Care Home: Dana House

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What the care home does well The care home has a very welcoming atmosphere. Residents live in a homely environment, with quality furnishings, and decoration that is attractive, and meets the needs of people using the service. People using the service told us that they liked living in the home and that they were happy with their bedrooms. Comments included `I am happy here`, `I like my bedroom`, and `I can get up when I want`. Residents spoke positively of the staff, and knew the names of their key workers. There are sufficient staff on duty to ensure that residents can participate in a variety of preferred activities as well as have their needs met. Residents are supported and encouraged to make decisions about their lives and in the running of the home. There is close liaison with health care professionals, and other specialists as and when required by the residents. Records told us that residents receive treatment and advice from a variety of health care professionals. People using the service have their views listened to, and respected. There are regular resident meetings, which they have the opportunity to attend. All the residents have a key worker, who supports them in many aspects of their lives. People using the service are supported to have the contact that they wish with relatives and friends. Holidays for residents are a regular feature of the care home. There are appropriate policies and procedures in place to ensure that people living in the home are protected and safe. What has improved since the last inspection? Requirements from the previous inspection have been addressed by the service. Several areas of the home have been redecorated, and some new furnishings and furniture have been bought and there are are plans to buy further items for the sitting room, to ensure that the home is an attractive and suitable environment for people using the service. The care plans are more `person centred` (the person being central to their plan of care) plan in picture and written format. Health care plans and risk assessments have also been developed and improved since the previous inspection. What the care home could do better: Some records could be better. The recording of residents complaints and `concerns` should be recorded in line with the care home`s complaint procedure. All records should be dated, and signed, by the staff member who wrote them and by people using the service if the information concerns them. It could be more evident that staff receive up to date training, including medication training. Each staff member should have an individual training plan. There could be improvement to the format of information relevant, and of interest to people using the service, such as the menu, to ensure that it is more accessible to those people who have difficulty in reading. It should be evident that staff receive at least six one to one formal supervision sessions to ensure that they are well supported to carry out their roles and responsibilities. Risk assessments could be further developed to ensure that it is evident that any risk to people using the service are assessed and that there is guidance in place for staff (and residents) to follow and so be consistent in the support that they provide to residents. Key inspection report Care homes for adults (18-65 years) Name: Address: Dana House 5 Fairfields Crescent London London NW9 0PR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Judith Brindle     Date: 1 7 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Dana House 5 Fairfields Crescent London London NW9 0PR Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Megwantee Shand Kriho (Mian) Type of registration: Number of places registered: care home 4 Dana Care Ltd 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: Four The Registered Person may provide the following category of service only: Care Home only-Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Code-LD Date of last inspection Brief description of the care home Dana House is owned by Dana House Ltd. It is registered to provide care and accomodation to four people with learning disabilities. The house is semi-detached and located in a residential area close to Kingsbury, where there are a variety of amenities, including shops, restaurants, banks, and a large park. Public bus and train transport facilities are accessible within walking distance or a short Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 4 4 Brief description of the care home drive from the home. There is parking available on the road in front of the home. Accommodation for residents is provided in single rooms on three floors. There is one bedroom, a lounge, dining/kitchen area on the ground floor, and en-suite bedroom in a loft conversion. Documentation about the care home and the service that it provides is accessible from the home. Information about the range of fees is available from the owner. Care Homes for Adults (18-65 years) Page 5 of 32 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 health care support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The unannounced inspection of Dana House took place throughout 6 hours in November 2009. This inspection was carried out due to the recent change of owner of the service. The previous key inspection of the home took place on the 9th January 2009. There was one vacancy at the time of this inspection. We were pleased to meet and talk to all the people living in the home. The manager was present during most of the inspection. A number of feedback surveys were posted to the care home prior to the inspection. At the time of writing this report the Commission had received no completed surveys from residents, staff, and and/or health and social care professionals. The manager told us that he was not aware that any surveys had been received by the home. Documentation inspected included, residents care plans, risk assessments, staff training records, and some policies and procedures. The inspection included a tour of Care Homes for Adults (18-65 years) Page 6 of 32 the premises. Observation was also significant tool used in the inspection process. Assessment as to whether the nine requirements, and the recommendations from the previous key inspection had been met, also took place during this key unannounced inspection. 