Care Home: First Choice Care Ltd 18 St Andrews Ave

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What the care home does well The admission procedure of the home is normally carried out in a comprehensive manner. Residents are offered all the information prior to deciding if they want to move into the home. The manager ensures that the home only accommodates residents whose needs can be met in the home by carrying out a comprehensive assessment of the needs of prospective residents and by liaising with other healthcare professionals involved in the Care Programme Approach, as required. The home supports residents in their daily lives with regards to finding opportunities for self-development and self-realisation and with maintaining their usual lifestyles. Residents have the opportunity to engage in social and recreational activities, which are suitable to their needs. The healthcare needs including the mental healthcare needs of residents are on the whole met to a good standard and residents are supported with regards to attending out patient`s appointments and to take responsibility for their healthcare needs. Meals are provided to residents according to their individual choices and cultural needs, even if that means cooking a number of meals everyday. Good records are kept about the meals, which are cooked in the home. Care is provided to residents by a team of staff, which has been fairly consistent over the past couple of years. Staff seem to appreciate the mental health needs of residents and are able to address these. Residents spoken to said that they were satisfied with the support that they receive from staff. What has improved since the last inspection? The service users` guide has been updated and now contains information about the fees charged by the home. Records were kept about the preadmission assessment of residents` needs prior to them being offered a place in the home. The manager and the proprietor have also been updating their knowledge about mental health issues to make sure that residents who were admitted to the home met the category of registration of the home. Care plans and risk assessments were comprehensive and were drawn up and reviewed with the involvement of the residents. Medicines management was on the whole of a good standard and few issues were noted (see next section). There has been an improvement to the standard of the environment and further improvement is planned. The corridor, stairs, communal area and a few bedrooms have been repainted. The areas where further improvement has been planned have been summarised in the report for follow up during next CSCI inspections. Staff have had fire training but training must be provided in other areas such as food hygiene, manual handling and infection control as identified in the home`s training plan. 50% of the care staff were trained to NVQ level 2 or above. The manager has been registered and is now qualified to NVQ level 4 in care and has also achieved the Registered Manager`s Award. The quality assurance procedure has been overhauled and the home now carries out a satisfaction survey of residents and stakeholders. The home now uses the AQAA, as a quality control tool for self-assessment and to monitor the quality of the service that it provides. CARE HOME ADULTS 18-65 First Choice Care Ltd 18 St Andrews Ave 18 St Andrews Avenue Sudbury Middlesex HA0 2QD Lead Inspector Mr Ram Sooriah Key Unannounced Inspection 18th October 2007 10:45 First Choice Care Ltd 18 St Andrews Ave DS0000017493.V346079.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 First Choice Care Ltd 18 St Andrews Ave DS0000017493.V346079.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. First Choice Care Ltd 18 St Andrews Ave DS0000017493.V346079.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service First Choice Care Ltd 18 St Andrews Ave Address 18 St Andrews Avenue Sudbury Middlesex HA0 2QD 020 8904 5250 020 8904 5250 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) Mr Divya Gandhi Mr Vinod Kabriya Care Home 5 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (5) of places First Choice Care Ltd 18 St Andrews Ave DS0000017493.V346079.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th August 2006 Brief Description of the Service: Mosaic House is run by a private company called First Choice Care Limited. The home is a semi-detached house, which has been extended on the side and back. It is situated in a residential area of Sudbury and is easily accessible by public transport. There is a garden to the back of the house, which is accessible to residents from the lounge and the kitchen. There is parking on the road in front of the home. Mosaic House is registered for five adults with mental health needs. The statement of purpose states that it caters for Asian, African and Caribbean residents. All residents have single bedrooms. The accommodation is on two floors with two bedrooms, lounge/dining area, an office, a toilet/shower and kitchen on the ground floor. There are three bedrooms, one bathroom with bath and toilet, and the sleep in room on the first floor. Residents normally have been inpatients or users of other services before being admitted to the home. The aim of the home is to provide rehabilitation and support to residents and to develop their independent living skills with regard to being discharged back to live independently in the community. Fees charged by the home range from £850 to £1150 according to the needs of the residents. At the time of the inspection there were four residents in the home. One bedroom was vacant. First Choice Care Ltd 18 St Andrews Ave DS0000017493.V346079.