Care Home: Desmond House Ltd

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What the care home does well On the whole the home`s assessment process ensures that new residents are admitted only on the basis that a full assessment of need has been undertaken by people competent to do so. People living in the home receive a statement of purpose and service user guide and these clearly describe what services and support they can expect to receive. Prospective residents are enabled to visit and sample the home prior to moving in on a permanent basis and this ensures that they are making an informed choice whether to live there. During discussion with the acting manager about meeting diverse needs it was clear that she had a good awareness of the different needs individuals may have and how these could be met. She gave examples about special dietary, cultural and religious needs of people living in the home and how these were met. It was confirmed from speaking to several residents that their religious, cultural and dietary needs were all being fully met. People living in the home are enabled to make choices about everyday life in the home. Reviews are held on a regular basis and documentation was in place to confirm this. Key workers are now involved in this process and care plans are looked at and updated on a monthly basis. A staff member stated, "I feel more involved in the care planning and reviews". Some of the people living in the home were spoken to about Residents` meeting and they were able to confirm that they have monthly meetings to discuss issues within the home. Some comments included; "It gives me a chance to tell the staff what I want", "I get to tell the manager what is wrong and they do listen". People who live in the home are enabled to take part in appropriate activities and education. People who live in the home are encouraged to maintain outside links with their family and friends and the routines in the home are flexible, therefore they have their rights respected and independence promoted. The menu and food offered is of a good quality, therefore people receive a varied and healthy diet. The home has good infection control procedures in place and staff have undertaken training in this area, this means that people live in a home where the risk of infection or cross contamination is managed safely. People using the service receive support from staff who have undertaken or updated essential health and safety training including; health and safety, first aid, safeguarding adults, infection control and food hygiene and therefore their health and safety is promoted. What has improved since the last inspection? The care planning system has been improved greatly and people who use the service have a care plan that fully describes their needs and what support is required.The risk management system has also been updated and now ensures that the people who live in the home are safe and risks are either eliminated or reduced to a minimum. On the whole the medication procedure is adhered to and staff have been appropriately trained, however the home should have sight of the prescriptions before they are dispensed and when writing onto the Medication Administration Records staff must ensure that they sign to confirm who has done this. People who use the service are informed about the complaints procedure and are able to express their concerns in an open culture. Overall people who use the service are protected from possible harm or abuse, as the home only employs staff when the appropriate vetting has taken place prior to them starting work. The financial records held for people living in the home are accurate and up to date and staff have undertaken the safeguarding vulnerable adults training. People live in a well maintained home, this means that people live in a clean, nicely decorated and hygienic environment that meets all of their needs. People receive support from staff who have been properly vetted and therefore the protection of the residents is promoted. Staff receive supervision and this is on a regular basis. This ensures that people using the service receive care from staff who are properly supervised and monitored. The quality assurance system seeks the views of the people who live in the home, their relatives, staff and other professionals recorded and evaluated, therefore currently the system reflects the views of the service users or their representatives. What the care home could do better: The home does not undertake a pre-admission assessment and this would ensure that the placement was appropriate before the person decided to move in. There were two differing risk assessment forms currently being used and this may cause some confusion, it is recommended that these be merged into one form. Although people live in a well maintained home, there are some outstanding requirements in relation to the environment that the Fire department made on 1.8.07 and this could pose a risk to the people living in the home.The staffing levels are sufficient in order to ensure that the health and safety of people using the service is maintained. However, a recommendation is made that the staffing levels be reviewed with a view to making the manager`s hours supernumerary, that is separate from the staff time for the direct delivery of care as this would ensure that there is sufficient time available to the manager in order to run the home well. The induction training does not meet the Skills for Care specification and therefore new staff may not receive an in-depth induction that covers all areas. The acting manager is not currently registered with the CSCI nor has she obtained the NVQ level 4 in Care and Management and this may affect the overall way that the home is managed. CARE HOME ADULTS 18-65 Desmond House Ltd 16-18 Desmond Avenue Hull East Yorkshire HU6 7JZ Lead Inspector Angela Sizer Key Unannounced Inspection 26th November 2007 09:30 Desmond House Ltd DS0000044243.V354444.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Desmond House Ltd DS0000044243.V354444.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Desmond House Ltd DS0000044243.V354444.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Desmond House Ltd Address 16-18 Desmond Avenue Hull East Yorkshire HU6 7JZ 01482 448865 F/P 01482 448865 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Desmond House Ltd Mr Colin Achmed, Mrs Sharon Achmed Position Vacant Care Home 19 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (19), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (19) Desmond House Ltd DS0000044243.V354444.