Care Home: Clock Tower Mews

Similar services:

• Claremont House
• Coopers Mill Ltd
• Sun Court Nursing Home
• Bramley Avenue (73)
• Paradise Lodge
• Grangewood
• Upaya Ananda
• 15 Bramble Close

What the care home does well The Annual Quality Assurance Assessment (AQAA) states: "We support the service users to live a full life experience. Their plan of care is implemented to a full standard, we record all information to suit their needs and choices. The staff have known the service users now for a number of years, this has given all of them new skills and standards." The ethos of Clock Tower Mews is that each person`s views are valued. The information in care plans, observation of the staff and residents, and what people wrote in the Have Your Say surveys, all confirmed that everyone is encouraged and supported to make their views and wishes known, and to make decisions about their lives in the home. One person said, "They take time to listen to what I am saying and signing." Another person said, "I like it here and have made lots of friends. The staff are friendly and I miss them when I go home for weekend visits." There is a stable staff team in the home, and the training programme makes sure that they have the necessary skills to meet people`s needs. Most of the care staff have NVQ qualifications. The staff are enthusiastic about their work and committed to the welfare of the people who live in the home. The manager is passionate about communicating effectively with each individual, and she leads by example in making sure that each person is able to express their own needs and wishes. We thought that the staff look after people`s health very well. What has improved since the last inspection? No requirements were made in the last inspection report. The Annual Quality Assurance Assessment (AQAA) states: "We all have worked very hard to keep up the high standards that are in place, we maintain provision of the services that are set down in our policies and procedures. Any issues that come to light are addressed with good professional conduct." Caretech introduced the structure for providing weekly Talk Time when people can discuss what activities they would like and how they feel about relationships within the home. Changes that have been made at Clock Tower Mews as a result of listening to the people who live in the home include the purchase of a new television and choices of outings. One person said, "I like my home and we have got new furniture and television so everyone can see it." What the care home could do better: The manager works very hard to maintain good outcomes for the people who live in the home, but it appears that the company do not support her in addressing the difficulties of employing new staff. Due to staff shortages, some people have to work excessive hours, and this may affect the quality of their work. The manager is included on the rota, which means that either she does not have sufficient time for her management role, or the people in the home do not receive the attention that they need at all times. Caretech has not carried out essential repairs in the home, and this means that people do not have the facilities that they need to maintain their health and safety and their quality of life. A bath needs replacing, and there is currently only one bath for seven people to share. The Environmental Health Officer inspected the kitchen and said that the kitchen cupboards must be replaced so that they can readily be cleaned. This has not happened, and isessential to prevent any risk to food hygiene in the home. There is a loose piece of carpet outside the kitchen that may cause a risk of tripping for anyone passing by. The manager does not have access to the Internet or to email in the home. This limits her access to information and guidance on good practice issues, and limits the communication that Caretech can have with its homes. CARE HOME ADULTS 18-65 Clock Tower Mews Morven Park The Causeway Potters Bar Hertfordshire EN6 5HA Lead Inspector Claire Farrier Unannounced Inspection 7th April 2008 11:45 Clock Tower Mews DS0000019324.V362054.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 Clock Tower Mews DS0000019324.V362054.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. Clock Tower Mews DS0000019324.V362054.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clock Tower Mews Address Morven Park The Causeway Potters Bar Hertfordshire EN6 5HA 01707 662253 01707 652419 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) Caretech Community Services Limited Ms Marlene Morris Care Home 11 Category(ies) of Learning disability (11), Physical disability (11) registration, with number of places Clock Tower Mews DS0000019324.V362054.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th April 2006 Brief Description of the Service: Clock Tower Mews is a care home for eleven people with a learning disability, who may also have an associated physical disability. It is owned and managed by Caretech Community Services Ltd, which is a private company. The home is a detached building that was originally the stable block of Morven House. It was converted into a care home in 1995. On the first floor two men live semiindependently in the self contained Flat, and one person lives separately with one to one care in The Lodge. The house stands in Morven Park adjacent to Morven House (also a registered care home). The buildings and park are owned by the National Trust and leased to Caretech. They are located on the outskirts of Potters Bar and are easily accessible to local shops and are close to public transport. The Statement of Purpose and Service Users Guide provide information about the home for referring social workers and prospective residents. The current charges are £1565.55 per week, and each person pays a personal contribution of £65.55 towards this. A copy of the most recent CSCI inspection report should be made available on request to the home. Clock Tower Mews DS0000019324.V362054.