Care Home: Forest Drive Rest Home,

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What the care home does well One of the benefits of this being quite a small home is that this makes it easier for staff to get to know people well, to better respond to their needs and wishes. Staff were noted to be attentive to residents. Another benefit is that the food is not mass catered and has a nice "home cooked" quality, there is plenty of choice and snacks are always available. The environment is nice for people to live in and they are encouraged to bring their important possessions to make their bedrooms more homely. The picture menus that have been developed are helpful for residents when they are choosing their meal. The activities, and life story and memory work that the home does with residents are excellent. The policies we saw were well thought out and clearly written. There is a thoughtful approach to staff reward and incentive. What has improved since the last inspection? The registered manager told us in the AQAA that continuous improvement is taking place in the home and we saw evidence of this in the improvement of records, activities available and improvements in staff levels and staff training. The management team are very responsive to suggestions for improvement and quick to take action to improve the service. The Service User Guide has been re-written with pictures so it makes it easy for residents to read and understand. It has also been re-written to include more information about how equality and diversity are promoted in the home. The way in which the daily notes about the residents were kept had been improved and is now kept in a way that provides a very easily accessible record of the care and support that resident`s are receiving and how they are spending their days. What the care home could do better: The references for staff need to be verified and the medication returned to the pharmacist monitored more closely. Staff training has improved and could be further improved with a better balance of training provided outside and inside the home. CARE HOMES FOR OLDER PEOPLE Forest Drive Rest Home, 2-4 Forest Drive East Leytonstone London E11 1JY Lead Inspector Caroline Mitchell Unannounced Inspection 10:00 16 May & 4th June 2008 th X10015.doc Version 1.40 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 Forest Drive Rest Home, DS0000007239.V364136.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 Older People. 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. Forest Drive Rest Home, DS0000007239.V364136.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Forest Drive Rest Home, Address 2-4 Forest Drive East Leytonstone London E11 1JY 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) 020 8925 4805 020 8281 2343 forestdrive@hotmail.co.uk Mr Nadeem Diwan Mr Nadeem Diwan Care Home 19 Category(ies) of Dementia - over 65 years of age (19), Old age, registration, with number not falling within any other category (19) of places Forest Drive Rest Home, DS0000007239.V364136.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. These categories to be used flexibly between 19 beds. Date of last inspection 4th December 2007 Brief Description of the Service: Forest Drive care home is registered to provide personal care and accommodation for up to 19 people over the age of 65. The home is registered to provide care to both physically frail older people and those with dementia. The home is not registered for nursing care. The home is a family run concern and a number of family members work in the home. The registered manager and deputy are brothers and their parents are involved in the running of the home. The property consists of two adjoining house which have been adapted for the purpose. The home is situated in a residential area close to Whipps Cross Hospital. There are good public transport links and there is limited car parking to the front of the property. Since the last inspection the development of the adjoining property and the refurbishment of the original property have been completed. There are now 19 single rooms of good size, with 17 rooms having en-suite facilities. There are several lounges and one dining room. There is an accessible garden. The fees are normally between £525-£625 per week with some extra charges for personal items. Following “Inspecting for Better Lives” the provider must make information available about the service, including inspection reports, to the people who use the services and other stakeholders. Forest Drive Rest Home, DS0000007239.V364136.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 this service is 2 star. This means that people using the service experience good quality outcomes. This inspection was done over 2 days, the inspector returning for the second day after the registered manager had returned from completing a training course. The registered provider, Mr Nadeem Diwan who runs the home on a day-to-day basis, and is also the registered manager was present and helpful throughout the 2 visits. The deputy manager was involved on the first day and came across as very well organised. We spoke to several residents, several staff and some relatives who were visiting at the time of the inspection. We looked at the written records, and some of the policies and procedures in the home including the Statement of Purpose and Service User Guide, residents’ records, care plans and risk assessments, staff personnel records, medication, complaints, accidents and maintenance records. We took the information provided by the home in the annual quality assurance assessment (AQAA) into account as part of the inspection. The AQAA is a self-assessment that the provider fills in to let us know about their service and how well they consider that they are meeting the needs of the people that they are caring for. It also gave us some numerical information about the service. We particularly focussed on how the home safeguards people from abuse. What the service does well: What has improved since the last inspection? The registered manager told us in the AQAA that continuous improvement is taking place in the home and we saw evidence of this in the improvement of records, activities available and improvements in staff levels and staff training. The management team are very responsive to suggestions for improvement and quick to take action to improve the service. The Service User Guide has Forest Drive Rest Home, DS0000007239.V364136.R01.S.doc Version 5.2 Page 6 been re-written with pictures so it makes it easy for residents to read and understand. It has also been re-written to include more information about how equality and diversity are promoted in the home. The way in which the daily notes about the residents were kept had been improved and is now kept in a way that provides a very easily accessible record of the care and support that resident’s are receiving and how they are spending their days. 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. Forest Drive Rest Home, DS0000007239.V364136.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Forest Drive Rest Home, DS0000007239.V364136.