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced key inspection started at about 10:45 and finished at about 17:45. The manager was present throughout the inspection and the proprietor was able to stay for a short time during the inspection to talk to me and to give me his perspectives about the service. During the inspection I was able to tour some of the premises, look at a sample of records in the home, talk to residents and members of staff to get their views about the service. I also telephoned members of staff when they were on duty to talk to them about the service. The manager has kindly completed an Annual Quality Assurance Assessment (AQAA) as part of the service’s statutory requirement and this has been used where possible to inform this report. I would like to thank all the residents who talked to me during the course of the inspection and the proprietor, manager and all his staff for their assistance during the inspection. What the service does well: The admission procedure of the home is normally carried out in a comprehensive manner. Residents are offered all the information prior to deciding if they want to move into the home. The manager ensures that the home only accommodates residents whose needs can be met in the home by carrying out a comprehensive assessment of the needs of prospective residents and by liaising with other healthcare professionals involved in the Care Programme Approach, as required. The home supports residents in their daily lives with regards to finding opportunities for self-development and self-realisation and with maintaining their usual lifestyles. Residents have the opportunity to engage in social and recreational activities, which are suitable to their needs. The healthcare needs including the mental healthcare needs of residents are on the whole met to a good standard and residents are supported with regards to attending out patient’s appointments and to take responsibility for their healthcare needs. Meals are provided to residents according to their individual choices and cultural needs, even if that means cooking a number of meals everyday. Good records are kept about the meals, which are cooked in the home. Care is provided to residents by a team of staff, which has been fairly consistent over the past couple of years. Staff seem to appreciate the mental First Choice Care Ltd 18 St Andrews Ave DS0000017493.V346079.R01.S.doc Version 5.2 Page 6 health needs of residents and are able to address these. Residents spoken to said that they were satisfied with the support that they receive from staff. What has improved since the last inspection? What they could do better: The home’s contract/statement of terms and conditions could be made more comprehensive to make sure that these address all the terms and conditions of living in the home, in a comprehensive manner. For example more information could be provided about the arrangements in place to deal with the personal contribution that are made by residents and use of words such as ‘reasonable’ should be clarified where possible. Care plans could address the way that the personal finances of residents are managed and the people involved in the process. First Choice Care Ltd 18 St Andrews Ave DS0000017493.V346079.R01.S.doc Version 5.2 Page 7 In the absence of accredited training, members of staff must be assessed for their competence with regards to medicines’ management, prior to them being allowed to administer medicines. The appearance of the front of the home could be enhanced by the prompt disposal of rubbish that was accumulated in front of the home. The garden areas at the back of the home could be made more attractive by the use of flowers and shrubs. The home has identified a number of areas, which should be addressed without delay to make sure that the home continues to provide a high quality environment for residents. These included the following: • • • • • • • • Disposal of the carpet and other rubbish in front of the home Replacement of kitchen work surface and sink Repair of the lock on the door of the shower/toilet on the ground floor Refurbishment of the bathroom on the first floor The use of electric hand dryers for bathrooms/toilets Provision of internet access to the computer in the communal areas Ensuring that the dining area in the lounge is made more congenial Promoting the personalisation of the bedrooms of residents With regards to management of the personal money of residents it is recommended that each resident has a book to maintain their financial records, instead of having one book with different sections for each resident, as any third party looking at these records would have access to other residents’ financial information and to facilitate auditing of the financial records of residents. Recruitment practices must be consolidated to make sure that appropriate references are received prior to employment being offered to applicants. The appropriate application form must be completed when an applicant applies for a job and consideration should be given to completing a medical questionnaire and an equal opportunity monitoring questionnaire as per equal opportunities practices. Staff at times seemed to work for about 24 hours, albeit with a sleep-in shift. Although staff may find these working arrangement suitable for them, the registered person must check whether he is complying with the working times directives and must carry out risk assessment about the shifts that the carers are working to make sure that the working practices are safe and that residents are not being put at risk. It was noted from the AQAA that a number of policies and procedures in the home have not been reviewed since 2000 and 2002. The registered person must ensure that these are reviewed as required to make sure that staff always have the most up to date procedures to follow. Please contact the provider for advice of actions taken in response to this First Choice Care Ltd 18 St Andrews Ave DS0000017493.V346079.R01.S.doc Version 5.2 Page 8 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. First Choice Care Ltd 18 St Andrews Ave DS0000017493.V346079.