Care Home: Eleri House

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What the care home does well Residents at Eleri House are offered a secure and comfortable "family" home. One person`s relatives and a friend of the home confirm they are happy with the service and feel it meets residents` needs. They commented "It provides a homely atmosphere". "We visit frequently and are always made welcome and join them in activities". "They take the residents out on visits and holidays". Staff support residents to lead active lives. They go out regularly and are part of the local community. A friend of the residents says "They provide a good basis for healthy living through diet, exercise and community involvement". Residents receive good support with their personal and health care. Staff also make sure they have routine health checks and manage their medicines safely.Eleri House is an ordinary, homely house, which helps residents fit in with the community. It is in a quiet place but is also close to shops and other amenities. There is a small and stable staff team who work well together. This helps them know what residents need and like and give them more consistent support. Staff receive training about how to keep the home and residents safe. Most have a care qualification so they should know and understand how to do their job. Staff are checked out to help ensure they are suitable to work as carers. What has improved since the last inspection? A patio area has been built in the garden. This gives the residents another nice place to relax and have their meals in when the weather is good. What the care home could do better: People living at Eleri House could benefit from help in having a bigger say in how they live their lives and how their needs are being met. They could be given more opportunities to communicate and to make their own plans. This would enable people to make more choices, to do more things themselves and to influence the way in which the home supports them. CARE HOME ADULTS 18-65 Eleri House 15 Laburnum Walk Malvern Worcestershire WR14 1HD Lead Inspector Christina Lavelle DRAFT REPORT: Key Unannounced Inspection 5th & 20thJune 2008 4.30-7pm & 10- Eleri House DS0000061478.V365748.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 Eleri House DS0000061478.V365748.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. Eleri House DS0000061478.V365748.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Eleri House Address 15 Laburnum Walk Malvern Worcestershire WR14 1HD 01684 899176 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) bill@elerihouse.fsnet.co.uk Mr Charles William Cole Mr Charles William Cole Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Eleri House DS0000061478.V365748.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th January 2007 Brief Description of the Service: The registered provider and manager of this home is Mr Bill Cole and it is run as a non profit-making organisation. Eleri House was first set up in November 2000 to provide a service for three particular adults who had previously lived in the same care home. It is registered to provide accommodation with personal care for three people who require care due to learning disabilities. The home’s statement of purpose specifies that the people living there may have autism, moderate behavioural difficulties and/or a sensory impairment but not mobility or severe behavioural difficulties. Eleri House is a converted, detached, family-sized house located in Malvern. It is in walking distance of the town centre and public transport links. There are also local shops and a range of other amenities. The home has quite a secluded position with gardens around it. Residents have single bedrooms on the first floor that do not have a wash hand basin or en-suite facilities. The house has a sitting/dining room, kitchen, utility room, bathroom and separate toilet they all can use. There is also an office and staff sleep-in room. An adjacent building is used for activities and has two rooms, one with sensory lights and equipment. Information about the home is provided in a statement of purpose and service users’ guide, which are available from the home. The weekly fee for the service is set by individual residents’ funding authorities. Extra costs include for such as clothes, toiletries, transport and drinks etc. when on outings and holidays. Eleri House DS0000061478.V365748.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for the service at Eleri House is 2 Star. This means people using this service experience good quality outcomes. This is a key inspection of the service provided at this home. This means the Standards that can be most important to adults living in homes are assessed. We, the Commission, visited Eleri House on two occasions. The first visit was made without telling staff or the people living there beforehand. Time was spent in the company of residents, but because of their communication difficulties it was not possible to ask them directly about the home and their lifestyles. We spoke to two staff about their role, training and the support given to residents. The second visit was arranged to discuss with Mr Cole the way the home is run and changes made since the last inspection. Two health or social care professionals involved with the home were asked their views of the service and surveys were left at the home for staff and residents’ relatives or advocates to complete. Six surveys were returned to us (four from staff, one relative and one advocate). Their feedback is referred to in this report. An annual quality assurance assessment (AQAA) was completed by Mr Cole as part