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 3 star. This means the people who use this service experience excellent quality outcomes. We (the Commission for Social Care Inspection) spent one afternoon and evening at Clock Tower Mews, and the people who live there and work there did not know that we were coming. The focus of the inspection was to assess all the key standards. Some additional standards were also assessed. We met most of the people who live in the home, and six people completed Have Your surveys before the inspection. Four members of staff also completed Have Your Say surveys, and we have used the information from these in this report. The surveys tell us what the people who live and work in Clock Tower Mews think about the home. We visited the home on the day before the main inspection to collect the surveys. We looked around the main home and The Flat. We did not visit The Lodge on this occasion. We talked to the home’s manager about what we had seen during the inspection. The manager sent some information (the Annual Quality Assurance Assessment, or AQAA) about the home to us before the inspection, and her assessment of what the service does in each area. Evidence from the AQAA has been included in this report. We have also looked at the reports of the visits that a representative of Caretech makes to the home. The CSCI Annual Performance Report for Caretech has provided additional information about the company’s corporate procedures. In March 2008 we carried out a review of the service (Annual Service Review). We looked at all the information we have asked for or received about the home, since the last inspection. In our judgement the home was still providing a good service and they knew what further improvements they needed to make. What the service does well: The Annual Quality Assurance Assessment (AQAA) states: “We support the service users to live a full life experience. Their plan of care is implemented to a full standard, we record all information to suit their needs and choices. The staff have known the service users now for a number of years, this has given all of them new skills and standards.” The ethos of Clock Tower Mews is that each person’s views are valued. The information in care plans, observation of the staff and residents, and what people wrote in the Have Your Say surveys, all confirmed that everyone is encouraged and supported to make their views and wishes known, and to make decisions about their lives in the home. One Clock Tower Mews DS0000019324.V362054.R01.S.doc Version 5.2 Page 6 person said, “They take time to listen to what I am saying and signing.” Another person said, “I like it here and have made lots of friends. The staff are friendly and I miss them when I go home for weekend visits.” There is a stable staff team in the home, and the training programme makes sure that they have the necessary skills to meet people’s needs. Most of the care staff have NVQ qualifications. The staff are enthusiastic about their work and committed to the welfare of the people who live in the home. The manager is passionate about communicating effectively with each individual, and she leads by example in making sure that each person is able to express their own needs and wishes. We thought that the staff look after people’s health very well. What has improved since the last inspection? What they could do better: The manager works very hard to maintain good outcomes for the people who live in the home, but it appears that the company do not support her in addressing the difficulties of employing new staff. Due to staff shortages, some people have to work excessive hours, and this may affect the quality of their work. The manager is included on the rota, which means that either she does not have sufficient time for her management role, or the people in the home do not receive the attention that they need at all times. Caretech has not carried out essential repairs in the home, and this means that people do not have the facilities that they need to maintain their health and safety and their quality of life. A bath needs replacing, and there is currently only one bath for seven people to share. The Environmental Health Officer inspected the kitchen and said that the kitchen cupboards must be replaced so that they can readily be cleaned. This has not happened, and is Clock Tower Mews DS0000019324.V362054.R01.S.doc Version 5.2 Page 7 essential to prevent any risk to food hygiene in the home. There is a loose piece of carpet outside the kitchen that may cause a risk of tripping for anyone passing by. The manager does not have access to the Internet or to email in the home. This limits her access to information and guidance on good practice issues, and limits the communication that Caretech can have with its homes. 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. Clock Tower Mews DS0000019324.V362054.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 Clock Tower Mews DS0000019324.V362054.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, 3, 4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who plan to move in to the home are involved in the choice of the home and in the assessment process. Staff have the knowledge and experience to meet each person’s care needs. EVIDENCE: One person has moved into the home since the last key inspection, and they have now lived there for 17 months. The home has a process for assessment before anyone moves into the home, and care plans are written with information and procedures drawn from these assessments. In the Annual Quality Assurance Assessment (AQAA) the manager wrote, “All new prospective residents have the choice of a visit to the home. This will assist them to either want to live here or not. On this visit we would assess most of their needs, aspirations, choices, and family members would also have the opportunity to ask about relevant information. If the person did feel that they would like to live here then we would gather more information and explain all of this to them either verbally, written, or with objects of reference.” Clock Tower Mews DS0000019324.V362054.R01.S.doc