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registration category MD(E) is to enable service users already resident in the home to remain there upon reaching pensionable age (as long as the The registration category MD(E) is to enable service users already resident in the home to remain there upon reaching pensionable age (as long as the home can continue to meet their needs). 18th December 2006 Date of last inspection Brief Description of the Service: Desmond House is a care home providing accommodation and personal care for 19 persons who have enduring mental health problems. The category for older people is to make sure that individuals can continue to have Desmond House as their permanent home as they approach and pass the age of 65. The care home is privately owned. The accommodation consists of two adjacent semi-detached houses. It is situated close to Beverley Road, a main thoroughfare into the centre of Hull. The home has 13 single and three double rooms, two of the single rooms and one double room have en-suite facilities. There are two lounges and a dining room. There is a garden to the rear and a small parking area. The weekly fees are currently £301.50 - information supplied by the Registered Provider on 26.11.07. The registered provider stated that inspection reports are available to the residents and these are displayed on the notice board in the dining room. The Registered Provider also stated that prospective residents are offered a copy of the home’s statement of purpose and service user guide. Desmond House Ltd DS0000044243.V354444.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced key inspection and took place over one day and took a total of 8 hours. Prior to the visit surveys were posted out to people living in the home, their representatives and social and healthcare professionals; 9 people living in the home returned their surveys, none of the relatives or care management surveys were returned, 4 staff members and 3 of the health and social care professionals were returned. The Annual Quality Assurance Assessment was completed and returned to the CSCI (Commission for Social Care Inspection). The previous requirements were discussed with the acting manager and it was identified that all but one has been met. A discussion occurred regarding how the residents are supported to follow their religion of choice and practise their faith and how the home meets diverse needs of individuals. Several of the residents were spoken to throughout the day regarding the care they receive and what it is like to live in the home, some of their comments have been included in this report. Three files of people living in the home were tracked during the site visit and two staff personnel files were looked at. Two of the staff were spoken to find out what it was like working in the home and what training, management and support was offered to them. A tour of the premises was undertaken and a number of records were looked at to ensure that the correct maintenance has been undertaken. The acting manager and the registered providers were given feedback during and at the end of the visit. The inspector would like to thank the residents, manager and staff for welcoming them into the home and contributing to the content of this report. What the service does well: On the whole the home’s assessment process ensures that new residents are admitted only on the basis that a full assessment of need has been undertaken by people competent to do so. People living in the home receive a statement of purpose and service user guide and these clearly describe what services and support they can expect to receive. Prospective residents are enabled to visit and sample the home prior to moving in on a permanent basis and this ensures that they are making an informed choice whether to live there. Desmond House Ltd DS0000044243.V354444.R01.S.doc Version 5.2 Page 6 During discussion with the acting manager about meeting diverse needs it was clear that she had a good awareness of the different needs individuals may have and how these could be met. She gave examples about special dietary, cultural and religious needs of people living in the home and how these were met. It was confirmed from speaking to several residents that their religious, cultural and dietary needs were all being fully met. People living in the home are enabled to make choices about everyday life in the home. Reviews are held on a regular basis and documentation was in place to confirm this. Key workers are now involved in this process and care plans are looked at and updated on a monthly basis. A staff member stated, “I feel more involved in the care planning and reviews”. Some of the people living in the home were spoken to about Residents’ meeting and they were able to confirm that they have monthly meetings to discuss issues within the home. Some comments included; “It gives me a chance to tell the staff what I want”, “I get to tell the manager what is wrong and they do listen”. People who live in the home are enabled to take part in appropriate activities and education. People who live in the home are encouraged to maintain outside links with their family and friends and the routines in the home are flexible, therefore they have their rights respected and independence promoted. The menu and food offered is of a good quality, therefore people receive a varied and healthy diet. The home has good infection control procedures in place and staff have undertaken training in this area, this means that people live in a home where the risk of infection or cross contamination is managed safely. People using the service receive support from staff who have undertaken or updated essential health and safety training including; health and safety, first aid, safeguarding adults, infection control and food hygiene and therefore their health and safety is promoted. What has improved since the last inspection? The care planning system has been improved greatly and people who use the service have a care plan that fully describes their needs and what support is required. Desmond House Ltd DS0000044243.V354444.R01.S.doc Version 5.2 Page 7 The risk management system has also been updated and now ensures that the people who live in the home are safe and risks are either eliminated or reduced to a minimum. On the whole the medication procedure is adhered to and staff have been appropriately trained, however the home should have sight of the prescriptions before they are dispensed and when writing onto the Medication Administration Records staff must ensure that they sign to confirm who has done this. People who use the service are informed about the complaints procedure and are able to express their concerns in an open culture. Overall people who use the service are