of this key inspection, as is required. This asks managers to say what they think their home does well, could do better, what has improved in the last year and their plans to improve it. It also gives information about people living there, staff and other aspects of the home. Various records kept by the home were checked and the premises looked around. All other information received by the Commission about the home since the last inspection is also considered. What the service does well: Residents at Eleri House are offered a secure and comfortable “family” home. One person’s relatives and a friend of the home confirm they are happy with the service and feel it meets residents’ needs. They commented It provides a homely atmosphere”. “We visit frequently and are always made welcome and join them in activities”. “They take the residents out on visits and holidays. Staff support residents to lead active lives. They go out regularly and are part of the local community. A friend of the residents says “They provide a good basis for healthy living through diet, exercise and community involvement”. Residents receive good support with their personal and health care. Staff also make sure they have routine health checks and manage their medicines safely. Eleri House DS0000061478.V365748.R01.S.doc Version 5.2 Page 6 Eleri House is an ordinary, homely house, which helps residents fit in with the community. It is in a quiet place but is also close to shops and other amenities. There is a small and stable staff team who work well together. This helps them know what residents need and like and give them more consistent support. Staff receive training about how to keep the home and residents safe. Most have a care qualification so they should know and understand how to do their job. Staff are checked out to help ensure they are suitable to work as carers. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Eleri House DS0000061478.V365748.R01.S.doc Version 5.2 Page 7 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 Eleri House DS0000061478.V365748.R01.S.doc Version 5.2 Page 8 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 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to the service. Good assessment and admission procedures would ensure that a prospective service user’s needs could be suitably met if they were to move into the home. EVIDENCE: Mr Cole explained the home was set up to provide a service specifically for the three existing residents with the intention that they continue to live together. It is therefore not envisaged the home will receive a referral for a placement that would require an assessment of the needs of the prospective service user. The home’s statement of purpose needs amending accordingly to reflect this. Residents’ terms and conditions should also be reviewed regularly to set out in detail what is included in their fee and what they can expect from the service. Whilst there have not been any referrals made to the home for a placement, the assessment and admission processes that would have been followed were discussed hypothetically. Mr Cole confirmed that the home would expect to obtain full information about any prospective service user from relevant people and also assess their needs. Introductory visits to the home would then be arranged to check their individual needs could be suitably met and importantly to make sure that they would be compatible with the current residents. Eleri House DS0000061478.V365748.R01.S.doc Version 5.2 Page 9 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including these visits to the service. Whilst residents’ basic needs are being met their care plans are poor and their communication is not supported as well as it could and so there is potential for people’s needs and choices not to be met. EVIDENCE: Each resident has a care plan based on an initial needs assessment carried out when they first moved into the home. Plans are brief with limited information about their specific personal, health and social care needs, goals, preferred routines, skills, communication and how identified goals and needs can be met with the support needed from staff. Plans also do not refer to how individuals’ diverse needs in respect of such of gender or specific disability are being met. Most staff have worked with the residents a long time (and so know their care needs) but care plans should be used to ensure a “person centred” approach. The manager and staff said that residents’ needs and plans are reviewed at monthly staff meetings and at six monthly reviews when their relatives are Eleri House DS0000061478.V365748.R01.S.doc Version 5.2 Page 10 invited to take part. However decisions made in reviews should be agreed and their input be recorded in plans, indicating by whom. Reviews should also show progress to meet goals, achievements and any further actions needed. Each resident has a keyworker allocated to them from the staff team, which is one way of personalising care. It does not appear however that keyworkers have a clearly defined role to contribute to their care plans or have specific time available to provide them with one to one support for activities, arranging and escorting them to health appointments, do personal shopping etc. which would be beneficial and could help individualise their support and activities. Whilst acknowledging residents’ limited ability to be involved in care planning (and plans are now in a format they would not understand anyway) there are other options e.g. life books. Life books could be set up with keyworkers with photographs of significant people, pictures of important things in their lives, their