Version 5.2 Page 10 Everyone who completed Have Your Say surveys for this inspection said that they were asked if they wanted to move into this home, and they got enough information before they moved in so they could decide if it was the right place for them. One person said, “I visited quite a few times and had meals as well. It gave me the chance to meet everyone.” The CSCI Annual Performance Report for Caretech stated that examples of very good practice throughout Care Tech include good initial assessment procedures and visiting arrangements ensuring that people are able to make informed choices about where to live. The Statement of Purpose and Service User Guide have been updated centrally to make them accessible in order to help prospective residents choose where they might stay. They have been simplified with user-friendly language and pictures, and the Statement of Purpose covers the requirements of the legislation more thoroughly. There is a central process for matching people with homes that can meet their needs. At Clock Tower Mews each person’s file contains the Service User Guide and Statement of Purpose, and an up to date service contract or pictorial statement of services. Although the Service User Guide and the Statement of Services are in pictorial form, some people need alternative formats so that they can understand them. For people who have visual impairment or who cannot understand written words or pictures, a format such as spoken word or video recording, or the use of photographs, may be a useful addition. During this inspection the staff said that they have sufficient information and training to enable them to meet the residents’ needs. The assessment process takes account of the skills of the staff, and how they can meet the prospective resident’s needs. The age range of the people in the home is from 26 to 65, and there is a gap of 17 years between the two youngest people. The 26 year old had not mixed with people of their age group before they moved to Clock Tower Mews. Their care plan shows that this person is now encouraged to listen to their choice of music, and to take part in activities that they choose and enjoy. Clock Tower Mews DS0000019324.V362054.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 and 9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The people who live in the home can be confident that they are fully involved in all decisions about their lives in the home and that the manager is pro-active in ensuring that each person is supported to make their views known. EVIDENCE: The CSCI Annual Performance Report for Caretech stated that Caretech has person centred systems in place for assessment and care planning that ensures that people have choice and control over where they live and how their quality of life is maintained. Care plans have a corporate format which has been revised in order to make it more straightforward to use by staff and accessible for people using the services. These plans cover needs associated with personal care, health, social and leisure needs as well as needs around equalities and diversity issues such as disability, culture and religion. Clock Tower Mews DS0000019324.V362054.R01.S.doc Version 5.2 Page 12 At Clock Tower Mews we looked at the files of three people, which show what care is provided for them and how it is recorded. They provide good details of the support that each person needs, and they are written clearly and from the person’s point of view. The focus of the care plan is to support each person to be as independent as possible, and where possible to improve their skills for independent living. Each item on the care plan is broken down into long term aims, short term aims and a monthly review of progress. The long term and short term aims are decided with the agreement of each person. One person has a long term aim to maintain their independence with personal hygiene. The short term aim towards this objective is for the staff to encourage the person to brush their teeth and wash themselves. The progress recorded towards this is that the person has cleaned their teeth independently, and has had some assistance with personal care. This is a good example of how the care plans are used as an effective tool for the staff to provide appropriate care, and for each person to monitor their own progress. All the staff who completed Have Your Say surveys said that they are given up to date information about the needs of the people they support. One person said that it is discussed in team meetings and supervision. There are risk assessments in each care plan, which provide guidance to staff in supporting the service users to take risks as part of an independent lifestyle. However all the risk assessments are general, for example for “using public transport”, and for “clients and staff in the kitchen assisting with cooking”. There are no individual risk assessments, although the care plans contain good details of the measures needed for all activities. The manager plans to review these, and make sure that each person has individual risk assessments for activities where a decision has been made concerning their safety. Everyone has their own bank account, and they keep their own cash securely in their rooms, together with record books to show how it is spent. The people who live semi independently in the Flat look after their own cash, and one goes shopping and enjoys buying computer games. Most of the people who live in the home are non-verbal, and there is very clear information in the care plans for each individual’s method of communication. For example, one care plan states, “I do understand what you are saying to me. I can understand some words, I do use sign language, but you do not need to sign back as I understand what you are saying to me.” The manager is very skilled in communicating effectively with each individual, and she is passionate about the need for all the staff to take the time and have the confidence to follow her example, and not ask more skilled members of staff to