewed demonstrated a sound understanding of what action they would take in the suspicion or allegation of abuse. A clear protocol is in place for safeguarding adults and staff have access to it. There have been no incidents of abuse for over two years in the home, which is positive. This is possible as the registered persons focus on building their equality and diversity strategy in the home along with appropriate training for staff. Churchill House DS0000027836.V348309.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): (24,30) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Service users live in a warm, safe, comfortable environment, with adequate and improved facilities. A good standard of cleanliness ensures that Churchill House is a safe and pleasant place to be. EVIDENCE: During the course of the inspection it was observed that steps had been taken to carry out all the improvements that were required at the previous inspection. As a matter of fact, the registered manager outlined a plan to have all areas of the home redecorated, which was observed being systematically carried out. There was evidence that service users were involved in the process of deciding colours, which is positive. All service users were happy with the works carried out and found great comfort in them. The home is indistinguishable from the other properties around it and offers access to local amenities, transport and support services in line with the personal and lifestyle needs of the individual/s living there. Most of the furnishings were in a good state of repair however there were chipped laminate on the edges of tables that are used regularly for activities. They must be repaired. Churchill House DS0000027836.V348309.R01.S.doc Version 5.2 Page 20 Sound laundry facilities are in place, which is used by staff in supporting service users to launder their washing. It is an area where service users’ skills are developed. An infection control policy is in place and service users and staff are encouraged to work in line with this e.g. hand-washing. The laundry equipment is designed to cater for soiled linen and appropriate arrangements were in place for maintaining them. The services and facilities do comply with the Water Supply Regulations 1999. Service users are also encouraged to play their part in the maintenance of health and safety at Churchill House and they were generally happy in doing so. Churchill House DS0000027836.V348309.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): (32,34,35) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Service users benefit from a staff team that is committed, adequately trained and effective in providing a good standard of care to them. Sound recruitment practices ensure that service users remain in safe hands, while living at Churchill House. EVIDENCE: There was an improvement in the number of staff achieving their NVQ Level 2 in Care. Fifty per cent have now achieved this qualification, with the other fifty having started their training. Up to two staff have started their Level 3 and this is positive. The manager would like to at some point for all staff to achieve an NVQ Level 3 in Care and as part of his recruitment practice aims at recruiting staff already obtaining their level 2 qualification. Service users are receiving care and support from a staff team that has a good basic understanding of the principles of good care. This was tested at interview with staff. External professionals were complimentary of the staffing skills and knowledge of the needs of the service user group and valued their contributions at CPA and external meetings. The recruitment records of the most recently recruited staff member was assessed and found to be in order and in line with good practice. All checks were adequately carried out on the staff prior to employment and this ensures Churchill House DS0000027836.V348309.R01.S.doc Version 5.2 Page 22 that service users are not exposed to working with individuals that may be unsuitable to support them. Good records were maintained of each employee so that an audit trail could be established of how staff were recruited. It was not evident as to how service users were involved in the recruitment process. The organisation may wish to look at this, as part of enhancing its user involvement in the recruitment process. From the training records examined, there were significant improvements to the quality and quantity of training that was provided to staff. The registered persons are taking the view that good training would enable a higher retention of staff. Some of the training provided included; First aid, COSHH, Infection Control, Basic Food and Hygiene, Fire Prevention and training in Literacy. This is important as service users rely on staff that have the necessary skills to met their needs. Feedback received from one service user informed that while most of the staff are good, some could not speak English fluently and this created a language barrier and misunderstandings in the process of care delivery. It is envisaged that the literacy training would improve that difficulty. It should be noted that the registered persons need to ensure that training in mental health and challenging behaviour needs to be carried out to enhance the skills and knowledge of staff. This would enable them to carry out their roles more effectively. Churchill House DS0000027836.V348309.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): (37,39,42) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Sound management systems are in place to provide a good quality service at Churchill House. This includes improved systems for quality assurance, record keeping, reviewing policies and procedures, and the promotion of health and safety in the home. EVIDENCE: The registered manager is a fully qualified in the speciality of the service i.e. he is a Registered Mental Nurse. He is also very experienced in management and has the overwhelming support of his staff and manager. He has updated his knowledge in areas related to he work he does and as part of this plans to cascade some of that training down to the staff team. Service users, external professionals and staff shared the view that he discharges his duties to great effect and most felt that he was approachable. It was clear from the progress he had made with the home that he was capable of effectively managing the service. Churchill House DS0000027836.V348309.R01.S.doc Version 5.2 Page 24 There were improvements in the quality monitoring of the service, as annual surveys with service users and their relatives have been carried out. Service user surveys are done twice yearly and an annual development plan was in place at the home. There are also regular monthly provider visits to the home and the views of external professionals are gathered at service users’ reviews. The registered manager also carried out monthly audits on food, rosters, medication, bedrooms, petty cash and risk assessments. Policies and procedures were updated and there were also regular staff meetings in the home. The health and safety policies and procedures and practices ensured that the home remains safe for all that use it. This is extended to the external parts of the home. Risk assessments for all safe working practice topics were in place and service users were also involved in maintaining a safe environment. All staff had health and safety training and this starts at induction stage. A monthly health and safety audit is undertaken to identify any deficiencies, which are acted upon. Safety records for fire, gas and electricity were found in order. Records of accidents were maintained and the home was compliant with all the building, fire and environmental health regulations. The inspector examined food handling in detail, which was satisfactory. Churchill House DS0000027836.V348309.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 2 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 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 2 x LIFESTYLES Standard No Score 11 3 12 4 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 x Churchill House DS0000027836.V348309.R01.S.doc Version 5.2 Page 26 Yes 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 YA1 Regulation 4 Requirement Timescale for action 03/12/07 2. YA9 3. 4. YA24 YA35 Statement of Purpose must be updated to hold the current information. This is a previously made requirement with a timescale of 30/11/06. 15 (1) 7 When reviewing risk 03/11/07 (2) & assessments the home must 13(4)(c) record ‘no change’ and date this if no change has taken place to evidence that they are monitoring the risk assessments. This is a previously made requirement with a timescale of 30/11/06. 23(2)(d) Repair or replace the chipped 03/11/07 laminated tables in the activities room. 18(1)(c)(i) All staff should attend training 30/11/07 in; mental health and dealing with challenging behaviour. This is a previously made requirement with a timescale of 30/01/07. Churchill House DS0000027836.V348309.R01.S.doc Version 5.2 Page 27 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 YA35 Good Practice Recommendations The registered persons should consider ways of including service users in staff recruitment in the home. Churchill House DS0000027836.V348309.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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