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 First Choice Care Ltd 18 St Andrews Ave DS0000017493.V346079.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): 1-5 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are offered information about the service for them to decide if the home will be suitable for them. Prospective residents’ needs are assessed by competent staff from the home, to make sure that the home will be able to meet the needs of the prospective residents. EVIDENCE: The service users’ guide (SUG) has been updated and it now contains all information about the service including the range of fees that is charged by the home. The manager stated that the SUG is provided to all prospective residents before they are offered a place in the home. One resident, from an ethnic minority, who has been recently admitted to the home, was offered a SUG in English and an older version in Gujurati. I was told that the home was in the process of translating the current SUG and statement of purpose for the resident. The preadmission assessment for the recently admitted resident was in place in the home. Although a format was not used, the preadmission report which was typed up was comprehensive and contained information about aspects of the care of the residents. I was told that the manager/senior staff from the home normally visits prospective residents on a number of occasions and liaise First Choice Care Ltd 18 St Andrews Ave DS0000017493.V346079.R01.S.doc Version 5.2 Page 11 with the relevant healthcare professionals to learn more about the needs of the residents before the home accepts the residents. The manager stated that prospective residents are encouraged to visit the home, see their bedrooms and facilities in the home and meet members of staff and other residents before deciding if the home is suitable for them. There was evidence that the manager has been reading up and keeping himself updated with regards to training on mental health issues and legislation to make sure that only residents who fit the category of registration of the home are admitted. Residents are offered the contract/statement of terms and conditions of the placement. It was noted that these could be made more comprehensive. For example there was no information in the contract about residents who have to pay a personal contribution to the home and issues in relation to that such as what happens when the resident does not pay that contribution. Good records were in place about the management of the personal contribution of residents, but it is recommended that some form of invoicing be used to make the system more comprehensive. There was information to the resident and to the home from the local authority about the amount of contribution that the resident should make. First Choice Care Ltd 18 St Andrews Ave DS0000017493.V346079.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 and 9 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The care plans and risk assessments are drawn up and reviewed with residents and comprehensively address the needs of residents while balancing these with their safety. EVIDENCE: The care plans of two residents were inspected. These were typed, in good condition and comprehensively addressed the needs of residents. There was an assessment of residents’ needs and care plans were in place in areas where residents were identified as needing support. These included areas of personal care to areas of mental health. As well as this the care plans addressed the cultural and ethnic aspects of the care of residents to a good standard. The care plan generated from Care Management Assessment and the Care Programme Approach (CPA) was available in the home and reflected in the home’s care plan to make sure that the aims and objectives which have been set up for each individual resident as per the care management assessment were being implemented. First Choice Care Ltd 18 St Andrews Ave DS0000017493.V346079.R01.S.doc Version 5.2 Page 13 The care plans were reviewed six monthly and were also discussed in CPA meetings. It was noted that the residents have also signed their care plans to show that they have agreed the care plans. A separate section was in place in care records addressing the risk assessments. Risk assessments were in place to make sure that each individual resident’s potential was being addressed while balancing this with the risks as well as any limitations to residents’ freedom and choice. These included areas of activities in the home such as taking part in cooking and cleaning and personal safety when outside the home Care plans and risk assessments included information about residents who are likely to be aggressive and challenging and the management of these behaviours. Each resident has a key worker who in the main is responsible to monitor progress with implementation of the care plan. None of the residents had an advocate as they were either able to make decision on their own or they had relatives to support them with aspects of their care and decision making. The key worker support residents in identifying areas where residents may be willing to develop their potential, to take part in for their personal development or as an activity. Care plans of residents contained some information about residents’ finances but these did not clearly document the way that the residents’ finances were being managed, the benefits that residents were receiving and the types of accounts that were held on behalf of residents. First Choice Care Ltd 18 St Andrews Ave DS0000017493.V346079.