interpret for them. During this inspection we observed the results of this good practice, which is that everyone is able to take part in the life of the home, and to express their very lively views effectively. Each person has a weekly Talk Time with their key worker, and this is recorded in the care plan. The Talk Time format includes questions about their care plan, any changes that the person thinks are needed in the home, and how they are involved in running the home. Examples of this include: “I’m happy with the way I moved my furniture around and do not want any changes made at this time.” “X signed that they Clock Tower Mews DS0000019324.V362054.R01.S.doc Version 5.2 Page 13 had enjoyed attending the service users meeting as it makes them feel more involved in the home.” “X signed that they liked the new TV in the sitting room and that everyone could see it.” Everyone who completed Have Your Say surveys said that they make decisions about what they do each day. One person said that they do not always feel like doing things every day. Another said, “If I want to go for a walk I am supported. I always get given choices.” Everyone had help to complete the survey. One person said, “I am not verbal but I make myself known by facial expressions, body actions, verbal sounds. I do understand what is being said to me.” The Annual Quality Assurance Assessment (AQAA) stated that in the next 12 months the home would look at the format of Talk Time and service users’ meetings to explore more accessible formats to support people who are visually impaired with their communication. Clock Tower Mews DS0000019324.V362054.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): 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. The people who live in the home are supported to live full and active lifestyles, which meets their needs and expectations. EVIDENCE: The staff support and encourage the people who live in the home to develop and maintain their independence. The care plans have a focus on maintaining each person’s independence. (See Individual Needs and Choices.) Most people attend day centres during weekdays, and on the day of the inspection everyone was at day care. When they returned, some people chose to relax in their rooms and listen to music or watch television, and others were in the lounge with a member of staff, talking enjoying a sociable atmosphere. Everyone has one day at home during the week, when they enjoy one to one activities with the staff, such as going for a walk, going shopping, having Clock Tower Mews DS0000019324.V362054.R01.S.doc Version 5.2 Page 15 lunch out. They also tidy their rooms and do their own laundry with support from the staff. The care plans have a focus on maintaining each person’s independence. (See Individual Needs and Choices.) The Annual Quality Assurance Assessment (AQAA) stated, “We support the service users to live a full life experience every day. We have in place a structured activity programme, which we have explored and enjoyed, this is also the service users’ choice. In the last 12 months we have accessed regular peer group activities in the home and locally. Most service users will go out on their day off, we try to have a trip out once a month.” Everyone who completed a Have Your Say survey said that they can do what they want to do. One said, “I like to do my own things, reading, drawing.” Another said they go home some weekends but when they are at the home they choose what they want to do. Everyone has families or friends who visit them or who they visit regularly. The cultural and religious needs of people are recognised and met, including attending church for those who wish to. The menu is drawn up each week with the involvement of the people in the home, and there is a choice of meals each mealtime. One person who completed a staff Have Your Say survey said that nutritional needs are adhered to and all meals are home cooked and fresh. The manager explained that people are encouraged to try out new dishes, notes are made of their individual likes and dislikes and photographs are used to choose menus for those who need this support. Everyone in the main home had supper together in the dining room with the staff who were on duty. The meal was taken at a leisurely pace and there was a sociable and enjoyable atmosphere. Supper was taken upstairs to the people who live in the Flat. It was reported that on occasion they join the people in the main home. Clock Tower Mews DS0000019324.V362054.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 and 21 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is proactive in addressing any possible health needs, there are an experienced and enthusiastic team of staff, who have the training and skills to provide a good quality of care for the people who live in the home, and to ensure that individual needs, choices and preferences are met at all times. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) stated, “We have a monitoring system which relates to the service users’ personal care, other needs and wishes, we review this regularly throughout the day to ensure these needs are implemented and met. We record all health checks, actions taken, any resulting outcomes to promote good care standards. We talk with the service users to express their views and wishes on their health care.” Eight people need the help of two staff for their care, and everyone in the main home has some difficulties with communication. One person is blind. The CSCI Annual Performance Report for Caretech stated that Caretech is able to support people in meeting their personal and healthcare needs. The level at which personal support was provided and physical and emotional needs of Clock Tower Mews DS0000019324.V362054.R01.S.doc Version 5.2 Page 17 people were met was high throughout Caretech. There are good examples of staff listening well and responding appropriately to the people living in the services. All the staff who completed Have Your Say surveys feels that they have the right support, experience and