likes and dislikes in respect of food, activities etc. This may be meaningful to them and provide a useful tool to enable them to communicate better and make more choices in their daily lives. As all the residents have communication difficulties staff received training on communication techniques from a speech therapist some years ago. However only a few Makaton (non-verbal) signs are now used by one resident and known to staff. Pictures of meals are available but staff say they are not often used as some residents would always pick the same meal. Mr Cole also said the home tried to use objects of reference, but they were not helpful. Two staff expressed a wish to attend communication training and input could be sought from the speech therapist again to introduce methods for individuals to promote choice making and so their independence. Risk assessments are in place, although the home’s risk policy is dated 2001 and individual risk assessments are basic and focus on environmental hazards. Some risk assessments have not changed for a considerable time and do not specify for example when a resident is described as having no road sense how this is managed. Residents’ medication and finances are also managed for them, which should be risk assessed and agreement obtained from their representatives and recorded. It may be necessary to limit an individual’s choices to protect them, but risk assessments should also show how they can and are being supported to take some risks as part of an independent lifestyle. Eleri House DS0000061478.V365748.R01.S.doc Version 5.2 Page 11 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, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to the service. Residents are supported to lead active lifestyles and be part of the community. Their plans could better reflect how they wish to follow individual interests and how their social and developmental needs are met. Links with their families are supported and staff encourage healthy eating and provide meals they like. EVIDENCE: Residents’ plans have only brief information about their interests and activities they enjoy such as swimming, walking, music, going to the library, trains etc. Plans do not specify how their activities are arranged in line with their interests and show the support needed, or identify their social and developmental needs and how they could be met. Although residents’ capacity to develop life skills may be limited their plans should also include their involvement in the home’s domestic routines and responsibilities they are expected to take for their room, laundry, helping with shopping, preparing and cooking meals etc. The AQAA states residents are involved in most general activities of a normal household. Eleri House DS0000061478.V365748.R01.S.doc Version 5.2 Page 12 Residents do not have set individual activity programmes and most activities are arranged flexibly. Daily routines are said to be flexible but it is not clear how residents are enabled to make choices in their daily lives and the use of communication aides was discussed. Whilst individual plans include some likes and dislikes preferred daily and care routines are not specified. The annexe is used specifically for activities and has two rooms; one for arts, crafts, games etc. and the other has various sensory equipment and facilities for relaxation and stimulation. The conservatory can also be used for relaxing and has soft beanbags and a music centre. There is a designated activity co-ordinator who works four hours a week to organise activity sessions and the deputy manager has completed an Indian head massage course. Many activities involve walking and being out in the open air and a friend of the home comments “They always appear relaxed when I visit and have been doing some outdoor pursuits”. Only one resident attends a day service on one weekday, which he/she enjoys. Work placements or educational opportunities are not appropriate because of residents’ learning disability and associated difficulties. Other options should be reviewed regularly and could provide more varied opportunities, especially as residents’ condition and behaviours have stabilised. Residents are supported to go out regularly with Mr Cole and staff and are all well known within the local community in shops, cafes, pubs and as regular Church goers. The home is also involved in fund raising events, including long distance sponsored walks and collecting clothes for charity, which is positive and must help to raise the profile of people with a disability being actively engaged in their community. The lifestyle at Eleri House is quite unique as the service was set up for the three current residents who formerly lived in the same care home. Mr Cole, the deputy manager and another care worker also worked with them at their previous home and so they have known each other for years. The ethos of the home is therefore more of a family and they are also involved with staff family and friends. One staff member says “Eleri House works well for residents and staff alike”. Clearly residents are content and comfortable living at the home, although there is more emphasis placed on group rather than on individualised activities than is normally expected. They also have their meals together and go on holidays several times a year to country cottages, camping or boating. Two residents have relatives and the home support them to maintain links. Mr Cole says they have been unable to find an advocate for the other resident. It is confirmed families and other people involved with residents are always made welcome at the home and invited to socials and annual