Care Home: Clements House

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What the care home does well What has improved since the last inspection? The home has appointed a new manager who is registered with the Commission. Recording of trial visits to the home by prospective residents has improved. A transition log is now completed after each visit. Written care plans and risk assessments have been developed. The availability of daily activities for residents has been improved and the home now has an activities coordinator. Health assessments have been introduced for each person. The home`s management has introduced a system of auditing medication procedures. Staff have attended training in protecting people from possible abuse and the procedures to follow when this is suspected. Improvements have been made to the environment by redecoration. Four new staff have been recruited since January 2008. Staff appraisals have been introduced. What the care home could do better: Greater attention is needed to ensure that residents` details are kept confidential as individual first names are recorded in the Statement of Purpose. Guidelines for the circumstances and symptoms indicating that occasional mediation is needed must be clear. Written risk assessments, and action plans where necessary, are needed to minimise the possibility of individual residents receiving burns from hot pipes in bedrooms. Risk assessments are also needed regarding the possibility of residents falling from first floor windows and for any risks regarding access to the bath. CARE HOME ADULTS 18-65 Clements House 36 Fish Lane Bognor Regis West Sussex PO21 3AH Lead Inspector Ian Craig Unannounced Inspection 16 September 2008 10:10 th Clements House DS0000048441.V369083.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 Clements House DS0000048441.V369083.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. Clements House DS0000048441.V369083.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clements House Address 36 Fish Lane Bognor Regis West Sussex PO21 3AH 01243 869004 01243 866679 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) Allied Care (Mental Health) Ltd Ms Alison Grace Middleton Care Home 7 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (0) of places Clements House DS0000048441.V369083.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1. The registered person may provide the following category of service only: Care home only - (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Mental Disorder, excluding disability or dementia (MD) 2. The maximum number of service users to be accommodated is 7. Date of last inspection 20th September 2006 Brief Description of the Service: Clements House is a detached two-storey care establishment in a residential area in the village of Aldwick, close to the coastal town of Bognor Regis, West Sussex. The property faces a busy main road but large gates provide seclusion. Parking is available on the road outside. The front of the property provides a courtyard with hanging baskets, and there is a secluded rear garden with a decked area and a vegetable patch. The home provides care for up to seven persons with mental disorder. Each person has their own room with an en-suite bathroom with a shower or bath, toilet and wash basin. Communal facilities consist of a large lounge/dining room and conservatory. The conservatory also provides an area where residents can smoke. The residents are able to develop independent living skills and have access to a variety of social events including an annual holiday, employment and day care. The owners are Allied Care (Mental Health) Ltd and the responsible individual is Mr Aslam Dahya. The registered manager is Ms Alison Middleton. The home’s weekly fees range from £863.00 to £1789.09. Clements House DS0000048441.V369083.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 was unannounced and lasted 4 hours 15 minutes. Discussions took place with the manager, Ms. Alison Middleton. One member of staff was interviewed about his/her work at the home. A resident and a visitor to the home were interviewed about their experiences of the service. It was not possible to speak to the other residents as they were either on holiday or were attending activities. Documents, residents’ care records, staff records and policies and procedures were looked at. A tour of the building took place. This included seeing several bedrooms and the communal areas. The Commission requires that care services complete an Annual Quality Assurance Assessment. This was completed by the home and information contained in it has been used for this report. What the service does well: Thorough assessments of the need are carried out and recorded for those referred for possible admission to the home. This includes obtaining comprehensive information from referring health and social services’ departments. The manager also attends multi agency planning meetings prior to a resident moving in. Prospective residents are able to spend time at the home to see if it meets their needs and are given information about the home. Clements House DS0000048441.V369083.R01.S.doc Version 5.2 Page 6 Care plans and risk assessments are comprehensive and of a good standard giving staff clear guidance on how care is to be provided and how risks are identified and handled. Residents have opportunities for contributing to decision