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are supported to lead a lifestyle, which is individual to each of them and one where their independence and ability to make choices and decisions, are promoted and respected. EVIDENCE: I was informed by the manager that all residents in the home were involved in some form of activities for personal development. These included attending day centres for residents to socialise with other people or to learn new skills. I was told that some of the residents were able to learn English, IT and gardening skills. Some residents who spoke to me said that they enjoyed going to the day centres. The manager said that some residents like to go to day centres and others not so much. However residents have the opportunity to make decision about the way they lead their lives. Those who did not want to go were First Choice Care Ltd 18 St Andrews Ave DS0000017493.V346079.R01.S.doc Version 5.2 Page 15 supported and encouraged by staff in the home to maintain some sort of activities, which was addressed in the care plan. Care plans contained a section about the goals that residents aim to achieve with the support of staff. These were individualised depending on the abilities of the residents and the willingness of the residents to achieve the goals. For example areas of personal hygiene, washing, dressing, cooking and travelling were addressed. These were signed by residents to show that they have agreed to these. During the weekend residents accompany staff to do the shopping if they want to, to develop skills in the community and become confident with shopping. Residents normally travel on their own in the local community using public transport. I noted that in the afternoon, residents returned from the day centre having used buses. Two residents who were in the home during the course of the inspection went out for walks. They were asked for a time when they expected to be back and they were then able to go out independently. None of the residents had keys to the home and I was informed that this is according to a risk assessment. If the risk assessments did not identify any significant risk and if it is the wishes of the residents then they would be offered keys to the home. A few of them had keys to their bedrooms. The manager stated that staff in the home were making arrangements for residents to go to the gym to play badminton. Other activities in the home are at times carried out with the involvement of residents who live in Medway House, the other care home, which belongs to the organisation. For example religious festivals and events are celebrated together. I was informed that residents from both homes recently met together to take part in a religious celebration. Residents have been on holidays to a number of places this year. One resident was observed talking to staff about his wishes to go on holidays and he was being supported to understand the reality of going on holidays and financial consequences. This was appropriate. From the care records it was noted that residents, as part of their personal development and promotion of their independence and rehabilitation, are encouraged to do their own laundry, ironing and to clean their room. They are supported as required by members of staff with regards to their development in these areas as part of their care plan. The meals in the home continue to be prepared according to the choices of residents. Some residents were involved in cooking and others had their meals prepared for them. Residents spoken to were satisfied with their meals and about the ability to make choices. The fridge and freezer temperatures were maintained as well as the records of all food cooked in the home. Residents were also given the opportunity to speak about issues in the home such as First Choice Care Ltd 18 St Andrews Ave DS0000017493.V346079.R01.S.doc Version 5.2 Page 16 their meals in residents’ meetings, which at times were minuted by residents themselves. First Choice Care Ltd 18 St Andrews Ave DS0000017493.V346079.R01.S.doc Version 5.2 Page 17 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): 18-21 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents receive support from members of staff to meet their personal and healthcare needs as required. Medicines’ management is of a good standard but the competency of any person administering medicines must be ascertained before they are allowed to administer medicines independently. The ageing process and hopes, fears and concerns of residents for the future are dealt with in a sensitive manner. EVIDENCE: The areas where residents receive personal support are documented in the care records. The care plans are signed and agreed with residents and the key workers and may include areas for the personal development of residents or to maintain independent living skills. It was noted that residents who required personal care were supported in a sensitive manner by staff that maintained the privacy and dignity of the residents. Most residents in the home were independent with regards to personal care and dressing but were supported and encouraged where required to maintain a high standard of hygiene. First Choice Care Ltd 18 St Andrews Ave DS0000017493.V346079.R01.S.doc Version 5.2 Page 18 The healthcare needs of residents were clearly identified in the care plans and the support required by residents to meet the healthcare needs was also recorded. These included monitoring of the mental health of residents, making contact with and reporting to various healthcare professionals and support for residents with attending appointments. There was evidence that residents were receiving annual health checks such as visits to the optician and the dentist as well as being seen by other healthcare