knowledge to meet the different needs of the people in the home. Everyone who completed a Have Your Say survey for the people who live in the home said that the staff treat them well and listen to what they say. One person said, “I get on well with the staff. I like them.” And another said, “The staff will listen and assist me if I want something”. During the inspection everything we saw supported the information that is quoted above. The care plans contain good details of each person’s care needs. The healthcare records seen included references to hospital visits, and contact with GPs and other health professionals. The staff are pro-active in addressing any possible health concerns. Everyone is weighed regularly, and fluctuations in weight are seen as an indication of a possible health concern. The manager said that she will fight for good health care for everyone in the home. One person has recently had an assessment for swallowing difficulties. Another person has been diagnosed with a life threatening condition. This was discussed with the person, and they were able to make their own decisions about the treatment they wanted to have. The home has access to palliative care services when they are needed, and the staff will support the person’s decision to remain in the home and not go to hospital or hospice in their final days. One person was assessed as having aggressive and challenging behaviour when they moved into the home. Through understanding of this person’s means of communication this is no longer a problem, and the mental health services are no longer involved. One person who has behaviours that challenge lives separately in The Lodge, with one to one care from experienced support workers. The home has sound systems in place to manage people’s medication safely. We checked a sample of medication records, which were free of errors, with no signature gaps found on the MAR (medication administration record) charts. Most medication is supplied in monitored dosage blister packs. For tablets that cannot be supplied in this way, the date of opening is written on the box. It would be preferable to also write the time that the box was opened, so that an accurate audit can be carried out to make sure that there are no medication errors. There is a thermometer in the drugs trolley, and we suggested that the temperatures should be recorded. This would make sure that all medication is stored according to the manufacturer’s recommended temperature, in order to prevent the risk of administering medication that has deteriorated and is no longer effective. Clock Tower Mews DS0000019324.V362054.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 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live in the home are encouraged and enabled to make their views and concerns known, and appropriate procedures are in place to ensure that they are protected from abuse and neglect. EVIDENCE: The CSCI Annual Performance Report for Caretech stated that Caretech services are able to protect people who use services by the provision of staff who are suitably trained, good procedures and a physical environment that is improving in quality. There is a corporate complaints procedure that is available in pictorial and easy read format. There is a corporate training course in safeguarding and protection of vulnerable adults procedures that most staff had accessed. In the Annual Quality Assurance Assessment (AQAA) the manager wrote, “We have had some improvements made (of the complaints procedure) in picture form. This can assist only service users with good level of understanding. We need to progress on to others who need more information on what is said or shown to them.” Everyone who lives in the home is able to make their views known, and the staff are skilled in helping them to communicate (see Individual Needs and Choices). No complaints have been recorded in the home, and any concerns are dealt with as they arise. People’s views and any concerns are recorded in the Talk Time record in their care plans. Any Clock Tower Mews DS0000019324.V362054.R01.S.doc Version 5.2 Page 19 complaints would be reported to and dealt with by the company’s area manager. Everyone who completed a Have Your Say survey said that they know who to speak to if they are not happy. “I normally sign and the staff understand what I want and they know when I am unhappy.” “I am not verbal but I make it known when I am unhappy.” Everyone knows how to make a complaint. “Have seen file and talk to staff.” “My co-ordinator explained it to me.” Clock Tower Mews DS0000019324.V362054.R01.S.doc Version 5.2 Page 20 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, 27, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The house provides a homely environment for the people who live there. However delays in completing essential repairs mean that people do not have the facilities that they need to maintain their health and safety and their quality of life. EVIDENCE: In the Have Your Say surveys one person said, “I like my home and we have got new furniture and television so everyone can see it.” One staff survey stated, “As most people come to our home they comment Always Very Homely.” The home is a detached building that was originally the stable block of Morven House. On the first floor two people live semi-independently in the self contained Flat, and one person lives separately with one to one care in The Lodge. We did not visit The Lodge during this inspection. The house is furnished and decorated in domestic styles that produce a homely, comfortable Clock Tower Mews DS0000019324.V362054.R01.S.doc Version 5.2 Page 21 environment, which allows the people who live there to relax and feel very much at home. Everyone has their own room, which is arranged and decorated to reflect their particular interests and tastes. The rooms are large enough for people in wheelchairs to move around easily, and there are sufficient hoists for the needs of the people in the home. The hoists are stored in the hallway outside two of the bedrooms. The people