protected from possible harm or abuse, as the home only employs staff when the appropriate vetting has taken place prior to them starting work. The financial records held for people living in the home are accurate and up to date and staff have undertaken the safeguarding vulnerable adults training. People live in a well maintained home, this means that people live in a clean, nicely decorated and hygienic environment that meets all of their needs. People receive support from staff who have been properly vetted and therefore the protection of the residents is promoted. Staff receive supervision and this is on a regular basis. This ensures that people using the service receive care from staff who are properly supervised and monitored. The quality assurance system seeks the views of the people who live in the home, their relatives, staff and other professionals recorded and evaluated, therefore currently the system reflects the views of the service users or their representatives. What they could do better: The home does not undertake a pre-admission assessment and this would ensure that the placement was appropriate before the person decided to move in. There were two differing risk assessment forms currently being used and this may cause some confusion, it is recommended that these be merged into one form. Although people live in a well maintained home, there are some outstanding requirements in relation to the environment that the Fire department made on 1.8.07 and this could pose a risk to the people living in the home. Desmond House Ltd DS0000044243.V354444.R01.S.doc Version 5.2 Page 8 The staffing levels are sufficient in order to ensure that the health and safety of people using the service is maintained. However, a recommendation is made that the staffing levels be reviewed with a view to making the manager’s hours supernumerary, that is separate from the staff time for the direct delivery of care as this would ensure that there is sufficient time available to the manager in order to run the home well. The induction training does not meet the Skills for Care specification and therefore new staff may not receive an in-depth induction that covers all areas. The acting manager is not currently registered with the CSCI nor has she obtained the NVQ level 4 in Care and Management and this may affect the overall way that the home is managed. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Desmond House Ltd DS0000044243.V354444.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Desmond House Ltd DS0000044243.V354444.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3 & 4 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. On the whole the home’s assessment process ensures that new residents are admitted only on the basis that a full assessment of need has been undertaken by people competent to do so. However, the home does not undertake a preadmission assessment and this would ensure that the placement was appropriate. People living in the home receive a statement of purpose and service user guide and these clearly describe what services and support they can expect to receive. Prospective residents are enabled to visit and sample the home prior to moving in on a permanent basis and this ensures that they are making an informed choice whether to live there. EVIDENCE: During this inspection visit three files of people who live in the home were looked at, this was to make sure that the home finds out what residents’ needs are and to ensure that the home can meet their needs. The acting manager Desmond House Ltd DS0000044243.V354444.R01.S.doc Version 5.2 Page 11 stated that the home usually receives a community care assessment of need from the placing Authority, in addition the home also undertakes their own assessment and evidence of this was seen on the files looked at. The assessment includes the personal history, family, communication, medication and mobility. The manager confirmed that people can visit the home or stay overnight before they decide whether to move in. From speaking to several people who live in the home and from the surveys received before the inspection it was confirmed that they were able to visit and test drive the home before making a decision to move in. Some comments received included; “I was in Avondale and came to look around”, “I liked the room and I decided to move in”. The home ensures that prospective residents or their representative are able to visit the home, have a meal, meet the other residents, see their room before making the decision as to whether they would like to move in. However, the home does not undertake a pre-admission assessment of needs and it is recommended that this be implemented. As a visit to meet the person before they come to live in the home would ensure that the home could meet their needs and also would have some information in relation to the person’s history, likes/dislikes etc. The statement of purpose and service user guide have been updated and reviewed since the last inspection and the manager confirmed that, “each person has a file in their room, this is updated on a regular basis and it contains a service user guide, statement of purpose and copies of minutes from residents meetings. It is clear that the home explains what services, facilities and support are available to people who live in the home. From speaking to several of the residents they confirmed that they had received a service user guide that gave them information about the room they would have, the food and mealtimes and also how to complain if they needed to. During discussion with the acting manager about meeting diverse needs it was clear that she had a good awareness of the different needs individuals may have and how these could be met. She gave examples about special dietary, cultural and religious needs of people living in the home and how these were met. It was confirmed from speaking to several residents that their religious, cultural and dietary needs were all being fully met. Desmond House Ltd DS0000044243.V354444.