professionals as required. Residents were accompanied by care staff during appointments for support and continuation of care. The manager said in the AQAA that residents who are more independent could be made responsible for arranging their own appointments with staff monitoring these processes. The outcomes of these visits were documented and the care plans were updated as required to take into account any changes or strategies to manage the health of residents. The management of medicines was of a good standard. All medicines were recorded when received in the home including medicines, which are administered when required. Medicines came into weekly dossette boxes, which are filled by the chemist except for medicines, which are administered when required. Staff were familiar with the medicines that residents were taking and with the reasons for administering the medicines, which are prescribed to be given when required. I was informed that all members of staff have had certificated training in the management of medicines except for a member of staff who has been recruited recently. The manager stated that this was covered as part of the induction but there was no evidence that the competency for the management of medicines was checked as part of this process. It is required that in the absence of certificated training in the management of medicines, that the competency of staff is sought and recorded according to national occupational standards for medication. The ageing process and the concerns and fears of residents were addressed in a special questionnaire, which was included in the care plans. I was informed that residents’ views about their future and expectations were discussed where the residents were willing to do so. Any wishes of residents with regards to funeral arrangements and death were also included. It was noted in the AQAA that further development in this area would include support for residents to write wills if they wish to. First Choice Care Ltd 18 St Andrews Ave DS0000017493.V346079.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home deals with complaints, allegations and suspicions of abuse in an appropriate manner to make sure that residents are safe. EVIDENCE: The complaints procedure was available in the service users’ guide and was in the foyer of the home. A copy in Gujurati was available for a resident whose first language was not English. Residents said that they would approach the manager or the owner if they had issues to discuss. The manager holds an open door policy and a number of residents were observed coming into the office during the course of the inspection. He stated in the AQAA that concerns of residents are also sought in residents’ meetings and staff’s meetings with a view to resolve these before complaints are made. There has not been any complaints in the home since the last inspection. The home has a policy on abuse. There has not been any allegation of abuse that has been received by the home since the last inspection. In the past appropriate action has been taken by the provider when allegations of abuse were made. Staff were aware of the action to take if allegations of abuse were made or if they suspected abuse. Introduction to abuse is addressed in the induction of new members of staff and during supervision. The manager stated in the AQAA that a POVA study pack for staff has been provided particularly for new members of staff to familiarise themselves with abuse. Further training on safeguarding people is provided when this is arranged by the local Borough. First Choice Care Ltd 18 St Andrews Ave DS0000017493.V346079.R01.S.doc Version 5.2 Page 20 There were records to show that members of staff were enrolled on training on abuse, which has been arranged in the near future. The management of the personal money of residents were inspected. The manager, the provider or staff were not agents for any of the residents who were accommodated in the home. Two of the residents managed their own finances with the support of staff, one is independent and the fourth resident is newly admitted and their were some issues about his financial circumstances that needed to be sorted out by his placement authority. The two residents who were being supported with the management of their money had two bank accounts each: one saving and one card accounts. Benefits are paid in the card accounts and money are drawn as required and kept in the home for daily expenditures of the individual residents. Any additional money in the card accounts are taken and placed in the savings accounts from time to time. The manager kept clear records of how much money was received in benefits, how much was drawn out, how much was transferred to the savings accounts, how much money was drawn out of the money held in the home by residents (they sign for it) and about expenditures that were made on behalf of residents. Bank statements were available to cross reference bank transactions and receipts were kept for all expenses made on behalf of residents. It was noted that records of money held in the home by residents and of their expenses, were made in one book with different sections for each resident. I recommended that each resident have a book to maintain these records as any third party looking at the current book to verify the account of a particular resident would have access to other residents’ financial information and to facilitate auditing of the financial records of residents. I spoke to two members of staff about the whistle blowing policy. One was clear about what it meant and one was not so sure what it was. It is recommended that the knowledge of all staff with regards to the whistle blowing policy be reviewed. First Choice Care Ltd 18 St Andrews Ave DS0000017493.V346079.R01.S.doc