who have these bedrooms use wheelchairs, but the manager should make sure that there is no risk of knocking into the hoists or tripping over them for anyone who may pass this area. There are only two bathrooms in the main home, for eight people, and the bath in one needs to be replaced. Only one person is able to use this bath, which means that there is effectively only one bathroom for the remaining seven people to use. This means that some people are not able to have a bath when they want one. In January 2008, three months before this inspection, the Environmental Health Officer inspected the kitchen and said that the kitchen cupboards must be replaced so that they can readily be cleaned. This has not happened, and is essential in order to prevent any risk to food hygiene in the home. There is a loose piece of carpet outside the kitchen. It was reported that this is to protect the fitted carpet from heavy wear in that area, but it may cause a risk of tripping for anyone passing by. The home appeared to be clean, and the staff follow appropriate procedures to maintain hygiene and prevent the risk of infection. The laundry has a professional washing machine with a sluice cycle, and a domestic style machine that people can use for their personal laundry. Clock Tower Mews DS0000019324.V362054.R01.S.doc Version 5.2 Page 22 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): 31, 32, 33, 34, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who live in the home are supported by a stable staff team who have the experience and training to understand and meet their needs. However due to staff shortages, people have to work excessive hours, and this may affect the quality of their work. EVIDENCE: The home has an experienced and stable staff team, who have all worked at the home for several years. However there are only fourteen staff in the home, including the manager. In the Annual Quality Assurance Assessment (AQAA) the manager wrote, “Some staff have left this year to move to better areas, which left us to work harder at providing services at a high standard. To meet the overall needs of the standards we will recruit more staff. We have some long term staff but need to recruit three more staff for the home.” The AQAA was written six months ago, but the situation has not changed. The manager said that it is very difficult to recruit staff with the skills to support the people in the home. This is due in part to the location of the home. There is a Clock Tower Mews DS0000019324.V362054.R01.S.doc Version 5.2 Page 23 continuous programme of recruitment, and one person was appointed, but left after a short while. Two people left when their visas expired and were not renewed. The staff who completed Have Your Say surveys said that there are usually enough staff to meet the individual needs of all the people who use the service. One said that due to staff shortage the home is not fully staffed but they are still able to provide a service for the service users. The evidence that we saw during the inspection, in care plans and by observation, show that the staff are maintaining a good quality of care provision and support for the people in the home. However in order to do this, some are working very long hours. The rotas for the last two weeks show that the manager worked seven days a week for the past two weeks, and over 70 hours each week. Another member of staff worked 101 hours one week and 99 hours the next. The manager is included on the rota, which means that either she does not have sufficient time for her management role, or the people in the home do not receive the attention that they need at all times. Agency staff worked in the home for 44 hours during the last month, and it has not always been possible for the agency to provide the staff that are requested. The rotas show that there are two people in the main home throughout the day and the night, and one person supporting the person who lives in The Lodge. Six people use wheelchairs, and the AQAA stated that eight people need two staff to assist them with personal care. 16 hours a week is allocated to support the people who live in The Flat. This was not evident from the rota, which suggests that there are insufficient staff in the main home when that support is provided in The Flat. There is a comprehensive training programme that covers all mandatory training in first aid, moving and handling, fire safety, food hygiene, etc, and training to meet special needs the residents have. All the support workers have a qualification at NVQ2 or above, and everyone has one to one supervision every month. One member of staff said in the Have Your Say survey, “I meet with my manager once a month for supervision. My manager has been very supportive and due to that I have been able to achieve my NVQ II & III and have been promoted and I am still being supported by manager who is a very approachable person.” The CSCI Annual Performance Report for Caretech stated that Caretech has good recruitment and training practices in place to ensure that staff are suitably safe and competent to meet the needs of people living in services. The recruitment processes are becoming centralised, and staff information is held centrally. The CSCI Provider Relationship Manager checks the staff records, including Criminal Record Bureau (CRB) disclosures. He said that people living in services can be reassured that they are being looked after by staff who are safe to do so. Clock Tower Mews DS0000019324.V362054.R01.S.doc Version 5.2 Page 24 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, 38, 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 managed, and the management actively seeks the views of the residents and other involved people in order to ensure that a good quality of care is provided. EVIDENCE: The ethos of the home is that it is the home of the residents, and the staff support them to live their lives as they wish to and to make their own decisions about every aspect of their lives in the home. There is a family atmosphere in the home. All