26 National Minimum Standards for Adults, including Key Standards, were inspected during this inspection. Prior to this unannounced key inspection the manager supplied the Care Quality Commission (CQC), with a completed Annual Quality Assurance Assessment (AQAA) document. This record includes required information from the manager (and/or owner) about the quality of the service provided to residents by the care home, and of any planned improvements. This document had been completed by the manager and told us generally what we needed to know about the service, though it could have been more developed and detailed in some sections (i.e what the home does well, and how the service has improved) of the document. Reference to some aspects of this AQAA record is documented in this report. We thank the people living in the care home, staff, and the manager for their significant assistance in the inspection process. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Some records could be better. The recording of residents complaints and concerns should be recorded in line with the care homes complaint procedure. All records should be dated, and signed, by the staff member who wrote them and by people using the service if the information concerns them. It could be more evident that staff receive up to date training, including medication training. Each staff member should have an individual training plan. There could be improvement to the format of information relevant, and of interest to people using the service, such as the menu, to ensure that it is more accessible to those people who have difficulty in reading. Care Homes for Adults (18-65 years) Page 8 of 32 It should be evident that staff receive at least six one to one formal supervision sessions to ensure that they are well supported to carry out their roles and responsibilities. Risk assessments could be further developed to ensure that it is evident that any risk to people using the service are assessed and that there is guidance in place for staff (and residents) to follow and so be consistent in the support that they provide to residents. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and health care 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 32 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 who may use the service have the information needed to choose a home that will meet their needs. Prospective residents have their needs assessed, with their participation (and/or family member/friend), prior to moving into the care home, which makes certain that the home knows about the person, and the support that they need. Evidence: The home has information about the service. This includes the statement of purpose and the service user guide. This documentation is in picture and written format. We were told by the Annual Quality Assurance Assessment (AQAA) that each person has a copy of the service user guide. A residents care plan file included a copy of this document. Both these documents were dated 2005, and should show evidence that they have been regularly reviewed, and include up to date information about the changes with regard to the management and owner. The manager told us that this was in the process of being carried out. AQAA told us that Service users family are fully engaged in moving in process and that the whole process is accustomed to individual needs to make sure that everybody is satisfied and comfortable with Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: environment, staff and other service users with whom they are going to share the home. The manager told us that the home has an admissions policy/procedure, and that there have been no admissions to the home since the last key inspection. We were told by the manager during the inspection that all prospective residents receive an initial assessment (with participation from the person and/or their relatives/significant others) of their needs that is carried out by the placing Local Authority, and by the manager of Dana House to ensure that it is evident that the care home can meet the needs of people using the service. Though there was some information about peoples religious needs, the initial assessment could be developed to include more information with regard to the six strands of diversity (race, gender identity, disability, sexual orientation, age, religion and belief), and include more information about how these could be met by the home. This was discussed with the manager. We were informed that each prospective resident has an individual transition plan that meets the persons needs and generally consists of a number of visits to the home before moving in. The AQAA told us that the home aims to improve the service by reviewing our written contract/statement of terms and conditions between the home and service users. This should be carried out by the service. Care Homes for Adults (18-65 years) Page 12 of 32 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 have an individual care plan to ensure that their needs are met. Care plans include details of the care and support that residents require from staff. People using the service are supported, and encouraged to make decisions and choices about their lives, and are supported to take risks as part of an independent lifestyle. Some further development with regard to risk assessment could be put in place. Evidence: Each person using the service has a plan of care. Three care plans were looked at. These indicated that they are based upon assessment of the persons needs. This assessment includes personal care, health care, communication and sensory needs, nutrition, financial, mobility, behaviour, relationships and dependency needs of the person using the service. Each of these needs included recorded guidance with regard to meeting the persons needs. These care plans indicated that they were generally Person Centred Plans (plans where the person using the service is central to and Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: takes a lead with regard to their care and other support needs), and are in picture and written format. They were up to date and evident of being working documents, so updated as the persons needs changed. These had been signed by the person using the service. The care plans looked at had been reviewed (with each person using the service). Staff should sign that they had read them. The people using the service should have their own copy of their plan of care and support that they can keep with them and refer to it as when they wish. A requirement from the previous inspection with regard to developing care plans with regard to guidance to meet specialist needs, was judged to have been met. The AQAA told us that the care plans guide the staff to identify the level, and area of support and guides them to promote individuals independence, and that service users make decisions about their lives