Version 5.2 Page 21 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 and 30 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The environment that the home provides will be better suited for the needs of the residents once a number of areas for redecoration and maintenance are addressed as planned by the manager. EVIDENCE: There were some items of furniture, old carpet and rubbish in front of the home, which needed disposal. The manager stated that these would be disposed of when the home completes some refurbishment work, which has been planned. The garden at the back of the home was maintained but there were no flowers or shrubs to enhance the experience of people using these facilities or looking onto the garden. There has been redecoration and maintenance in the home. A small fire, which happened a couple of months ago, caused some damage to the corridors and to at least one bedroom. There has been therefore a necessity to redecorate many areas in the home. The corridors and foyer have been painted in a lighter colour than previously to make these areas brighter and more pleasant. First Choice Care Ltd 18 St Andrews Ave DS0000017493.V346079.R01.S.doc Version 5.2 Page 22 The communal areas have also been repainted and new light fittings have been provided for the lounge. As a result the lounge, which used to be dark, were lighter when the lights were switched on. The home has a no smoking policy inside the building. It was noted that the lounge was fresher and that there were no odours in the home. The manager plans to erect an awning for those people who have to go outside the home to smoke. Some new items of furniture have been provided for the lounge. A computer was also noted in the communal area. The manager stated that there are plans to provide the residents with Internet access. The dining area within the communal space was noted not to be as congenial as it used to be. The table, which used to be there, has been used to place the computer on, an exercise machine has also been placed where the table used to be and some other items were kept in this area. It was however noted that there was a small eating facility in the kitchen. Bedrooms of residents were in a good standard of redecoration. Some residents were able to keep a key to their doors according to their wishes. Furniture provided for individual residents’ use was also of a good standard. A few comfortable chairs, which have recently been purchased, were noted in the bedrooms for residents. The bedroom of a recently admitted resident was noted to be slightly bare, not very homely, with few pictures or items of decoration and with little personal possessions. The manager stated that he has plans to address the issue of personalisation of the bedrooms of residents. The bathroom on the first floor has been marked for refurbishment and the manager stated that this will happened before the end of the year. The shower/toilet on the ground floor was in need of attention. The lock on the door was not in place and there was an issue of spillages when the toilet is used. The manager stated that he has made the necessary referral to the occupational therapist to address the specific needs of residents. There were no odours in the home, but I was informed that staff have to regularly clean the toilet on the ground floor to ensure that it remains clean and free from odours. The manager stated that the lock was going to be repaired during the week following the inspection and a new set of locks has indeed been purchased for this purpose. I was informed that the work surface and the sink in the kitchen were also due to be replaced over the coming days. It had previously been noted that the sealant around the sink was not watertight and that there was water ingress into the kitchen cabinet. The home provided towel/paper dispensers for residents to use after they have used the bathrooms. The manager stated that there are plans to introduce a hands electric dryer as a result of the inappropriate disposal of the paper towels. First Choice Care Ltd 18 St Andrews Ave DS0000017493.V346079.R01.S.doc Version 5.2 Page 23 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 and 36 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides adequate number of staff to care for residents, but it was not very clear if the home was complying with the working times directives with regards to the shifts that staff were doing and therefore potentially putting staff and residents at risk. Recruitment procedures were not thoroughly applied to make sure that all members of staff have appropriate references before they are offered employment in the home. Members of staff in the home receive training but are not always up to date with regards to statutory training. EVIDENCE: There are normally one member of staff on duty. The manager stated that this number is adequate for the needs of the residents who are accommodated in the home. He added that more staff are brought in when residents have to be accompanied for appointments or when this is needed, such as during social occasions or when the needs of residents change. Residents stated that they were happy with the support that they receive in their daily life from the manager and his staff. First Choice Care Ltd 18 St Andrews Ave DS0000017493.V346079.R01.S.doc Version 5.2 Page 24 The duty rosters for October were kindly provided to the inspector. These addressed the staff rosters for both of the care homes, which belonged to the organisation. They showed that on many occasions staff spent 24 hours in the home or homes albeit with one or two sleep-in shifts. For example on one occasion one member of staff worked from 9am-3pm in one home then 3pm9pm in the other home, did a night sleep in, then worked 9am-3pm in the previous