reviews. Relatives also say the home keeps them informed and up to date about important matters. Regarding food provided at the home a set menu is not used and so staff shop with residents and make their meals flexibly. Residents being more involved in choosing meals has already been discussed. Records are kept of meals they have each day and it is good staff report they are now promoting an improved, healthier diet with more varied homemade meals, fruit and vegetables. Eleri House DS0000061478.V365748.R01.S.doc Version 5.2 Page 13 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 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to the service. Residents’ personal and health care needs are being appropriately met. Staff are also managing medication safely in the home on people’s behalf. EVIDENCE: Staff say residents’ self care is encouraged as much as possible, although most do need physical support and/or guidance. Whilst staff clearly know residents’ personal care needs well they should be fully recorded in their plans, specifying the support required to meet their needs. Two people from outside the home say that residents always appear well cared for, one commenting “As well as looking after their mental health residents always look relaxed when I visit”. Care records include a brief description of each person’s learning disability and diagnosed condition. There is also information available for staff about autism, epilepsy and sensory impairments and it is good that the home has recently obtained a distance learning pack called Autism Focus, which the staff team are going through. Staff also know residents’ health care needs well and make sure they all have regular health related checks e.g. Dentist, flu jabs, Optician, Chiropodist and annual well person checks. Records are kept of appointments Eleri House DS0000061478.V365748.R01.S.doc Version 5.2 Page 14 each person attends and any health care input from GPs and other specialists. Health care issues are recorded in daily reports and are monitored, followed up with appropriate advice and treatment obtained. Although residents currently only have regular involvement with a Consultant Psychiatrist it is confirmed that the home does maintain links with the Community Learning Disabilities Team (CLDT) and have sought their input when necessary. The implementation of Health Action Plans (HAPs) was discussed with Mr Cole, as they are considered good practice in care services for people with learning disabilities and are also recommended by the Department of Health. Whilst acknowledging residents may not be able to be actively involved in setting up their HAP, or managing their own health care, they provide a comprehensive overview of individuals’ health needs and could be helpful for their keyworkers. Consideration should be given to introducing HAPS as part of the development of a more person centred approach, and the CLDT could assist with this. Regarding management of residents’ medication none of them are able to selfadminister and staff take full responsibilty on their behalf. There is a list kept of residents’ current medication, stating the reason each medicine has been prescribed and patient information leaflets are also available. It was confirmed in previous inspections that the home has a policy and procedures in place for managing medicines. Records of all medication administered were found to be maintained appropriately. A monitored dosage medication system is used by the home, which is checked regularly by a Pharmacist from the company providing it. Mr Cole and the deputy manager have completed accredited safe handing of medicines training and instruct staff in-house and as part of their induction. The home has suitably secure storage for medicines. Eleri House DS0000061478.V365748.R01.S.doc Version 5.2 Page 15 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 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to the service. Frameworks are in place for people living at the home or their representatives to make complaints about the service. Residents are protected from abuse by the home’s policies, procedures and staff training. EVIDENCE: The home provides a written complaints procedure. This is also available in a format that should be easier for people with learning disabilities to understand, although residents are not able to express their views or concerns verbally due to their disabilities. Resident’s relatives and a friend of the home confirm they would know how to make a complaint and say they are happy overall with the service. Staff also say they would know how to deal with any concerns raised with them. There had not been any complaints made to the home and/or Commission, or any issues raised that could adversely affect the welfare and safety of residents, since this and the previous inspection of the service. Policies and procedures are in place to promote the safety and protection of residents and the manager has attended training on protection of vulnerable adults (POVA). Relevant information has been passed onto the staff team and abuse and protection are also included in the induction of new staff and are part of the NVQ (National Vocational Qualification) course. Training in relation to POVA should be regularly arranged by the home to also cover the updated safeguarding procedures, which include the role of external agencies when referring any incident or suspicion of abuse or neglect of vulnerable adults. Eleri House DS0000061478.V365748.R01.S.doc Version 5.2 Page 16 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to the service. People living at Eleri House are provided with