with our assistance. Residents told us about the choices that they regularly made. These include shopping for clothes, toiletries, food, times of getting up and going to bed, and choosing preferred activities. From talking to people using the service, it was evident that residents are supported to make decisions about their lives. People using the service spoke positively about the staff. Two residents told us the name of their key worker, and spoke of key workers supporting them with shopping and other activities. The manager told us that resident meetings take place regularly, so that people using the service had the opportunity to communicate their views of Dana House, and their wishes and needs. It was evident from talking to staff and people using the service, that supporting residents to be empowered is an on-going aim of the Dana House. We were told that at present no resident has an advocate and/or befriender. The AQAA told us that care home has a management of residents monies policy/procedure. We were told that the support that people using the service needed with their finances varied in accordance with their needs. We were told that residents have their own bank/savings account and that one person manages their own money. We saw that records of residents finances are maintained, and receipts of purchases are obtained. The manager told us that he is the appointee and signature (the only signature) to some residents savings accounts. As far as practicable persons working at the care home should not act as agent of a person using the service. This was discussed with the manager, and should be reviewed, and a second signature should be looked at. The registered person should look at the process of auditing peoples monies on a regular basis, so that it is not only the manager checking the financial records of people, and so minimise the risk of an allegation of financial abuse. There was evidence of risk assessment documented in the care plans. These risk Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: assessments varied for each person and included risk of falls, making tea, and risk with regard to symptoms of peoples medical needs. These could be further developed to include other risks to do with leading as independent life as possible; such as travelling in the car, catching public transport, road safety, financial, bathing etc. Some of the recorded risk assessments, such as risk of choking, could include more information with regard to how to respond if a person falls, chokes, self harms etc. There needs to be a risk assessment in place with regard to the large windows in the top floor bedroom being locked. The risk assessments that were looked at had been reviewed. Care Homes for Adults (18-65 years) Page 15 of 32 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 who use the service are able to make choices about their lifestyle, and are supported to develop their life skills, and to take part in a variety of activities that meet their individual needs. The people living in the care home have their rights respected, and their responsibilities are recognised in their daily lives. Meals are varied, and wholesome, and meet the needs of people using the service. Evidence: The home is located close to a variety of community facilities and amenities, which include shops, restaurants, cafes, libraries, banks and parks. We saw information displayed about each persons activities that they planned to take part in during the week of the inspection. People using the service told us of the activities that they participated in and enjoyed. These activities included taking part in a variety educational programmes as well as a variety of leisure pursuits at resource centres. It Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: was evident from talking to people using the service, speaking to staff and from records that residents are fully involved in choosing the various activities that they want to participate in, and that these activities meet their individual needs. A previous requirement with regard to assessing peoples recreational needs was judged to have been met. We were told from the AQAA that it is the homes policy to give every service user plenty of opportunities and choices for further education distant learning and supporting them to realise the potential while promoting healthy choices. Residents told us about the activities that they did at college and at a resource centre. They told us that they had recently enjoyed a holiday abroad. A person using the service, spoke of enjoying shopping, and seeing friends and family. A resident spoke of the celebration that she had had for her recent birthday. Another resident kindly showed us a certificate that she had obtained following completion of a college course. The AQAA told that people using the service have the opportunity to attend church services. We were told by staff and the AQAA that residents have varied contact with family and friends. One person using the service told us that she regularly sees a family member. The AQAA stated our service users are encouraged to keep in touch with the family and friends. Records and the manager told us that residents have the opportunity to attend regular residents meetings, and that there is on-going contact between the home with the relatives/significant others of people using the service. The manager told us that the menu is flexible, and people using the service choose what they wish to eat. Residents confirmed that they could decide what to eat, and enjoyed the meals provided by the home. A resident told us that she and other people using the service often ate out in local restaurants. Drinks were offered to people using the service. During the inspection a resident joined the inspector in having a cup of tea. We were told that the content of meals eaten by residents is recorded. A previous requirement with regard to ensuring that meals are varied and nutritionally balanced was judged to have been met. Care Homes for Adults (18-65 years) Page 17 of 32 Personal and health care 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. The health and personal care that people receive is based on their individual needs, and the principles of respect, dignity, and privacy are put into practice. Systems are in place to ensure that medication is stored, and administered safely to people using the service. Evidence: It was evident from talking with staff, residents, general observation, and from looking at records that staff have knowledge, and understanding of the importance of ensuring that the residents have their health care needs assessed and met. Some