home. Although the sleep in duty shift is from 9pm –9am, the carer does not always go to sleep at 9pm as some of the residents are still up. They also do not wake up at 9am, as they have to support residents with their medicines and with regards to attending the day centres. There are also times when the carer has to wake up in the night to support residents when they wake up in the night. On another occasion one member of staff did 24 hrs in the same home with a sleep-in shift. Another member of staff finished his shift at 3pm and started a night shift without the statutory break of 11 hours between his working days. Guidance from the Department of Business Enterprise and Regulatory Reform indicates ‘that on-call time would be working time when a worker is required to be at his place of work. When a worker is permitted to be away from the workplace when on-call and accordingly free to pursue leisure activities, on-call time is not working time. http:/www.dti.gov.uk/employment/employment-legislation/employmentguidance/page28978.html . I was informed that very often staff request to work these shift patterns as this suit their lifestyles, but the registered person must check whether he is complying with the working times directives and must carry out risk assessment about the shifts that the carers are working to make sure that these are safe working practices and that residents are not being put at risk. The staff team has been quite stable since the last inspection. There was one new member of staff and the rest of the staff team have been in post for a number of years. It was noted that there were plans to reorganise the staff team and to create senior carers post with more responsibilities. The personnel files for 2 members of staff were inspected. All the records as required by legislation were in place except for having appropriate references in place. Both members of staff had testimonies addressed ‘to whom it may concern’, which were dated prior to them applying for the jobs and which had not been requested by the home. One of the employees did not have an application form and there was therefore no declaration with regards to having committed offences. He was recruited through an agency, but the legislation with regards to employment of staff in care homes, still places the manager and the provider as responsible to make sure that all checks are carried out as required. It was noted that there were no medical questionnaires and no monitoring as per equal opportunities practices. New members of staff were offered an induction to the home when they started work in the home. The recent member of staff has not started the First Choice Care Ltd 18 St Andrews Ave DS0000017493.V346079.R01.S.doc Version 5.2 Page 25 common induction standards as per Skills for Care, although this was available in the home. I was told that the member of staff would start straight away with an NVQ level 2 in care. The AQAA provided information that the home employs 6 carers and out of them 3 have an NVQ qualification in care. Another carer is working towards an NVQ qualification or higher. As a result the home does have 50 of its carers trained to NVQ level 2 or above. There was a training plan for the home and individual training plans for each member of staff. A number of training have been identified as necessary for each individual member of staff, to make sure that they are competent to care for residents who live in the home. The manager said that all members of staff have had fire training except for the new member of staff. Staff have not had manual handling training, infection control or accredited training in food hygiene as per its training plan. The proprietor stated that the home has purchased learning packs in Food Hygiene, Fire training and Protection of Vulnerable Adults. Areas for training that have been identified include training in mental health issues and care and managing challenging behaviour. All members of staff have had training in 1st Aid except for the new member of staff. Records also showed that staff were mostly receiving supervision every two months or at least six times a year. Staff said that they were happy with the training that they receive and the training that have been arranged for them in the future. First Choice Care Ltd 18 St Andrews Ave DS0000017493.V346079.R01.S.doc Version 5.2 Page 26 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 and 42 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The management of the home ensures that the home is run in an open and inclusive manner. The home has a quality assurance procedure, which is suitable for it to measure the quality of the service that it provides. Health and safety issues are addressed as appropriate to make sure that residents are safe. EVIDENCE: The manager has now been registered. He has also completed the Registered Managers’ Award and the NVQ level 4 in care. He has also booked training in Mental Health but has been keeping himself updated by doing his own reading. He runs the home in an open and transparent manner. There was evidence of staff meeting where residents were being encouraged to attend and residents meetings where residents were being encouraged to take the minutes themselves. Other initiatives to involve residents further in running the home First Choice Care Ltd 18 St Andrews Ave DS0000017493.V346079.R01.S.doc Version 5.2 Page 27 include involving residents in the recruitment of staff. The home is commended for progress achieved in this area. The home has a quality assurance procedure, which has been reviewed. As part of its quality control measures, a satisfaction survey and an annual quality audit are carried out. The manager stated that the satisfaction survey has been carried out for this year and