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People who use the service have a care plan that fully describes their needs and what support is required. People living in the home are enabled to make choices about everyday life in the home. The risk management system ensures that the people who live in the home are safe and risks are either eliminated or reduced to a minimum. EVIDENCE: During the inspection visit three files of people living in the home were looked at and a discussion with the acting manager occurred and an update was given with regard to the ongoing work in relation to the care files, care plans and risk assessment documentation. The files that were looked at showed significant Desmond House Ltd DS0000044243.V354444.R01.S.doc Version 5.2 Page 13 improvement to the content and recording in the care plans. All of the new paperwork has now been implemented and the care plan covers a lot of areas including personal details, likes and dislikes, personal care and hygiene, social skills, medication, nutrition and health and safety. The recording was up to date, clear and gave clear instruction to staff about what they should do and when. From speaking to two staff members it was evident that the improvements to the system has made a positive change to the way the home records information. Some comments included; “I feel that the care plans and risk assessments have improved since the last inspection”, “service users are well cared for, all their individual needs are taken into account. Due to the size of the home the atmosphere is friendly”. From speaking to the majority of the people living in the home during the visit it was confirmed that the new care planning system had been discussed with them and they were aware of the content of their own care plan. From speaking to staff it was clear that they feel more involved in the care planning process, “since the care plans have been updated it is better and I am involved in the process too”. The home manages risk in a safe way and there are assessments in place covering a variety of things including smoking, self-harming behaviour, falls, people going missing. There is also a risk assessment in place for each person in relation to self-administering their medication. Since the previous visit and from speaking to the Manager it was obvious that she has continued to improve the standard of recording, however there were two differing forms currently being used and this may cause some confusion, it is recommended that these be merged into one form. From speaking to several people living in the home, it was apparent that overall choice is promoted and they are able to make their own decisions about everyday life within the home. Some of the more able residents are free to and go and the majority lead a fairly independent lifestyle. Some comments included; “I like to go out to the shops”, “I can have a bath every morning. Several residents manage their own finances and one person confirmed, “my money goes into my bank account and I can go and withdraw money whenever I want to. I do let the staff know when I am going out though”. Other residents who are less able and have communication problems do require more support and staff were observed to offer support in a caring and sensitive way. Reviews are held on a regular basis and documentation was in place to confirm this. Key workers are now involved in this process and care plans are looked at and updated on a monthly basis. A staff member stated, “I feel more involved in the care planning and reviews”. Some of the people living in the home were spoken to about Residents’ meeting and they were able to confirm that they have monthly meetings to discuss issues within the home. Some comments included; “It gives me a Desmond House Ltd DS0000044243.V354444.R01.S.doc Version 5.2 Page 14 chance to tell the staff what I want”, “I get to tell the manager what is wrong and they do listen”. There was written evidence that monthly meetings take place for both residents and staff members. Management stated that any changes to the environment, policies and procedures etc are discussed at the residents’ meetings and that residents are consulted to find out their views. Desmond House Ltd DS0000044243.V354444.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16 &17 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People who live in the home are enabled to take part in appropriate activities and education. People who live in the home are encouraged to maintain outside links with their family and friends and the routines in the home are flexible, therefore they have their rights respected and independence promoted. The menu and food offered is of a good quality, therefore people receive a varied and healthy diet. EVIDENCE: During the inspection visit several people who live in the home were spoken to about the range of activities and outings, it was confirmed that since the last Desmond House Ltd DS0000044243.V354444.R01.S.doc Version 5.2 Page 16 inspection visit the activities have been maintained to a good level. The acting manager said, “we now a senior care assistant who organises all of the activities and she puts suggestions forward that the residents have”, “more recently we have purchased a Karaoke machine and Bingo is offered twice a week”. She also said that another carer had trained in hand and foot care and offers manicures and pedicures to the residents on a regular basis”. Some of the more able residents go out with the registered provider on a regular basis. One resident commented, “we go out with the owner”. Other residents informed the inspector that they go to local community centres and day centres on a regular basis. Some comments included; “We have a meal and play bingo, it is nice to see other people”. Several of the residents attend local colleges and community groups and this was confirmed by looking at the case files for individual residents and from speaking to them. During the visit staff were observed interacting with residents and this was carried out in a caring and sensitive way. From speaking to several people who live in the home it was clear that on the whole staff treated them with respect and called them by the name they prefer. Staff who were spoken to could describe clearly the principles of good care and how they should treat the residents, “each person is treated as an individual and they want for nothing”. A visitor to the home was spoken to confirming that they had been made welcome by the staff. They commented, “the staff are very friendly and the home has a very nice feel to it, it is homely and warm”. A discussion took place with the acting manager about the diverse needs of individuals and she described how the home has made a big effort in trying to find out the best way to support less able residents. Support is offered to the home from the local mental health team and Community Psychiatric Nurses visit the home on a regular basis. Three surveys were received back from health and social care professionals and some comments included; “provide quality care and support to residents. They liaise well with families and professionals”, “I always feel that there is an informal and homely atmosphere in this care service, which should be helpful to patients giving them a feeling of homeliness and belonging to the place”, “as