accommodation which suitably meets their needs and offers them a secure and comfortable home. The house is satisfactorily maintained, furnished and decorated and is kept clean and tidy. EVIDENCE: Eleri House is situated in the town of Malvern and is within walking distance of the town centre and a range of local facilities and services. The home provides a vehicle for outings and holidays and public transport can also be accessed easily. The property is in a quiet, safe location and in view that residents are all physically able it does not need to have any specialist adaptations and aids. The impression of the home is comfortable and well “lived in” and the premises appear to be maintained to a reasonable state of repair, furnishings and décor. All the areas visited were clean, tidy, fresh and airy. There is a sitting/dining room, kitchen, utility room, bathroom, separate toilet, the garden (which has a patio and gazebo) and a conservatory that are available as communal space. Eleri House DS0000061478.V365748.R01.S.doc Version 5.2 Page 17 There is also the annexe used for residents’ activities, which has two rooms, one used for arts, crafts and games etc and the other sensory equipment and furnishings. Residents have their own bedrooms, which are personalised but do not have en-suite facilities or a wash hand basin. The AQAA confirms that the home provides an infection control policy for staff and two staff have attended training on infection control. Other staff receive in-house instruction and this topic is also included in the induction programme for new staff. Laundry facilities are suitably sited. Eleri House DS0000061478.V365748.R01.S.doc Version 5.2 Page 18 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, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to the service. Residents receive consistent support from a small, stable staff team, most of whom are qualified. Staff work together and feel well supported as a team and individuals. Residents could benefit from staff completing or updating training related to their special needs to use to inform their practice. Good recruitment procedures help to ensure suitable staff are employed for residents’ protection. EVIDENCE: The staff team comprises of the manager, four full time and two part time care staff. Two staff are rostered to work at the home from 8.00am until 9.30pm each day with one sleeping in on call at night. They work flexibly and say they can cover the home when staff are on leave and are able to support residents to go out for long periods during the day. The manager and staff surveys show that staff feel there is always enough staff to meet residents’ individual needs. The manager and two permanent staff have worked with the residents since Eleri House first opened and at their previous care home. Only one of the care staff has left the home since the last inspection and has been replaced. This is positive for consistency of care and means they all know residents’ needs well. Eleri House DS0000061478.V365748.R01.S.doc Version 5.2 Page 19 Staff and the home’s AQAA confirm that necessary checks are taken up on all prospective new staff (including an enhanced Criminal Records Bureau police check (CRB) and two written references) before they can start working at the home. Records checked of the most recently appointed care staff contained two satisfactory references (one from their last employer as required)) and a CRB. Their application appropriately included proof of their identity and a full employment history. This person confirmed they had completed a 3 month probationary period before being appointed and an in-house induction. It is expected however that new care staff should complete an accredited induction and foundation programme, LDQ (Learning Disabilities Qualification), which is especially for staff working in care with people who have learning disabilities. Regarding training four care staff have achieved an NVQ (National Vocational qualification) and another is doing this training currently, which is faciltated by the manager who is an NVQ assessor. The home recently acquired a distance learning training pack on autism, which the staff team are working on and should provide helpful information about people’s behaviours and how staff can best support them. Staff spoken with seem keen to complete further training relevant to residents’ special needs such as BSL (British Sign Language), communication and various therapies. This training could help people express their needs and wishes better and have more opportunities for stimulation. Staff say there is open communication within the team and they have regular, constructive staff meetings and care forums when residents and other matters are discussed. A diary is used for any special events and/or issues relating to residents and daily reports are completed. Staff feel the team works together and they have regular contact with the manager and are well supported. They receive individual supervison and have an annual appraisal when they have to self-assess their own performance. Staff sign a contract for supervision with the manager, who also assesses their skills and this results in an action plan agreed and signed by both parties as to their personal skills development. Eleri House DS0000061478.V365748.