making in the home via the residents’ own meetings. Each person’s social needs are assessed. There are numerous activities that residents’ benefit from including voluntary work, attending day services, day trips and educational courses. Residents are encouraged, and have opportunities to develop independent living skills. Some of the residents have their own budget for food and cook their own meals under the supervision of the home. One person attends a life skills course at a college and another person an art course. Sports activities are arranged and the home has arranged a personal trainer for gym classes for some of the residents. A holiday fund of £520.00 per annum is included with the fees. Those that do not want a holiday can use the fund for weekend breaks or day trips. At the time of he visit three residents were on holiday accompanied by staff. The home has its own car for transporting residents to activities. Residents are not charged for this, as it is included in the contract price. Each person has a Health Assessment record which assesses and details needs relating to dental checks, blood pressure, hearing, heart checks, breathing, women’s and men’s health. This is recorded in an easy read format from the point of view of the resident. Records show that the home’s manager deals with complaints and keeps the complainant informed of the outcome and progress of her investigation. Staff receive training in dealing with any possible aggression from residents. Clear guidelines are recorded for staff to follow where residents have a challenging behaviour. Staffing levels can be adjusted at short notice to take account of changes in need. There is a lone working policy, which gives guidance for staff safety when working alone. Each bedroom has its own en suite bathroom, which has a shower or bath, toilet and wash basin. Bedrooms are personalised by the residents. Residents have a key to lock their bedroom door as well as their own small safe for securing valuables. The lounge/ dining room is comfortable with seating and tables. There is a separate conservatory, which is also an area where residents can smoke. A resident stated how much he/she likes his/her room saying that it was decorated in colour schemes he/she chose before moving in. The following comment was also made: Clements House DS0000048441.V369083.R01.S.doc Version 5.2 Page 7 ‘I like the building. It’s just like an ordinary house, like the others in the street.’ The home has a good ratio of staff to residents with at least 3 staff on duty at any given time as well as the manager. Each resident has allocated 1:1 time with a staff member. The home has a thorough recruitment procedure. Three written references are obtained and criminal record bureau (CRB) and protection of vulnerable adults (POVA) checks are completed before someone starts work. There is an extensive staff training programme. Five of the nine staff have attained National Vocational Qualification (NVQ) level 2 or are studying for the qualification. Three of these staff also have, or are studying, NVQ level 3. The owners carry out regular audits by way of unannounced visits to the home, which generates a report with an action plan of matters that need addressing. Residents are given surveys to ask for their views on the service. What has improved since the last inspection? The home has appointed a new manager who is registered with the Commission. Recording of trial visits to the home by prospective residents has improved. A transition log is now completed after each visit. Written care plans and risk assessments have been developed. The availability of daily activities for residents has been improved and the home now has an activities coordinator. Health assessments have been introduced for each person. The home’s management has introduced a system of auditing medication procedures. Staff have attended training in protecting people from possible abuse and the procedures to follow when this is suspected. Clements House DS0000048441.V369083.R01.S.doc Version 5.2 Page 8 Improvements have been made to the environment by redecoration. Four new staff have been recruited since January 2008. Staff appraisals have been introduced. 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. Clements House DS0000048441.V369083.R01.S.doc Version 5.2 Page 9 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 Clements House DS0000048441.V369083.R01.S.doc Version 5.2 Page 10 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 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are given information about the home and are able to visit the home to see if it meets their needs. The home carries out thorough assessments of need involving close liaison with referring health and social services departments. This ensures the home is able to meet the needs of those it admits. EVIDENCE: The home has a Statement of Purpose and a Service Uses’ Guide, which give details of the home, its staff, the facilities and the services provided. Both a resident and a visitor to the home confirmed that they received a copy of the Service Users’ Guide. It was noted that the first names of the residents are recorded on the Statement of Purpose, which does not adhere to rules of confidentiality, as the Statement of Purpose is a public document. Procedures for assessing those referred for possible admission to the home were looked at by viewing records, talking to residents and by discussions with Clements House DS0000048441.V369083.R01.S.doc Version 5.2 Page 11 the manager. Assessments of need are carried out and recorded by the home prior to the person being admitted. These are called, ‘Daily Living and Needs Assessment Form,’ and cover the following: • Personal details • Personal care and well being • Mental health and cognition with details of any supervision under the Mental Health Act 1983 • Medication • Food and allergies • Dental and foot care • Religion • Diet and weight • Daily living Prospective residents are able to visit the home to have a meal and spend time with the staff and other residents. This was confirmed from discussions with the manager and with residents, as well as from the records of the visit in a ‘Transition Log.’ One person said that he/she was made to feel welcome by the staff when visiting and was able to go out with the other residents to activities. The home also obtains copies of relevant information from the referring health and social services departments. These include details of any special arrangements under the Mental Health Act 1983, psychology reports, occupational therapy reports, multi agency Care Programme Approach meeting minutes and plans, NHS care plans and NHS Risk Screening Assessments. The manager described how she attends hospital reviews and multi agency meetings on those referred for possible admission to the home. Clements House DS0000048441.V369083.R01.S.doc Version 5.2 Page 12 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, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are comprehensive and of a good standard. Residents are supported to make decisions about their lives and are able to contribute to decision making in the home. Risk assessments are of a good standard and involve liaison with outside agencies plus the agreement of the resident as well as giving clear guidance for staff to follow in supporting residents to lead a more independent lifestyle. EVIDENCE: Clements House DS0000048441.V369083.R01.S.doc Version 5.2 Page 13 The home accommodates 5 residents and care records were looked at for three residents as well as someone referred for possible admission to the home. The initial assessment leads to a care plan being devised. The home also has an ‘Interim care plan,’ which is completed before the person moves in. The ‘Service Users’ Assessment and Care Plan,’ is written with the resident as the central focus and includes personal care, mental health, communication, personal safety and risk assessment. There is space on these documents for the staff member and resident to sign. These were not completed for one person. Daily running records are maintained for each resident. These are signed and dated by the staff member completing them. Staff receive training in care planning. Each staff member records a signature to acknowledge that they have read the care plans for each resident. The home has copies of the health service Risk Screening Assessment and completes its own assessments for each person covering areas such as the following: challenging behaviour, using public transport, fire safety, cooking, budgeting and smoking. The risk assessments are structured in the following way: • Area of risk? • What is the risk? • Who is at risk? • How can we minimise the risk? • What is the action plan? • Who will take responsibility to ensure the action plan is being followed? Residents record their signature to acknowledge agreement to the risk assessments and action plans. The home completes a pro forma entitled, ‘Infringement of rights’ where the resident needs support that restricts him or her in some way. The resident also records a signature to acknowledge agreement to this. Residents have their own meetings when they are able to discuss matters about life at the home. The manager described how the meetings resulted in changes being made to the arrangements of the meals. Two residents described how they wish to develop their independence and that assistance is given in this. One person said how he/she is able to spend his/her time as he/she wishes but is also encouraged to have an active life. The manager has looked at ways of involving residents in aspects of the running of the home such as staff recruitment. Clements House DS0000048441.V369083.R01.S.doc Version 5.2 Page 14 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, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are encouraged to develop independent living skills and their personal goals are reflected in their life at the home. There are opportunities to pursue social, leisure, educational and occupational activities in the community. The residents have a nutritious diet and are supported by staff in cooking their own meals in line with their own plans for developing independence. EVIDENCE: Clements House DS0000048441.V369083.R01.S.doc Version 5.2 Page 15 The home’s philosophy is to encourage residents to develop independent living skills. This involves staff support and assessment of these needs. Two people who use the service confirmed their aspirations to live independently and that the home’s approach was assisting them to achieve this. The manager described how the home works with the residents and mental health professionals in identifying educational, occupational, social, leisure and relationship needs and how these can be met. One person