far as I am aware the diverse needs of individuals are met”. The home is attempting to meet diverse or different needs of the residents and this is promoting inclusion within everyday life in the home. Residents confirmed that they feel they are equal and are treated fairly. The home offers a varied menu, the week’s menu is displayed on the notice board in the dining room. During the inspection visit the residents who were spoken to only had positive comments about the food stating. There were no negative comments on the visit to the home. The main meal of the day is served at teatime and a lighter option is offered at lunch. From speaking to Desmond House Ltd DS0000044243.V354444.R01.S.doc Version 5.2 Page 17 the residents it was confirmed that if there is something that they do not like on the menu then they can have an alternative, “it is good here, you can have whatever you want” “the cook or staff talk to us everyday about what we are having”, “the food is good”. Evidence of this was recorded in the residents meetings. Breakfast and supper are also offered, there are set times for drinks (hot), staff explained that cold drinks are available throughout the day. Desmond House Ltd DS0000044243.V354444.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People who use the service receive a good level of personal and healthcare support that ensures their needs are met. Personal support is provided in a way that respects the person’s dignity and privacy. On the whole the medication procedure is adhered to and staff have been appropriately trained, however the home should have sight of the prescriptions before they are dispensed and when writing onto the Medication Administration Records staff must ensure that they sign to confirm who has done this. EVIDENCE: During the inspection some people who live in the home were spoken to about the way personal support is offered to them. All of the people spoken to could confirm who their key worker was and that they spent time with them on a regular basis. Some comments included, “staff are good, they help me do my Desmond House Ltd DS0000044243.V354444.R01.S.doc Version 5.2 Page 19 hair”, “the staff help me when I need it”, “I can talk to the staff if I have a problem”. Staff spoken to could describe the needs of the people living in the home and what support was required from them, it was obvious that the staff had developed a good understanding of what the residents needs were and on the whole residents were treated with respect and their dignity maintained at all times. From looking at written evidence and from speaking to some of the people living in the home it was confirmed that health care and personal care needs are fully met. Regular appointments are offered with healthcare professionals including GP, Community Psychiatric Nurse, District Nurse and Psychiatrist. Some comments included, “I go to see the Psychiatrist every three months”, “I see the doctor when I need to”. Three surveys were received from health and social care professionals comments included; “provide quality care and support to residents. They liaise well with families and professionals”, “I always feel that there is an informal and homely atmosphere in this care service, which should be helpful to patients giving them a feeling of homeliness and belonging to the place”, “as far as I am aware the diverse needs of individuals are met”. The home has a medication procedure and this includes a self-administering risk assessment. It was observed that the procedure is adhered to. The records were of a good standard and there was a clear audit trail of medication being received into the home through to either being administered or returned to the Pharmacy. The stock control was of a good standard, no errors were found. Although it was noted that when transcribing onto a Medication Administration Record the staff were not signing that they had made the entry. The ordering and booking in the medication was discussed with the manager confirming that the order for prescriptions is sent straight to the pharmacist and then dispensed direct from the GP’s surgery to the home. However, the prescriptions are not sent to the home before the supply is made. The person in charge of ordering medication must have sight of the prescriptions before a supply is made. The prescription is the authority for the staff to administer medication. This also provides an opportunity to check if any new medicines or dose changes are included. Any problems with prescriptions can be addressed at this point rather than after the supply has been made. The checking of prescriptions is an important part of the management of medication. The manager confirmed that since the last inspection all of the residents have been assessed as to whether they could self-medicate and currently one person is self-administering a cream and they have a mini fridge in their room Desmond House Ltd DS0000044243.V354444.R01.S.doc Version 5.2 Page 20 to accommodate this. A comment was received from a Health-care professional, “Supports individuals to manage their own medication”. All staff who administer medication have undertaken the managing medicines safely course provided by the Local Authority and Primary Care Trust. Desmond House Ltd DS0000044243.V354444.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People who use the service are informed about the complaints procedure and are able to express their concerns in an open culture. Overall people who use the service are protected from possible harm or abuse, as the home only employs staff when the appropriate vetting has taken place prior to them starting work. The financial records held for people living in the home are accurate and up to date and staff have undertaken the safeguarding vulnerable adults training. EVIDENCE: The home has a complaints procedure and it was clear from speaking to several of the residents that they were aware of the procedure and knew how to make a complaint if necessary. There have been seven complaints since the last inspection, they had been recorded and there was clear information about whether an investigation had been undertaken and what the outcome was. The acting manager stated that the complaints procedure had been updated in October 2007 and staff have been informed of this. Some comments from people in the home included, “I would speak to the staff or the manager”, “I have seen the manager in the past and she always listens”. All nine surveys returned confirmed that the complaints procedure is clear and they know who to talk to if they had any problems. Desmond House Ltd DS0000044243.V354444.R01.S.doc Version 5.2 Page 22 The home has a copy of the multi-agency