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to the service. Residents benefit from living in a stable, safe, family-like home, but they are not involved in how the home plans and reviews the support they receive. EVIDENCE: The sole provider and manager Mr Cole has many years experience working with people with learning disabilities and originally completed nursing training, which included a specialism in learning disabilities. Mr Cole has achieved the Advanced Management of Care Award, is an NVQ Assessor and Verifier and also has certificates in Youth and Community work and mountain leadership. There is a deputy manager who shares some management responsibilities and has achieved an RMA (Registered Managers Award) in care and management. Eleri House DS0000061478.V365748.R01.S.doc Version 5.2 Page 21 Mr Cole is clear about the aims, objectives and ethos of the home, which is to provide a secure, comfortable long-term home for the three existing residents based on a group “family” lifestyle. This approach is not in line with currently accepted care practice where more emphasis is placed on “person centred” individualised care provision. Although Mr Cole is aware of current thinking and developments he considers that some are not appropriate to the service and/or because of residents’ disabilities. The principles underlying this service must therefore be clearly described in the home’s statement of purpose to show how they are achieved and result in positive outcomes for residents. In respect of quality assurance and monitoring a system must now be in place and to review the quality of care services. This is to ensure there is continuous development and improvements made are based on what service users and/or their representatives want. Quality reviews must be reported and result in a development plan which includes year-on-year development for service users, based on their plans. Quality assurance processes must involve consultation with service users and their representatives. Although people living at Eleri House are not able to express their views and wishes directly there needs therefore to be a more formal way of consulting their representatives (e.g. through questionnaires) to inform how the service improves. The home has a management committee, a member of which visits the home monthly so their feedback, and the input of external advocates could also be considered. The AQAA is required annually from all registered care services. AQAAs should provide clear, relevant information and detailed evidence about what services do well and let the Commission know about changes in the last year and the manager’s plans for improvements. The home’s AQAA was completed briefly and provides no information about how the service has improved in the last year very little about plans to develop it. There is also limited evidence about what the service does well and reference was not made to each of the outcome areas of the National Minimum Standards. The AQAA and its important role in the inspection and QA processes were discussed with Mr Cole and he was given a copy of Commission guidelines KLORA (key lines of regulatory assessment). Regarding the promotion of health and safety within the environment, and for residents’ protection and welfare, staff receive training in the mandatory topics of fire safety, first aid, food hygiene and general health and safety (some of this provided in-house). The home has a health and safety policy and relevant procedures are in place for such as food hygiene and infection control, which staff should be following in their working practices. Risk assessments had been carried out for possible hazards e.g. for substances such as cleaning products (COSHH) and windows with wide openings. Information in the AQAA confirms required tests and checks of the fire safety system and equipment are carried out at the specified frequencies and regular servicing and/or maintenance of electrical circuits and portable appliances, heating and gas installations. Eleri House DS0000061478.V365748.R01.S.doc Version 5.2 Page 22 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 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 X 14 3 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X 1 X X 3 X Eleri House DS0000061478.V365748.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Previous requirements have been reviewed and are not being carried forward as requirements. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered provider must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the registered provider to consider carrying out. No. 1 Refer to Standard YA6 Good Practice Recommendations Residents’ plans and risk assessments should be reviewed and updated so they reflect their individual, diverse, current and changing needs and personal goals in more detail and how they are to be met. Consideration should also be given to adopting a more “person centred approach” to care planning and using communication techniques and userfriendly care and health action plan formats. This could all enable residents to be more actively involved in planning their own care and making more choices and decisions about how they receive their care, their health, daily lives and routines. Staff should complete or update their training related to the special needs of people with learning disabilities so they can increase their skills and give better support to residents. The home should introduce a more formal system of monitoring, reviewing and assuring the quality of the service. This should result in an annual plan for its continuous development and these planned improvements to the home should be based on what residents and their representatives want and/or which would benefit them. 2 3 YA35 YA39 Eleri House DS0000061478.V365748.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Eleri House DS0000061478.V365748.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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