Care Home: Cottisbraine House

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What the care home does well The home provides a very warm and homely, intimate environment for people living at the service; staff members clearly providing close attention to each person. The home provides a focus for people with learning disabilities in their later years, the average age currently being 64, ages ranging from 55 to 76. The culture of the home, though far from elderly, acknowledges this reality. All spoke generally highly of the care and service provided. The food served at the house is nutritious, home-cooked and plentiful, the kitchen continuing to be the hub of the house, with service users to an extent helping themselves, and assisting in preparing the meals and the clearing up afterwards. Life, socially within the house, and engagement with the local community, is encouraged for the majority, through attendance at various day centres, social venues and through attending evening clubs, and through taking other opportunities to go out with staff from the home. All relatives were positive about the service, reporting they are positively welcomed in to the home at any time, and staff were very positive about the service given, one staff member stating that they had never worked in a nicer place. The presence of a qualified learning disability-experienced manager has clearly brought benefits to the home, complementing the more care-focused approach of the registered manager and his mother, the other registered person. The consolidation of person centred care planning and the health action plans, matched alongside the modernisation and wider improvements in the general fabric of the home, continues to indicate a positive future for the home. What has improved since the last inspection? We noted previously the vision and determination shown by the proprietors in taking steps to improve the quality of the whole accommodation at the home, and aligned to this renewal, the appointment of Beverley Clancey as interim manager (since May 2006). She has clearly assisted in the redevelopment of the homes processes and taken the helm, alongside Mrs George, in leading the service into its new phase of life. The dining room has been redecorated and new furniture provided. Staff training in NVQ Care practices has improved and now exceeds the national minimum standard, and Induction and Foundation Training has been introduced to appropriate standards. Robert Brand - one of the two proprietors, has continued to be registered as manager, with the appointment of Mrs Clancey being the first step in moving to registering her as a permanent manager as the person in day-to-day control of the service. Sadly, Mrs Clancey has now chosen to leave the service, so the proprietors are currently advertising for a new person to steer the service forward for the future. What the care home could do better: The premises appeared to be generally in good repair and decoration at the time of the visit, and the standards of care and focus on providing a positive service for people living there is undoubted. Premises recommendations cover: that the ground floor shower facility be reviewed in the light of there only being one bathroom upstairs; that the fire escape at the side of the house be provided with additional lighting lower down the staircase to make clearer the pathway during nighttimes; that consideration be given to a single wrap-round chair lift, rather than the current two-stage lift which can require a difficult transfer, currently, half way up the staircase, and that bedroom windows at the front of the house be double glazed. Quality assurance elements, however, continue to require work; some work has been completed in this regard - with the homes financial adviser being involved, so this process has started, however the proprietors should finalise the Business and financial Plan so that the incoming manager will benefit from a knowledge of the proprietors projections for the service in the future. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Cottisbraine House 36 Sandy Lane South Wallington Surrey SM6 9QZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: David Pennells     Date: 1 6 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Cottisbraine House 36 Sandy Lane South Wallington Surrey SM6 9QZ 02086477981 02086477981 cottisbrainehouse@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Maureen Ann George,Mr Robert Daniel Brand Name of registered manager (if applicable) Mr Robert Brand Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 9 The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Date of last inspection Brief description of the care home Cottisbraine House is a detached family-type residence situated on a fairly busy road connecting Wallington to Woodcote to the east of Sutton. The house provides a service to up to nine adults with a learning disability. The home is situated on a slope extending up from the road, so not so suitable for those who may use a wheelchair, although access is possible from the driveway, then through the rear patio entrance into the sitting room. Care Homes for Adults (18-65 years) Page 4 of 30 care home 9 Over 65 0 9 Brief description of the care home The home provides accommodation comprising a separate lounge and dining room, and a kitchen of ample, domestic size. Bedrooms are provided on a basis of nine single rooms. All but one bedroom has ensuite facilities. Access to the first floor is provided by stairs, or by using a (two stage) stairlift facility. An accessible shower is available on the ground floor, and a bath on the first floor. Toilets are also provided within these two bathing facilities. There is also a newly created small, but serviceable, office on the ground floor - ideally situated close to the main entrance. There is a second floor loft which is the staff sleeping-in facility. External facilities provided comprise a small patio to the rear of the building accessed from the sitting room, and a small inclined, landscaped, car park / drive, & wellplanted and maintained front garden. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support peterchart Concerns, complaints and protection Environment Staffing Conduct and management of the home Poor Adequate Good Excellent How we did our inspection: The inspection visit was undertaken throughout an afternoon and evening enabling us to meet both one of the proprietors and the appointed interim manager of the home. We spent some time with people who used the service, and then toured the building, speaking to others and, following a chat with the proprietor, spent some time auditing paperwork within the new office space with the interim manager. Following further discussion and audits of processes undertaken at the home, we left the building in the early evening. We are grateful to the proprietor - Mr Brand, the interim manager - Beverley Clancey, and the people using the service for their welcome and cooperation given throughout this visit. Care Homes for Adults (18-65 years) Page 6 of 30 Questionnaires were left for the staff, the people using the service, and also for their relatives carers and advocates. We had a reasonably good response, with four staff, five people living at the home, and five relatives responding. Generally the overwhelming response from the survey was positive - for the service, the staff and the management at the home. There were no major negative issues raised, and many points of quality were expanded upon - as they will be, the detail being highlighted throughout this report. What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Adults (18-65 years) Page 8 of 30 The premises appeared to be generally in good repair and decoration at the time of the visit, and the standards of care and focus on providing a positive service for people living there is undoubted. Premises recommendations cover: that the ground floor shower facility be reviewed in the light of there only being one bathroom upstairs; that the fire escape at the side of the house be provided with additional lighting lower down the staircase to make clearer the pathway during nighttimes; that consideration be given to a single wrap-round chair lift, rather than the current two-stage lift which can require a difficult transfer, currently, half way up the staircase, and that bedroom windows at the front of the house be double glazed. Quality assurance elements, however, continue to require work; some work has been completed in this regard - with the homes financial adviser being involved, so this process has started, however the proprietors should finalise the Business and financial Plan so that the incoming manager will benefit from a knowledge of the proprietors projections for the service in the future. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are able to find out about life in the home from both live contact with staff and people at the home and from accessible formats of information, such as the Service User Guide and Statement of Purpose. The service provides people with appropriate focused care and attention through the use of an assessment tool enabling the home to discover, gauge and record the level and detail of an individuals preferences, needs and aspirations. Prospective users of the service may expect to have their needs clearly identified through person-centred planning, through which people can expect to receive appropriate and focused services to meet their needs. Evidence: The Service User Guide - including the Complaints procedure - is in an accessible format using Widget symbols. The Statement of Purpose is up to date and meets current regulatory requirements. A brochure complements the Statement of purpose. Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: Assessment documentation used is a well-developed and reliable template document. The use of person-centred care plans and health action plans, allows the home to identify more closely the needs of the current service user group, and is well able to meet those specific needs. Assessments now ensure that all needs are closely identified prior to an admission - enabling an informed process to take place, and ensuring that people are only admitted if the home can meet their needs. The age range for people at the service spans from 55 to 76. The average age of the population is 64. The home focuses well on acknowledging this maturity factor, whilst certainly not being run like a traditional older persons home. Placements are currently funded by Surrey County Council and the London Boroughs of Lambeth, Merton and Sutton. Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can expect to be supported by a comprehensive care plan with risk assessments reflecting their needs and goals, with safety provisions clearly identified. People may expect to be treated as individuals, to be respected, and to be given the chance to make informed decisions about their lifestyle at the home. Each person is encouraged to express their own personalities, choices and preferences, through being consulted either individually, or as a group, where appropriate. Evidence: Person-centred care planning is now in place for all people living at the home; this process being assisted with support from the London Borough of Sutton Learning Disabilities PCP worker. Comprehensive care plans are clearly working documents, and people using the service are being drawn in more to understand their purpose. Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: Records of care plan reviews showed that the calling of review meetings had continued to be a priority, and that all those who should, and could, contribute were invited to do so. Both the local authority and the service records of reviews were on file. Consequently revised care plans were in place for all, with staff members commendably being required to countersign that they had read and understood the newly revised plan, this ensuring that all were approaching the plan of action in a similar way. Health Action Plans form an integral part of the care planning process, and these elements were also well documented and seemingly live. All risk assessments seen were current and well constructed, all again being recently updated, and taking into account new factors encountered. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service have opportunities to develop their varying skills and to fulfil their spiritual needs, engaging in appropriate religious, day care, leisure / social activities either as a group, or individually, at home or in the community. Family and friends are made welcome at the house and people are encouraged to develop appropriate relationships between themselves and with others in the wider community. Daily routines at the house encourage independence and rights for people to enjoy the house and the service in their own preferred way. Meals are a pleasurable shared experience, with wholesome and nutritious food provided, and eagerly and positively enjoyed. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: People using the service indicated that they generally are able to make their own decisions about what they do, though sometimes at weekends there is not enough support for everyone to do individual activities. Everybody felt the staff treated them generally well and act on what they say. Some people at the home regularly attend structured Day Care services outside the home, attending Hallmead Centre, Mencap resources, Orchard Hill College, The Link Club, and SCOLA - the Sutton Adult Educational facility. People can attend Church with staff support. Some people have been recently test-driving other local social groups and activities. It remains clear that positive attempts are made to find a fulfilling and enjoyable lifestyle, for most people, outside the four walls of the home. One person also undertakes some voluntary work at the Vine Project. Holidays had again been arranged for individuals during the past year, including one who goes out on day trips on a 1:1 basis, rather than going totally away. The Project Worker from Tandridge Music Project continues to regularly attend the home, as he has since 1997 - and his input is continues to be greatly appreciated and thoroughly enjoyed. Music is evidently vitally important to - and enjoyed by - all service users. Another popular session each week at the house is the Keep Fit / exercise to music session. People are encouraged to engage with the world through the E-live magazine, which communicates news in an accessible format, and through watching and discussing the TV news and through access to daily papers. Relatives again have confirmed a very positive welcome at the home - we have noted, throughout inspection, a long history of relatives and friends engagement with the home being warmly and unconditionally encouraged. One relative spoke of their delight that their relative has now learned to make phone calls and is in touch regularly with them. Another relative stated that they were impressed by the way their relative has become their own person whilst living at Cottisbraine House. The standard of food provided at the home continues to be at its excellent best; healthy dietary needs are identified and encouraged (healthy food is identified in the person-centred health action plans). Mealtimes are flexible, depending on the mood of the house, though some people prefer a predictable, reliable routine. Weekend mealtimes are a little later than during the working week. People are encouraged to remain independent with regard to drinks and snacks; one person interviewed confirmed that he has his own kettle and full drinks-making facilities in his room. Other people continue to follow the daily rhythm of the household, participating in Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: domestic chores such as laying tables and helping wash up after meals. All such contributions to community life ensure that all feel involved. Care Homes for Adults (18-65 years) Page 17 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be assured of personal, respectful and focused attention to their personal care and support, including health care, medication needs and emotional support. The home can provide suitably sensitive care and attention for service users at the point of serious illness / death, including having sufficient information concerning last wishes, to ensure a focused, individual and personal approach to support. Evidence: Personal care is provided by staff on a day to day basis, and by visiting practitioners, such as hairdressers and chiropodists as needed. Care is provided according to need, from distant observation and encouragement given to the relatively independent people, through to those who need greater direct personal care assistance. Health Action Plans are now in place for all people at the home, clearly identifying and highlighting the health needs and interventions appropriate to each service user. The all-important influenza jabs had again been arranged. Daily walks were introduced to Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: encourage exercise, and are integrated as part of the health action plans. Relatives questionnaires again unanimously reported that staff carefully monitored each service users wellbeing and general health, and being happy with the cooperation and service provided by the staff - both seniors and care workers. One relative described the staff as amazingly good in meeting the needs of their relative. Staff members were all, more recently, fully retrained in medication procedures by an accredited agency. We examined the medication cupboard and stock and administration