attends a life skills course, another resident works for 2 days a week, another person is supported by staff to attend a college course for 3 days a week and several residents attend a local day service. The manager described how residents can progress to more independent living in supported housing, following assessment and planning by the home and mental health services. The home has established working relationships with local colleges so that residents can attend courses. It has also been possible to arrange a personal fitness trainer for the residents at a local gymnasium. Residents also attend swimming classes. The home has an activities co coordinator. The Statement of Purpose gives details of an annual holiday budget of £520.00 per person. At the time of the visit three residents were on holiday in Somerset supported by staff. One person has been on holiday in Spain supported by staff. Those residents that do not wish to have a holiday can use the fund for day or weekend trips. Documents show that one person is due to have a weekend at a health spa in Cornwall, again with staff support. Residents have also been on visits to Old Trafford football stadium and to exhibitions. The home has its own car for transporting residents to community activities. Residents are not charged for transport or maintenance of the vehicle, as this is included in the contract fee. The manager also explained that residents have been supported to get transport passes from the local council. There are rotas so that residents take part in daily domestic routines such as cleaning and shopping for food. The home has a weekly timetable detailing activities for each person. Residents can cook their own meals and are given a budget to buy food and plan a menu, which is carried out after assessment and with staff support. A resident confirmed that he/she is supported to cook meals on certain days and that the food is ‘good’. The home has menu plans and consults residents at meetings about the meal contents. Fresh fruit is available in the dining area. Clements House DS0000048441.V369083.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 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health needs are thoroughly assessed and the home works closely with health professionals to ensure that health and emotional needs are met. Each resident is given support with his or her medication although more detailed recorded guidance is needed so that staff know when a person may need occasional medication. EVIDENCE: Discussions with the manager and records show that the home is aware of each person’s personal relationships as is relevant for the purposes of giving support with emotional needs. Personal care needs are detailed in care plans where relevant. Clements House DS0000048441.V369083.R01.S.doc Version 5.2 Page 17 A Health Assessment pro forma is comprehensive and is completed for each person. The assessment is written in an easy read format with the person as the centre of the process and includes the following: • Emotions and feelings • Relationships • Lifestyle • Skin • Eyes • Hearing • Teeth • Eating and drinking • Heart • Chest and breathing • Getting around • Women’s health • Men’s health The above identifies needs such as dental checks, high cholesterol and blood pressure and any action that is needed to check and treat. Records also show that each person’s weight is monitored and that residents receive help with health needs such as stopping smoking. A resident states that his/her care needs are met. The home liaises with mental health services; this was observed at the time of the visit. Documents such as reports from occupational therapy services and psychology services are held with care records. Relevant documents regarding the monitoring of mental health are held with records. The home has clear guidance of what staff should do to handle identified risks involving mental health needs. Staff receive training in mental health needs such as aspergers syndrome, mental health, learning disability, positive communication and drug and alcohol misuse. Medication procedures were looked at. Any staff member that handles medication attends a course as well as having an ‘in house’ assessment followed by a period of shadowing other staff before they are deemed competent. The medication file has a signature and initials used in medication recording so that they can be identified. Medication records have a photograph of each resident. Medication recording sheets show that staff record a signature each time medication is administered to a resident. There are procedures for the circumstances when medication ‘as required’ should be given to a resident. This includes guidance for staff who must seek Clements House DS0000048441.V369083.R01.S.doc Version 5.2 Page 18 the approval of the manager or on call manager. It was noted that the guidance needs to be in more detail so that staff can consistently identify when medication ‘as required’ should be given. For instance, for one person the guidance states ‘emergency use only.’ Additional information is also needed for 2 other residents who receive medication ‘as required.’ Clements House DS0000048441.V369083.R01.S.doc Version 5.2 Page 19 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 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home acts on any complaint made and residents are protected from possible abuse or self harm. EVIDENCE: Residents are able to raise any matters at meetings with their keyworker and at residents’ meetings. A resident confirmed that his/her views are listened to. There is a complaints procedure in the Statement of Purpose and Service and Service Users’ Guide, which are supplied to residents. A copy of the procedure is also displayed on the residents’ notice board. The home has a complaints file which shows that when a complaint is made that the manager records the details and writes to the complainant. Each staff member records a signature to acknowledge that they have read the complaints and whistleblowing procedures. Clements House DS0000048441.V369083.R01.S.doc Version 5.2 Page 20 Records show that the home liaises with social services regarding any adult protection matters involving the safety of the residents. Copies of individual social services alert forms were seen. The home has copies of its own adult protection procedure as well as the West Sussex Social Services Safeguarding procedures. All staff receive training in adult protection although one staff member was unable to attend this. Individual resident’s records show how challenging behaviour is to be handled. Staff receive training in dealing with challenging behaviour with an emphasis on de-escalation and the use of ‘breakaway’ techniques. There is a lone working policy and staff have access to an on call staff member throughout the day and night. The manager described how the owner allows for staff levels to be adjusted to meet the changing needs of the residents especially in circumstances of heightened risk. The home supports residents in managing their finances and holds cash and valuables on their behalf. Records are kept of any amounts deposited or withdrawn, including a balance as well as a record of any valuables such as bank books or personal items. An audit is carried out twice a day and a record made to show that amounts, valuables and records all tally. The home has secure storage and each resident has his or her own safe in their bedroom. Clements House DS0000048441.V369083.R01.S.doc Version 5.2 Page 21 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, 25, 26, 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a home that is non institutional in appearance, provides good facilities, and is a place where they are able to express themselves. EVIDENCE: A tour of the home took place. Each resident’s room has a door lock. A resident confirmed that he/she uses the lock. Bedrooms are all single and each has an en suite bathroom with a shower or bath, a toilet and a wash basin. Clements House DS0000048441.V369083.R01.S.doc Version 5.2 Page 22 Residents’ bedrooms are personalised with items relating to hobbies. It was noted in one bedroom that there was no lampshade. Bedrooms are clean and decorated in a variety of colour schemes. One person said: ‘I like the building. It’s just like an ordinary house, like the others in the street.’ This person also said how much he/she likes his/her bathroom and that the bedroom was redecorated in colours he/she chose before moving in. The home has a passenger lift, which is not used. The lounge and dining room are comfortable with seating and tables as well as a computer for the residents to use, although this does not have internet or e mail. There is a smoking area in the conservatory. The garden has a wooden deck area. The manager states that residents may grow vegetables in the garden in the near future. Residents are able to access the kitchen to make drinks and snacks. Environmental health and safety risk assessments are carried out but the ‘Conduct and Management’ section of this report highlights where this needs to be improved. The home was found to be clean. Staff receive training in infection control. This was confirmed from training plans and staff themselves. Clements House DS0000048441.V369083.R01.S.doc Version 5.2 Page 23 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, 33, 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a well trained and organised staff team supplied in sufficient numbers to meet their needs. Residents are protected by a thorough recruitment procedure. EVIDENCE: The home aims to provide at least 3 care staff on duty from 8am to 8pm each day. The manager’s working hours are additional to this. The staff rota for the week of the visit, and observation, confirmed that these staff levels are maintained. At night time there is one ‘waking’ staff member. A staff member described how the staff work as a team and that each person has a responsibility for a different part of the home’s operation. These duties are displayed on a notice board in the office. Clements House DS0000048441.V369083.R01.S.doc Version 5.2 Page 24 A resident said that the staff are helpful, adding, ‘They are so good I would like to go home with them.’ Five of the nine staff are qualified at NVQ level 2 in care or are studying for the qualification. Three of these staff have NVQ level 3 in care or are studying it. There is a training programme, which is displayed in the office. Individual staff training needs are identified and this is recorded. The training programme includes the following courses which are in addition to the NVQ: fire safety, moving and handling, first aid, infection control, report writing, mental health and learning disability awareness, diet and nutrition, food hygiene, care planning, positive communication, stress management, leadership skills, medication and adult protection. One staff member’s records shows that he/she has attended the following training in the last 2 years which is in addition to the NVQ: adult protection, first aid, moving and handling, positive communication and challenging behaviour. A staff member confirmed that he/she has access to a variety of training courses and will be shortly undertaking the NVQ level 2. The home has a set induction procedure based in nationally recognised standards. A staff member stated that he/she has had a period of ‘shadowing’ other staff to familiarise him/herself with the work. Regular supervision takes place and is recorded. This was confirmed by the manager and a member of staff. Recruitment procedures were looked at for 2 staff who have recently started work in the home. Each person completes an application form. Criminal record bureau (CRB) and protection of vulnerable adults (POVA) checks are carried out before staff start work. Three written references are obtained. A staff member confirmed the recruitment process and that he/she was assessed at interview. Clements House DS0000048441.V369083.R01.S.doc Version 5.2 Page 25 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 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run with effective and organised management that benefits the residents. The health and safety of the staff and residents is promoted, although the home is not checking all environmental risks where there is the potential for injury to residents. EVIDENCE: Clements House DS0000048441.V369083.R01.S.doc Version 5.2 Page 26 The home’s manager is qualified at NVQ level 4 in care and has the Registered Manager’s Award. The staff team is structured so that responsibilities are delegated to individual staff. Daily work sheets are used to monitor the running of the home and to organise daily tasks. The home has a quality assurance and audit folder. Allied Care carry out unannounced inspection visits of the home four times a year. These focus on different aspects of the home’s operation and an Internal Quality Audit Report form is completed which includes any actions that are needed. Monthly visits are also made to the home by Allied Care, which also produce a report. Residents’ views are sought by annual surveys and these are summarised into a diagram format. Staff receive training in health and safety, first aid, moving and handling, food hygiene and infection control. Residents are protected from possible scalding hot water by temperature controls on taps. Regular temperature checks are also carried out. Radiators are covered to prevent possible burns to residents. Hot pipes are exposed in residents’ bedrooms and in one room the head end of a bed is pushed against pipes. Assessments of the likelihood of risk of burns have not been completed and these pipes are not boxed in. Information was received from the home to confirm that the hot water pipe next to the head end of a bed has been ‘boxed in.’ Restrictors are not fitted to first floor windows to prevent possible falls and there are no assessments regarding the risk of this occurring to individual residents. One bedroom has an en suite bathroom with a bath. At the time of the visit the room was unoccupied. Risks related to access to the bath should be assessed for anyone occupying the room. The home’s appliances and equipment are tested and serviced by suitably qualified persons. Clements House DS0000048441.V369083.R01.S.doc Version 5.2 Page 27 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 4 3 X 4 3 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 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 4 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 4 2 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 2 X 3 X 3 X X 2 X Clements House DS0000048441.V369083.R01.S.doc Version 5.2 Page 28 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA10 Regulation 12 Requirement Information on residents must be confidential and be in accordance with the home’s policies and procedures on confidentiality and the Data Protection Act 1998. Residents’ names should not be included on the Statement of Purpose or any other public document. 2 YA20 13 Details of the circumstances, behaviour and symptoms when occasional medication may be required must be recorded for each person so that staff have clear guidelines to follow. This will ensure that residents receive medication in a consistent manner. 3 YA42 13 Assessments of the risk of possible burns to residents must be carried out regarding exposed hot pipes in bedrooms. Action must be taken to minimise any identified risks. 16/11/08 16/11/08 Timescale for action 16/11/08 Clements House DS0000048441.V369083.R01.S.doc Version 5.2 Page 29 Assessments of the risk of individual residents falling from first floor windows must be carried out and action taken to minimise any identified risks. An assessment of the risks of a resident having access to a bath must be carried out and action taken to minimise any identified risks. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Clements House DS0000048441.V369083.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Clements House DS0000048441.V369083.R01.S.doc Version 5.2 Page 31 - 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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