Protection of Vulnerable Adults procedure and it has also developed it’s own safeguarding policy that includes finances/monies, violence and aggression and from speaking to two staff members and management it was confirmed that all staff have undertaken the protection of vulnerable adults training. Two staff members were spoken to during the visit it was clear that they had a good understanding of the procedure and where aware of what their responsibilities were. Since the last inspection there has been three safeguarding referrals made to the local care management team, the outcome for one resulted in no further action being taken. The other two referrals are ongoing, but the acting manager has responded in accordance to the procedure and sought advice about what action if necessary she would need to take. The home has a policy and procedure for dealing with residents’ monies and financial affairs. Records for maintaining the personal finances of residents are kept. Several of the records were checked and on the whole were up to date and accurate. The manager stated that eight residents manage their own finances and pay their fees via standing order. If a person is able to sign for their own money then they do so, but currently staff do not sign to confirm that this has been given. It is recommended that this would be good practice and would ensure that there was a record of who has given the money out in the event of any discrepancies arising. Desmond House Ltd DS0000044243.V354444.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,27 & 30 People who use the service adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People live in a well maintained home, this means that people live in a clean, nicely decorated and hygienic environment that meets all of their needs. Although there are some outstanding requirements in relation to the environment that the Fire department made on 1.8.07 and this could pose a risk to the people living in the home. The home has good infection control procedures in place and staff have undertaken training in this area, this means that people live in a home where the risk of infection or cross contamination is managed safely. EVIDENCE: A tour of the building was undertaken confirming that the previous very good standard of cleanliness has been maintained. Overall the standard of the environment is good and there have been some improvements made since the previous visit and these include; bathrooms 1 and 11 have had a new Desmond House Ltd DS0000044243.V354444.R01.S.doc Version 5.2 Page 24 floor fitted and have been redecorated and there is hand dispensing soap with hand paper towels in bathroom/toilet. Overall the bedrooms and communal areas were homely, personalised and comfortable and from speaking to the people living in the home it was confirmed that they were happy with their room and the general environment. Some comments included; “I still like my room”, “I read in my room and like to be alone”, “I have everything I need including my own furniture”, “I am happy in the home”, “I like living here at Desmond House”, “nice home to be in”. A letter was received by the home from the Fire department on 3.8.07 detailing requirements that had made in relation to the fire risk assessment and that this was in need of review and updating, automatic self-closing devices on some doors and smoke detectors to be fitted in place of heat detectors and the date for compliance was 1.10.07. During this visit the registered provider gave an update confirming that all of the requirements had been addressed, but there were two fire doors which the Fire Officer was not happy with and would be returning to the re-inspect in January 2008 and ascertain whether the work had been completed to a satisfactory standard. The registered provider stated, “the fire risk assessment has been updated and the Fire Officer has seen this”. The home received a visit from the Health and Safety Department on 20.11.07 and no requirements were made. Since the last inspection the home has put in place a smoking hut in the garden and it has adopted a no smoking approach within the home. The manager did state, “we are finding this difficult to implement at times, as some people persist in smoking inside”. The manager was advised to speak to the Fire and Environmental health department to seek further advice in relation to this problem. The home has undertaken an audit of the building in order to prioritise what areas require updating and renewal. From speaking to the Registered Providers it was clear that they have focused upon the requirements made at the last inspection visit and it was evident that all of the requirements relating to the environment have now been met. Although in saying this there are some areas that are clean they require updating and one comment received from a health care professional said, “perhaps by providing more amenities to the residents and improving the general upkeep of the place”. A survey was received by a health care professional and this stated, “I always feel that there is an informal and homely atmosphere in this care service, which should be helpful to patients giving them a feeling of homeliness and belonging to the place”. The home has a separate laundry room and there are infection control procedures in place. From looking at written records it was confirmed that all Desmond House Ltd DS0000044243.V354444.R01.S.doc Version 5.2 Page 25 staff have undertaken training in this area and demonstrated a good awareness of current good practice when they were spoken to about it. The home has disinfectant gel in several areas and staff were seen to use this. No offensive smells were detected during the visit and if anything the home’s domestic staff be commended for their hard work in maintaining a clean and fresh home. Desmond House Ltd DS0000044243.V354444.