the staff have worked there for several years, and the staff and residents know each other well. The manager has been in Clock Tower Mews DS0000019324.V362054.R01.S.doc Version 5.2 Page 25 post for eleven years. She has recently completed the final units of the Registered Managers Award (RMA), and she is waiting for the results. In the Annual Quality Assurance Assessment (AQAA) the manager wrote, “We all have worked very hard to keep up the high standards that are in place, we maintain provision of the services that are set down in our policies and procedures. Any issues that come to light are addressed with good professional conduct.” The manager leads by example, and she is passionate about promoting the rights of each individual in the home. However in order to achieve this, the manager works excessively long hours (see Staffing). The manager is included on the rota, which means that either she does not have sufficient time for her management role, or the people in the home do not receive the attention that they need at all times. This is not addressed in the reports of the proprietor’s monthly visits to the home. In the reports of the visit made in October and December 2007 the proprietor’s representative listed three staff on duty, including the manager, and stated, “All appear happy;” “Staff busy attending to clients. All cheerful.” The representative did not check the duty rotas to see how many hours each person worked, or consider whether sufficient staff were employed in the home. The manager works very hard to maintain good outcomes for the people who live in the home, but it appears that the company do not support her in addressing the difficulties of employing new staff. The manager does not have access to the Internet or to email in the home. This limits her access to information and guidance on good practice issues, and limits the communication that Caretech can have with its homes. The AQAA template is available on line, and CSCI recommends that managers complete it and return it on line. As Clock Tower Mews does not have Internet access, this was not possible. The AQAA that was used for this inspection was sent to the home in May 2007 but only returned following a reminder in September. A new AQAA was sent in March 2008, but the manager said that she has not received it. It was reported that mail often goes missing, as one of the residents may pick it up and dispose of it. The CSCI Annual Performance Report for Caretech stated that Caretech has recently introduced a new structure for Quality Assurance that has the potential to be comprehensive in obtaining the views of people who use the services as well as other stakeholders. Caretech have appointed a Director of Quality who, in turn, is appointing a team of Quality Managers. Previously questionnaires were sent to people using services, however this is in the process of being replaced by a new system of quality monitoring which will include a more thorough analysis. Specific features being introduced are quarterly checklists, regional panels with user involvement and regional action planning. Arising from this will be a development plan for each service. There was no evidence at Clock Tower Mews of this new system for quality assurance. The manager said that it is still in the process of development. Residents have been asked if they would like to join the regional panel for user involvement, but no-one who lives at Clock Tower Mews has chosen to do so. Clock Tower Mews DS0000019324.V362054.R01.S.doc Version 5.2 Page 26 However, as described in Independent Needs and Choices above, everyone is supported to make their views and opinions known. Caretech introduced the structure for providing weekly Talk Time when people can discuss what activities they would like and how they feel about relationships within the home. As a result action plans are developed co-operatively with people using services. Changes that have been made at Clock Tower Mews as a result of listening to the people who live ion the home include the purchase of a new television and choices of outings. The AQAA provided evidence that there are good procedures for maintaining health and safety in the home. All the staff have training in moving and handling, fire safety, food hygiene and infection control as part of their induction. There is a monthly health and safety audit in the home. Health and safety records include regular checks of water temperatures, fire equipment and fire drills. Clock Tower Mews DS0000019324.V362054.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 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 2 28 X 29 3 30 2 STAFFING Standard No Score 31 3 32 3 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 3 3 4 3 X X 3 X Clock Tower Mews DS0000019324.V362054.R01.S.doc Version 5.2 Page 28 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 YA24 Regulation 13(4)(a) Requirement Timescale for action 31/05/08 2. YA27 23(2)(j) 3. YA30 13(3) 4. YA33 18(1)(a) Measures must be put in place to make sure that there is no risk to residents or staff in the home from the loose carpet in the hallway near the kitchen. Sufficient numbers of baths must 30/06/08 be made available to meet the needs of the residents without further delay. The kitchen cupboards must be 30/06/08 replaced so that they can be cleaned affectively, to maintain prevent the risk of infection. The registered person must 30/06/08 ensure that sufficient staff are employed in the home in order to comply with the Working Time Regulations and to meet the needs of the residents. Clock Tower Mews DS0000019324.V362054.R01.S.doc Version 5.2 Page 29 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 YA1 Good Practice Recommendations It is recommended that the organisation should explore imaginative ways to make the service users’ guide more accessible to the people who use their services. Clock Tower Mews DS0000019324.V362054.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Clock Tower Mews DS0000019324.V362054.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!