of the care plans that were looked at, included an individual Health Action Plan, which had some recorded guidance to maintain and monitor the persons health needs. It was evident from records that people using the service receive treatment and care from health care professionals including the GP, dentist, chiropodist, psychiatrist, and optician. Attendance at specialist clinics and hospitals appointments were also documented. We were told that advice was sought as and when required from health care professionals, and that referrals were made in accordance to residents needs, and their changing needs. In a residents personal file, we saw that there was specific guidance to ensure that a particular medical need was met. This information should be Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: documented in the persons care plan and it should be evident from records that all staff have read and understood this guidance. We were told that a similar protocol for another resident was in the process of being completed by a specialist nurse. Following the inspection the manager supplied us with the current staff guidance and staff response to a person using the service in the event that they had a seizure. This guidance showed evidence of having been reviewed and included information of when staff would need to call an ambulance. The manager told us that the home would develop recorded guidance with regard to minimising the risk of and responding to a possible outbreak of swine flu in the home. We were told from the AQAA that the home has a medication policy, and that that all the people using the service require support with taking their prescribed medication. Medication is stored in a locked cabinet in the sitting room of the home. The issue of a medication cabinet was discussed with the manager, who told us that due to the size of the home and the aim for a homely environment, this cabinet was less institutionalised, and had been used for sometime. The manager agreed record a risk assessment with regard to this system of storage of the medication and he told us that he would fix the cabinet to the wall. Following the inspection this was discussed with a Care Quality Commission pharmacy inspector who agreed that this was appropriate action to take. The manager was aware of the need to have a specific medication cabinet in place when/if residents are prescribed controlled medication. Medication administration records were up to date. We were told that a pharmacist regularly inspects the medication storage, and administration systems in the care home. The manager told us that all staff have medication training when they commence employment in the home. He also spoke about the process of assessing (including new staff observing more senior staff administer medication to people using the service) staff to ensure that they were competent to administer medication to residents in the home. It needs to be evident from records that that all staff receive sufficient medication training including in house assessment of their competency, to ensure that they are competent and skilled to administer medication safely to people using the service. This is of particular importance in view of the varied needs (ie a person has swallowing difficulties) of the people living in the home. The manager should ensure that staff receive regular refresher medication administration assessment and training to ensure that they always administer medication safely. The AQAA told us that the home has managed to train all the staff to understand epilepsy and rectal diazepam administration. Care Homes for Adults (18-65 years) Page 19 of 32 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. People who use the service, have access to an effective, robust complaints procedure, and are protected from abuse, and have their rights protected. Evidence: The care home has a complaints procedure. A summary of which is recorded in the service user guide in written and in a signs and symbols format. We were told that there were no recorded complaints. The AQAA told us that the home has a complaint procedure available to our service users as well as their families and that staff are well trained to deal with any kind of complaint appropriately. We discussed with the manager whether any people using the service ever expressed any concerns/complaints. He told us that they did and that these were recorded in the daily records. It should be evident that all concerns communicated by people using the service are managed in line with the complaints procedure, to ensure that it is evident that people using the service are listened to and that appropriate action is taken to resolve their concern/complaint. The AQAA told us that all our service users are encouraged and have plenty of opportunities to speak out or talk about their concerns and worries in private, and that staff have managed to listen to all the concerns and dealt with it with sufficient manner before they evolved into a complaint. The AQAA told us that home has appropriate policies and procedures in place that ensure people using the service are protected. We were told by the manager that the Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: policies and procedures (including the safeguarding procedure) with regard to Dana house were in the process of being reviewed due to the change of provider, and that at the time of inspection the old policies were being used by the service. We looked at the homes safeguarding procedure. This was lengthy and unclear with regard to the reporting and recording procedures, and in who should carry out an safeguarding investigation following a suspicion or allegation of abuse. This was discussed with the manager. Following the key inspection the manager supplied us with an appropriate safeguarding procedure/policy. We saw at the time of the inspection that the home has a copy of the lead Local Authoritys safeguarding policies/procedures. Records told us that some staff had received training in safeguarding adults. It was not clear from records in staff personnel files if all staff have had recent safeguarding adults training. The AQAA told us that the home sends all our staff for POVA (protection of vulnerable adults) training. Records of safeguarding training should be better. We were told that that safeguarding adults training is included in the staff induction programme, and in the National Vocational Qualification (NVQ) level 2 in care, which we were told all staff have achieved or are in the process of achieving. The service lets us know about notifiable incidents/accidents, and records them appropriately. AQAA