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 & 36 People who use the service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The staffing levels are sufficient in order to ensure that the health and safety of people using the service is maintained. However, a recommendation is made that the staffing levels be reviewed with a view to making the manager’s hours supernumerary, that is separate from the staff time for the direct delivery of care as this would ensure that there is sufficient time available to the manager in order to run the home well. People receive support from staff who have been properly vetted and therefore the protection of the residents is promoted. People are supported by staff who have received the mandatory training required, therefore the health and safety of residents is promoted. However, the induction training does not meet the Skills for Care specification and therefore new staff may not receive an in-depth induction that covers all areas. Staff receive supervision and this is on a regular basis. This ensures that people using the service receive care from staff who are properly supervised and monitored. Desmond House Ltd DS0000044243.V354444.R01.S.doc Version 5.2 Page 27 EVIDENCE: The manager confirmed that 87.5 of the staff members have achieved NVQ level 2 or above, this well exceeds the minimum requirement of 50 . From speaking to the staff members it was clear that they feel the training has improved over the past two years and some comments included; “the training has been very good since I have started and I am booked onto some more soon”, “mandatory courses are always on offer”. From speaking to two staff members it was evident that they had a good understanding of the needs of individuals living in the home and they had also undertaken more specific training in relation to mental health awareness, diabetes, epilepsy and dealing with violence and aggression and equality and diversity. Staff were observed interacting with the residents throughout the visit, this was done in a sensitive and respectful way. From speaking to the people who live in the home it was clear that they had developed good relationships with the staff and acting manager and some comments included; “staff help me do my hair”, “the staff help me when I need it”, “I can talk to the staff if I have a problem”. Both staff members who were spoken to could clearly describe the needs of the people living in the home and how they are to be assisted. Surveys from a health care professional and a care manager were received and these contained positive comments about the staff and the manager. This means that on the whole people living in the home are supported by welltrained staff that have a good understanding of their needs. During the inspection a representative from a training organisation was spoken to about the home and staff. Some comments included; “very friendly staff”, “there is a board in the dining room containing leaflets and certificates and this was very informative”, “the home is welcoming and the environment comfortable”. Discussion with residents, staff and management confirmed that overall the staffing levels are sufficient in meeting basic care needs. Some comments from residents included; “I think they are really good, there is always a senior on duty here”. It would appear that general care needs are met. Since the last inspection visit the manager has had her employment terminated and the deputy manager has taken on the role of acting manager. She has more responsibility in relation the managing of staff, implementing new policies and procedures, but is continuing to undertake a large proportion of care shifts. The manager said, “I spend at least 10 hours doing management and administration”, “I think I am managing this well, as the seniors have taken more responsibility for medication, entertainment and activities and also supervision”. The registered provider will need to revert to Desmond House Ltd DS0000044243.V354444.R01.S.doc Version 5.2 Page 28 the original agreement made with the CSCI that the manager’s hours are divided and at the most 2 days spent in a caring role and 3 days in the office attending to management procedures. The staffing level is that agreed by the previous regulating authority and under current protocols the home is not required to meet the current standard. A recommendation is made that the staffing levels be reviewed with a view to making the manager’s hours supernumerary, that is separate from the staff time for the direct delivery of care. During the inspection visit two staff personnel flies were looked at and this confirmed that the home undertakes appropriate checks including Criminal Records Bureau disclosure and two references prior to staff commencing work. The files were up to date and it was easy to find evidence confirming that training had been undertaken. All of the mandatory training including health and safety, first aid, food hygiene, protection of vulnerable adults, infection control, fire safety and moving and handling were all either up to date or planned. The induction that the home offers consists of a checklist approach and covers health and safety, environment, policies and procedures, fire, basic personal care, but unfortunately this does not meet the Skills for Care specification. A discussion with the manager occurred and she confirmed that she was aware that the induction training required updating and she said, “I am planning to contact a training organisation and offer the Skills for Care induction programme to all of our new starters”. From looking at the written records and speaking to staff it was confirmed that formal supervision is offered on a regular basis. In addition the home offers informal support on a daily basis and some comments from staff included; “supervisions are in place and are reviewed every 6 weeks, but we can always approach the manager at any time”, “I have received support on a regular basis, if I need to talk I could go and speak to any of the seniors”, “the owners are really friendly and I could go to them with any issues”. A survey received from a staff member stated, “staff meetings are held every 6 weeks, also supervisions with allocated senior staff”. Desmond House Ltd DS0000044243.V354444.R01.S.doc Version 5.2 Page 29 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Desmond House Ltd DS0000044243.V354444.R01.S.doc Version 5.2 Page 30 37,38,39 & 42 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People live in a warm and friendly home, there is clear leadership and an open door policy ensures that residents are able to speak to the manager on a regular basis. However, the acting manager is not currently registered with the CSCI nor has she obtained the NVQ level 4 in Care and Management and this may affect the overall way that the home is managed. The quality assurance system seeks the views of the people who live in the home, their relatives, staff and other professionals recorded and evaluated, therefore currently the system reflects the views of the service users or their representatives. People using the service receive support from staff who have undertaken or updated essential health and safety training including; health and safety, first aid, safeguarding adults, infection control and food hygiene and therefore their health and safety is promoted. EVIDENCE: A discussion occurred with the Registered Providers and they explained that the previous manager had their employment terminated and since that