records, and all were found to be in good order. The amount of medication used at the home continues to be (commendably) relatively small, this attributable to the 1:1 attention given. Evidence has been seen that people at the home and their representatives have now agreed clear instructions concerning their wishes should they be taken ill or suddenly pass away, this including religious and cultural instructions. Care Homes for Adults (18-65 years) Page 19 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a written complaints procedure which is recognised and known by all stakeholders, through a version in an accessible format being provided for people using the service. The service provider is recognised to respond to comments and suggestions encouraging and using informal routes where possible. The home seeks to ensure that people are protected from harm or abuse, through recognising and relating to the local authority Safeguarding procedure - and through mechanisms such as ensuring external audits of financial transactions. Evidence: The complaints procedure - which is attached to the Service user plan as well as displayed in the home - is presented in Widget symbol format, thus ensuring it is more accessible to service users. Relatives responding to the our questionnaire reported not having to make a complaint about the service; this was confirmed by the home. All respondents also confirmed they were aware of who to speak to in case of a concern at the home. All staff within the home have attended Safeguarding training. The home follows the Safeguarding procedure issued by the London Borough of Sutton, as the host borough, and is mindful of those procedures from placing authorities. Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: Social services or relatives are predominantly appointees to people in regard to money. One person using the service is assisted, through the registered provider being the appointee to them, with regard to funding via an externally managed Trust Fund. Full records and auditing of personal funds is provided. Records are kept of personal allowances held by the home and spent either by the service user or the staff on their behalf. Care Homes for Adults (18-65 years) Page 21 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect to live in a clean, well-managed & safe environment, their own bedrooms being distinctively different, and offering scope for the personalisation / individual characteristics, which the home encourages. The communal lounge and dining facilities are homely, warm and comfortable. Communal toilets and bathrooms are well suited to the needs of people using the service. Facilities at the home promote privacy and dignity for all service users, encouraging independence and self-esteem. Evidence: The house now provides entirely single occupancy bedrooms (with a consequent reduction in the total number accommodated), and all but one room possesses ensuite facilities. The loss of the two double occupancy rooms has contributed to the creation of an office, and an equalisation of room sizes on the first floor, leading to most rooms virtually meeting the national minimum standards. The creation of an all singlebedroom home has removed the need for a designated Visitors Room, and the reduction in numbers ensures that communal space now does meet the new national Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: standards. The dining room has been redecorated and new furniture provided. The entire feel of the house is now modern and very attractive. The house is now designated a nonsmoking establishment; this providing for a safer environment for service users, none of whom smoke. Some double-glazing has been undertaken during the refurbishment process; however it remains a recommendation that other windows at the front of the building be double or secondarily glazed to reduce the noise from the busy road outside - this an ongoing issue highlighted by a service user accommodated at the front of the house. We were told that a ramp is to be created to ensure ease of access to the front door for wheelchair users; this will be in place by February 2009. It is recommended that the following three items are considered: that the ground floor shower facility be reviewed in the light of there only being one bathroom, upstairs; that the fire escape at the side of the house be provided with additional lighting lower down the staircase to make clearer the pathway during nighttimes; that consideration be given to a single wrap-round chair lift, rather than the current two-stage lift which requires a difficult transfer, currently, half way up the staircase. The house remains, as ever, well maintained, odour-free and clean. All necessary maintenance and servicing contracts are in place and up to date. Care Homes for Adults (18-65 years) Page 23 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provides staffing, suitably qualified to meet the day-to-day needs of the people living there, and to run the establishment itself. Recruitment practices ensure the safety of service users. Ongoing professional supervision, appraisal and support is now developed to ensure support for staff, and to assist in the translation of the homes philosophy and aims into work with individual people living at the home. Staff members are better supported by a developed staff induction, training and development programme, this bringing clear benefits to the individual people using the service. Evidence: Relatives reported that they felt unanimously that staff have the right skills and experience to look after their relative. One stated The staff are very caring. Another described how the staff make them feel welcome when they visit. Another stated they would like to give 100 praise for the kind, caring and efficient way all the residents are looked after. Fully employed staff numbers are provided in