told us that the home has policies/procedures with regard to counter bullying, dealing with violence and aggression, equal opportunities, diversity, and anti-oppressive practice, and whistle blowing. The care plans looked at included some guidance with regard to meet the needs of people using the service who could on occasions challenge the service. The manager had an awareness with regard to the Mental Capacity Act 2005/Deprivation of Liberty safeguards, and told us of the contact that he had with a Local Authority regarding this issue. The AQAA told us that the home aimed to compile and implement Mental Capacity Act Policy. This should take place and all staff should receive Mental Capacity Act 2005/Deprivation of Liberty safeguards training. Care Homes for Adults (18-65 years) Page 21 of 32 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. The layout of the home enables residents to live in a clean, safe, well maintained, and comfortable environment, which supports and encourages their independence. Residents bedrooms, meet their individual needs, and are individually personalised. Evidence: The care home is a semi-detached house, located on a residential road close to the amenities and facilities of Kingsbury. The inspection included a tour of the premises. The home is well maintained, and is clean, light, airy and homely. The AQAA told us that he home is kept as homely as possible. The communal living room is small, but with sufficient seating for people living in the care home. There is a dining table and chairs in the kitchen area. The living room was in the process of being decorated during the inspection. We were told that most areas of the home had been recently decorated and that some areas of redecoration was in the process of being completed. The AQAA informed us that all service users have their say during decoration especially their room. The home has an enclosed garden, which is accessible from the living room area. We saw that there was garden furniture located in the garden. Staff told us that the garden is regularly used in the good weather by residents. Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: Staff told us that the decor of some bedrooms has been updated within the last twelve months. Two people using the service kindly showed us their bedrooms. This bedrooms were individually personalised, with items of the persons choice that included their own television, music system, photographs and attractive furniture. Residents told us that they were happy with their bedrooms. We were told by a resident that she was supported to be fully involved in the laundering of their clothes. AQAA confirmed that the home has an infection control policy, and that staff had received infection control training, and that residents participate in daily cleaning and/or organising of their rooms within their capabilities. Care Homes for Adults (18-65 years) Page 23 of 32 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. Staff in the home receive training, and are in sufficient numbers to meet the needs of the people using the service, and to support the smooth running of the service. People using the service are supported and protected by the care homes recruitment policy and procedure. Evidence: The staff rota was available for inspection. It was evident from the this record that there two staff on duty during the day and a sleep in staff member on duty at night. We were told that there were sufficient staff on duty at all times to ensure that the varied needs of people using the service are met. Records told us that staff meetings take place. The AQAA told us there are always sufficient staff on duty to support the residents and they are well trained to meet residents needs and that recruitment procedures are thorough, which safeguards residents best interests. Staff spoke of knowing the residents well, and of working as a good team in the home. AQAA told us that there is little staff turnover, all staff have undertaken a common induction programme and have a job description. The manager told us that the staff induction meets National Minimum Standards for the service, and that staff keep their induction records. The home should keep a copy of each staff members induction programme records. Following the key inspection we were provided with a copy of a Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: certificate that told us that a staff member had completed their Skills for Care Induction programme. At the time of the inspection it was not evident that there was a staff training plan. Following the key inspection the manager supplied us with a training plan which included targets and goals for appropriate staff training, but this did not include actual dates of when planned training is to take place. The manager told us that he was going in the process of developing an individual training development plan for each staff member. Training certificates told us that most training that staff had received had been during previous placements. The manager spoke of training that had been carried out by the service and of staff training that was planned. Certificates of staff training told us that staff had received food safety, basic first aid, health and safety, infection control, manual handling and safeguarding adults training. The manager told us that all staff have either achieved or in the progress of achieving NVQ (National Vocational Qualification) level 2 or above care qualification. Of the three staff records looked at we were informed that two staff had have achieved Level 4 in Health and Care and that one had an A1 NVQ Assessors Award. The home has a staff recruitment and selection procedure. Three staff personnel records were looked at. These confirmed that appropriate required checks including an enhanced Criminal Record Bureau check (a check to gain information as to whether a person has a criminal record) was carried out. Records told us that staff have written contracts and job descriptions. AQAA told us that the home has an Equal Opportunity Policy. Records, told us that staff have only recently been receiving regular 1-1 staff supervision. The records looked at told us that staff had received two one to one staff supervisions this year. There should be at least six formal one to one staff supervisions carried out each year as well as and an annual appraisal, to ensure that staff are supported in their role, and have the opportunity to develop and achieve goals in regard to carrying out their duties in caring and supporting people using the service. It was evident from talking to people using the service, records, and from