that he was waiting for responses to complete the report summarising the findings of the survey. The home has decided to use the format of the AQAA, as a tool for self-assessment and to measure the quality of the service that it provides. It has updated its quality assurance procedure to reflect this. The management of the home is also proud that the home is IIP accredited. The home has most of the policies and procedures that have been detailed in the AQAA and which apply to the service, including one about the use of alcohol, drugs and cigarettes in the home. It was noted that not all of them have been reviewed and that according to the AQAA, some have not been updated since 2000 and 2002. As the policies and procedures form an integral part of the provision of a quality service these must be reviewed according to the timescale that has been established by the provider in its quality assurance procedure. All certificates were in place in the home to show that items of equipment were maintained. Safety checks, including fire detector tests and emergency lights tests were carried out. A fire risk assessment and a fire emergency plan were available for inspection. The issue with regards to exiting the home at the back, should the fire alarm be activated has been addressed. I was told that staff and residents should stay at the back of the home until the fire brigade get to them. The manager has also updated the health and safety risk assessment. First Choice Care Ltd 18 St Andrews Ave DS0000017493.V346079.R01.S.doc Version 5.2 Page 28 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 3 2 3 3 3 4 3 5 2 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 2 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 3 X 3 2 X 3 X First Choice Care Ltd 18 St Andrews Ave DS0000017493.V346079.R01.S.doc Version 5.2 Page 29 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 YA5 Regulation 5 Requirement The home’s contract/statement of terms and conditions that are offered to residents must be reviewed to make sure that these fully covered all aspects of the service that is provided. While awaiting certificated training in medicines the competency of new members of staff with regards to the management of medicines must be ascertained as per the national occupational standards for medication. As members of staff are at times working and on the premises for about 24 hours (including one or two sleep-in shifts), the registered person must check whether he is complying with the working times directives and must carry out risk assessment about the shifts that the carers are working to make sure that these are safe working practices and that residents are not being put at risk. To make sure that residents are protected by the home’s recruitment practices the DS0000017493.V346079.R01.S.doc Timescale for action 31/12/07 2 YA20 18(1)(c) 30/11/07 3 YA33 18(1) 30/11/07 4 YA34 19(1) 30/11/07 First Choice Care Ltd 18 St Andrews Ave Version 5.2 Page 30 5 YA35 18(1)(c) registered manager must ensure that appropriate references are in place before offering employment to an applicant. The relevant application form must be completed when an applicant applies for a job as per the recruitment procedure. The registered person must consider the provision of more formalised training in food hygiene and health and safety (Repeated requirementtimescale 15/10/06 partly met). The registered person must ensure a review of policies and procedures in the home (Repeated requirementtimescale 15/10/06 partly met). 31/03/08 6 YA40 10(1) 31/12/07 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 YA5 YA9 Good Practice Recommendations It is recommended that some form of invoicing be used for residents who have to pay a contribution to the fees to make the records more comprehensive. That the way residents’ personal finances are managed be detailed in their care plans to enable a person reading the record make a judgement as to whether this is appropriate. It is recommended that each resident have a book to maintain individual financial records instead of one book with different sections for each resident, to ensure confidentiality of these records and to facilitate auditing of the financial records of residents. It is recommended that the knowledge of all members of staff with regards to the whistle blowing policy be reviewed to make sure that they are familiar with this policy. DS0000017493.V346079.R01.S.doc Version 5.2 Page 31 3 YA23 4 YA23 First Choice Care Ltd 18 St Andrews Ave 5 6 YA24 YA24 That the use of flowers and shrubs is considered to enhance the garden at the back of the home. A number of areas have been identified with regards to the environment that the home provides which should be attended without delay: • Disposal of the carpet and other rubbish in front of the home • Replacement of kitchen work surface and sink • Repair of the lock on the door of the shower/toilet on the ground floor • Refurbishment of the bathroom on the first floor • The use of electric hand dryers for bathrooms/toilets • Provision of internet access to the computer in the communal areas • Ensuring that the dining area in the lounge is made more congenial Consideration should be given to request that applicants complete a medical questionnaire and an equal opportunity form as part of the recruitment process. The registered person should make sure that staff have manual handling and infection control training to make sure that they can fully attend to the needs of residents. 7 8 YA34 YA35 First Choice Care Ltd 18 St Andrews Ave DS0000017493.V346079.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 First Choice Care Ltd 18 St Andrews Ave DS0000017493.V346079.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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