sufficient number to support the seven current service users at the home; however at weekends especially, there is Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: sometimes a need to call in an occasional agency worker to cover a shift - though most is covered by very familiar - and well liked - staff members. Staff were very happy with the recruitment and induction process; they were also very happy about the training opportunities that were now available. Induction now relies on the Skills for Care underpinning documentation, leading on now to the establishment of a clear pathway towards NVQ Level 2. The interim manager is a qualified assessor for NVQ qualifications. Excluding the proprietors, NVQ training is now completed for 66 of the staff complement, with a further three staff working on qualifications to either Levels 2 or 3. Two care staff also have nursing qualifications. First Aid and Manual Handling training has also been provided recently. Infection Control training is being accessed from the London Borough of Sutton. The interim manager has ensured that workbooks and course material are available to take staff through the LDAF Induction & Foundation level training, this providing the base to move onto appropriate further higher-level training courses. Local Authority training courses have been made good use of more recently; a clear training needs analysis was prepared to submit to the council to access such opportunities. Recent recruitment to support worker roles evidenced, once again, all principal elements of the items as required by Regulation being in place: including an application form, two written references, Criminal Records Bureau check, a contract, supervision notes, and training profiles. Staff members now receive 1:1 supervision, this now being provided on a regular basis by the interim manager - and appraisals are follow within this annual cycle. Staff questionnaire responses confirmed this reality. Care Homes for Adults (18-65 years) Page 25 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overseen by two proprietors offering various skills in residential care, the home has positively benefits from focused management provided by the newly appointed qualified, competent, and learning disability-experienced manager. Although attempts are being made at addressing the issues of quality assurance, the home must aim to consolidate such areas to ensure that the home reflects the aspirations and opinions of service users and stakeholders. To properly address the needs of the home in its entirety, the business and financial plan needs to be completed to ensure the effectiveness, financial viability and accountability of the home, and to set the agenda for future years. Evidence: The proprietors step of appointing Beverley Clancey as interim manager has enabled them to ensure that she has been able to co-work alongside them in the redevelopment of the homes fabric and processes. Mrs Clancey settled in well, and it is Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: unfortunate that she has now elected to leave the service. Appointed since May 2006, she had a Diploma in Nursing and her background has been in learning disability services, with several years of experience at home manager level in both the NHS and private sector. She also developed local contacts through attending the local authority Learning Disability Providers Forum. Robert Brand, one of the proprietors, continues to be registered as manager, (and he continues, alongside his mother - Maureen, to have the financial responsibility for the home). Beverley Clancey has undertaken - with advice and support from the proprietors - the management of the caring side and the general day-to-day management of the house. Robert Brand has indicated his continuing intention to stand down from this registered manager position, once a new manager is identified, recruited and registered with the Commission. Quality assurance elements still require significant work; this area was, inevitably, the last for Mrs Clancey to address in a list of various developments at the home. This focus on quality assurance and quality monitoring systems must be integrated within the homes practice and principles - and inform planning for the future. All maintenance records for the home were readily available for inspection, and declared on the Annual Quality Assurance Assessment required by the Commission. All health & safety aspects, both building and equipment-wise, continued to be satisfactorily maintained. A professionally produced Fire Risk Assessment has been commissioned by the home to ensure full compliance with new legislation. The requirement that the proprietors produce a Business & Financial Plan has moved on, in so far as the financial statements have been provided to assist in the development of the build this document. The proprietors will now have to complete this work for themselves, or rely on their new appointee to take it on. Such a plan will be useful to evidence the input of quality assurance surveys & enquiries, alongside the plans for the future, aligned to the financial development of the service. We are clear that the home has now clearly positively turned around, with the assistance of the interim manager, and we looks forward to the recruitment of a new manager to see these developments further. Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 24 That the fire escape at the side of the house be provided with additional lighting to make clearer the pathway during nightimes. That bedroom windows at the front of the house be double glazed. That the developing Business and Financial plan be completed as soon as possible to ensure that the new manager has a clear focus of where the proprietors see the priorities for the future. 2 3 24 43 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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