observation that residents know the staff team well, including knowing their names, and the names of their key workers. A resident confirmed that she liked the staff and told us that they are approachable. Care Homes for Adults (18-65 years) Page 25 of 32 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. The management, and administration of the home is based on openness, and respect. So far as reasonably practicable the health, safety and welfare of people using the service is promoted and protected. Evidence: The manager has managed the care home since the early part of this year. He manages another home within the organisation which he has managed for some years. He has experience of working with people who have a learning disability, and has a City and Guilds Management in Care qualification. He told us that he regularly updates his skills and takes part in staff training sessions. He told us that he was planning to register with us. The name of the previous registered manager is still recorded on the certificate of registration. The manager told us that he would contact us in writing with the up to date information with regard to the management of Dana House. It was evident from the completed AQAA, and from talking to the manager that he is motivated and competent in ensuring that people using the service are provided with Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: a quality service. It is evident that where there are areas for improvement that emerge, the manager recognises this, and puts systems in place develop and improve the service provided to people using the service. The AQAA, care plans, health and safety checks, and staff, confirmed that the home has systems in place to improve, and to monitor the quality of the service provided to people using the service. The manager told us that there was quality assurance plan in place, and that feedback questionnaires were supplied to people using the service and to others. There are policies, and procedures in place to ensure that people using the service are safeguarded. We were told that the annual portable appliance check of electrical items and the electrical installation check is due. The manager contacted the electrician during the inspection and a date for this check to be carried out was agreed. we were told that the home has an emergency plan. The AQAA told us that all equipment in the home is regularly serviced/checked by appropriate persons. The employers liability insurance is up to date. Care Homes for Adults (18-65 years) Page 27 of 32 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 32 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 1 9 13 There needs to be a risk assessment in place with regard to the large windows in the top floor bedroom being locked. This needs to include any recommendations and/or requirements from the fire service. To ensure that the person whose bedroom it is safe at all times. 01/02/2010 2 20 13 It needs to be evident from 01/02/2010 records that that all staff receive appropriate and sufficient medication training including in house assessment of their competency to administer medication to each person using the service. To ensure that staff are competent and skilled to administer medication safely to people using the service. Care Homes for Adults (18-65 years) Page 29 of 32 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 1 The service user guide and the statement of purpose should be up to date to ensure that they include all appropriate relevant information about the service provided to people living in the home. The initial assessment could be developed to include more information with regard to the six strands of diversity (race, gender identity, disability, sexual orientation, age, religion and belief), and include more information about how these needs of people using the service could be met by the home. The registered person should look at the process of auditing peoples monies on a regular basis, so that it is not only the manager checking the financial records of people, and so minimise the risk of an allegation of financial abuse. As far as practicable persons working at the care home should not act as agent of a person using the service, and if staff are signatures to residents monies there should be at least two signatures to residents bank and/or building society accounts/ Recorded risk assessments, such as risk of choking, could include more information with regard to how to respond if a peson falls, chokes, self harms etc. There could be further development with regard to assessment of risk to residents. The home should develop recorded guidance with regard to minimising the risk of and responding to a possible outbreak of swine flu in the home. The recorded specific guidance to ensure that a particular medical need of a resident is met, should be documented in the persons care plan so that it is easily accessible to staff, and it should be evident from records that all staff have read and understood this guidance. The manager should ensure that it is evident that staff receive regular refresher medication administration assessment and training to ensure that staff always administer medication safely. There should be a recorded risk assessment with regard to the present system of storing medication and the medication cabinet should be fixed to the wall. Page 30 of 32 2 2 3 7 4 7 5 9 6 19 7 19 8 20 9 20 Care Homes for Adults (18-65 years) 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 10 22 It should be evident that all concerns communicated by people using the service are managed in line with the complaints procedure, to ensure that it is evident that people using the service are listened to and that appropriate action is taken to resolve any concern/complaint that they might have. Records of all staff safeguarding training should be up to date and accessible, and all staff should receive Mental Capacity Act 2005/Deprivation of Liberty safeguards training. 11 23 12 13 35 36 Each staff member should have an individual staff training and development plan. There should be at least six formal one to one staff supervisions carried out each year as well as and an annual appraisal, to ensure that staff are supported in their role, and have the opportunity to develop and achieve goals in regard to carrying out their duties in caring and supporting people using the service. The manager should ensure that he is registered with the Care Quality Commission. 14 37 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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. 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