time the deputy manager has agreed to act as manager with a view for this to become a permanent position. From speaking to the deputy manager it was clear that she has taken on the role with enthusiasm and commitment and has also made improvements in several areas including the care planning, risk management system and supervision of staff. The staff group appear to have confidence in the current management set up and some comments included; “the acting manager is always available”, “we have a stand in manager at the moment and I get support always”, “it is much better now, the new manager is very approachable and listens to us”, “it is more of a team and I feel included”. Some of the people living in the home also stated that the new manager is “approachable”, “nice and friendly” and “always there to listen to me”. The acting manager has commenced NVQ level 4 in Care and has completed four units. She confirmed that she is planning to commence the Registered Manager’s Award in the near future. She did say, “I have been acting up since August, I feel that I have come a long way and learned a great deal too”. Other training that she has completed since the last inspection include; IOSHH – Health and Safety certificate, equality and Desmond House Ltd DS0000044243.V354444.R01.S.doc Version 5.2 Page 31 diversity workshop, values and attitudes and safeguarding adults for managers. Since the last inspection the quality assurance system has been updated and evidence was seen confirming that surveys had been given to people living in the home, staff and other people such as relatives and other professionals. The system now incorporates the views of all people who live, work and visit the home and the surveys have been analysed and an action plan completed. It was confirmed by speaking to several people living in the home that residents meetings are held on a regular basis. The manager said, “the residents are vocal and tell us what they think”, “they have a spokesperson too”. Overall the health and safety of the people living in the home is safeguarded and the training in relation to the mandatory training is now offered within six months of employment commencing. From speaking to staff it was evident that the training has improved vastly over the past two years and staff feel more confident in carrying out their duties. A letter was received by the home from the Fire department on 3.8.07 detailing requirements that had been made in relation to the fire risk assessment and that this was in need of review and updating, automatic selfclosing devices on some doors and smoke detectors to be fitted in place of heat detectors and the date for compliance was 1.10.07. During this visit the registered provider gave an update confirming that all of the requirements had been addressed, but there were two fire doors which the Fire Officer was not happy with and would be returning to the re-inspect in January 2008 and ascertain whether the work had been completed to a satisfactory standard. The registered provider stated, “the fire risk assessment has been updated and the Fire Officer has seen this”. The home received a visit from the Health and Safety Department on 20.11.07 and no requirements were made. Accident records are kept and reported to the appropriate authorities. The home has taken action in relation to the protection of vulnerable adults and safeguarding referrals have been made to the Local Authority’s appropriate Care Management Team. Other maintenance records were looked at including a report confirming that the water had been tested in April 2007 for Legionella. Certificates confirming the safety of the gas and electrical wiring were also in place. The fire alarm had been maintained correctly. Feedback was give to the Registered Providers and the manager at the end of the inspection visit. Desmond House Ltd DS0000044243.V354444.R01.S.doc Version 5.2 Page 32 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 2 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 3 3 X X 2 X Desmond House Ltd DS0000044243.V354444.R01.S.doc Version 5.2 Page 33 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 12,13 Requirement Timescale for action 26/04/08 2 YA24 12,13,23 3 YA32 18 4 5 YA35 YA37 18 9 When recording onto a Medication Administration Record staff must ensure that they sign to confirm what they have done, there should be two signatures. This would ensure that the recording is accurate and people receive the correct medication. The premises must meet the 26/04/08 requirements of the Fire Department. See standard 42. All staff must receive 26/04/08 structured induction training within six weeks of their employment and this must meet the Skills for Care specification. See standard 32. 26/04/08 The manager must complete 26/11/08 NVQ level 4 in both Care and Management. This would ensure that a well-trained person who fully understands the management systems within the home manages the home. The registered provider must 26/04/08 DS0000044243.V354444.R01.S.doc Version 5.2 Page 34 6 YA37 8 Desmond House Ltd 7 YA42 12,13,23 appoint an individual to manage the home and an application to become the registered manager must be submitted to the CSCI. This would ensure that a qualified and registered manager runs the home. There are some outstanding 26/01/08 requirements in relation to the environment that the Fire department made on 1.8.07 and this could pose a risk to the people living in the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA2 YA9 Good Practice Recommendations The home should undertake a pre-admission assessment of needs as this would ensure that the person’s needs can be met before they move in. There are two differing risk management assessment forms and it is recommended that these are merged into one, this would make it easier for the staff and reader to understand. The person who has ordered the medication should have sight of the prescriptions before they are dispensed, this provides an opportunity to check if any new medicines or dose changes are included. Staff should sign for any money being given out. It is recommended that this would be good practice and would ensure that there was a record of who has given the money out in the event of any discrepancies arising. The registered person should review the homes staffing level in the light of the changing needs of service users and also with a view to the manager’s hours becoming supernumerary. 3 YA20 4 YA23 5 YA33 Desmond House Ltd DS0000044243.V354444.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Desmond House Ltd DS0000044243.V354444.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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