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home about them and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract/statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. EVIDENCE: The registered manager said the home doesn’t accept emergency admissions. Prior to people moving in, the registered manager visits potential residents to make sure that the home will be suitable for their needs. He completes a preForest Drive Rest Home, DS0000007239.V364136.R01.S.doc Version 5.2 Page 9 admission assessment form, which was kept in their written records and there was also a copy of the Care Manager’s assessment. We looked at 3 residents’ files, including the person who had moved in recently. The needs assessment included information about their medical and social history background and details of specific care needs such as dietary plan, psychological, healthcare and mobility needs. We spoke to a relative of a resident who had not been in the home very long and they said that they felt happy with the way the resident had been admitted. A personal profile questionnaire had been completed with the resident or someone close to them to find out details about their family history and any other significant events in their lives. This is good practice as such information can be particularly useful to staff when working with people who have dementia or memory loss. Potential residents are then be invited to the home, for a visit, to see if they liked it, to look at the room that they would have and meet other residents. The registered manager said that he likes them to stay for a meal. We looked at the Statement of Purpose for the home, which sets out the aims and objectives, and how it is intended that care will be delivered. A Service User Guide has also been produced and we noted that residents have a copy of this in their bedrooms. This is intended to be a “guide book” to the home and sets out all of the services that will be provided. As some of the residents in this home have some degree of dementia, at the last inspection it was recommended that the Service User Guide and any other information that is intended for residents should be produced in a format that is more suitable for their abilities. At this inspection we noted that the Service User Guide has been written in clear language and produced with pictures to help make it easy for people to read and understand. The managers had looked at guidance from Age Concern and the Service User Guide has been re-written in a way that makes sure that people are clear about the homes approach to all areas of equality and diversity. Forest Drive Rest Home, DS0000007239.V364136.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine the care home supports them with it, in a safe way. Peoples’ right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. EVIDENCE: We looked at 3 people’s written records in some detail and those residents were also spoken with. Each resident had an individual care plan and these were in good order, well organised and well presented. They provided a very good profile of the care and support that each person needed so that the staff that are supporting them know how this should be done. We noted that where residents were reluctant to accept support with their personal appearance, such as not wanting to part with worn out clothing, this was noted as part of their care Forest Drive Rest Home, DS0000007239.V364136.R01.S.doc Version 5.2 Page 11 plans. Different approaches were being tried, which took peoples’ choice, pride and dignity into account. There was evidence of input from other healthcare professional as required. Resident’s healthcare needs are monitored regularly and any changes are identified and addressed. Regular reviews take place on a monthly basis with a more formal review every six months. There were Health Care Plans in place for each person. These were of an acceptable standard, although the registered manager said he is looking for way to improve them. Additionally, the registered manager spoke about the need for consistency in the lives of the residents, particularly those that have dementia. He showed us evidence of the work that he has been doing to make sure that it is usually the same people who come into the home each time, especially those providing health care services, such as dentists and chiropodists. This is so that they are recognised by residents and can build relationships with them. At the last inspection it was recommended that some thought should be given to collating day-to-day information into one file for each person. At this inspection the way in which the daily notes about the residents were kept had been improved and was being kept in a way that provided a god record of the care and support that resident’s receive, their welfare and how they are spending their days. This makes it easier to monitor the welfare of each person in all aspects of their daily lives. There is a key worker system in place and several of the residents we spoke to knew who their key worker was. There are key worker forms in place that prompt staff to look regularly at whether residents need clothing or something for their room. Risk assessments about how to protect residents’ health and safety were up to date and informative. They covered key areas such as fall prevention and reflected the individual mobility needs of each person. 1 care plan included specific risk assessments for supporting one person’s social behaviour. The registered manager said that none of the residents are able to take their medication independently although lockable facilities are available in each bedroom should a person want to do this and have been appropriately assessed. The home uses a monitored dosage system, with most medication being delivered in blister packs by the dispensing pharmacist from Boots. Medicines are stored appropriately in a mobile locked cabinet and the administration records that we looked at were up to date and signed accurately. A staff member was seen administering medication in a safe manner and said that Boots had provided their medication training. She was able to describe clearly what they had learnt and had some good knowledge of the medicines that people were prescribed. There were no controlled drugs being stored or administered at the time of the inspection. We noted that the medication fridge had the temperature displayed on the door for ease of monitoring. The residents’ photographs were on their medication charts. The staff member showed us the medication that needed to be returned to the Forest Drive Rest Home, DS0000007239.V364136.R01.S.doc Version 5.2 Page 12 pharmacist. We noted that there was room for improvement in monitoring the amounts returned and a requirement is made about this. Several residents need minimal help with their personal care. Staff were observed to be very attentive to residents, kind, polite and caring throughout the course of the inspection. At the last inspection the registered manager was required to make sure that consultations between residents and other healthcare professionals were not undertaken in other resident’s bedrooms, as a visiting optician had gone into someone’s room by mistake. At this inspection we found that the registered manager had dealt with this issue. Forest Drive Rest Home, DS0000007239.V364136.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. People are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities and excellent work is being put into helping people keep active in both body and mind. The focus on providing choices for people is also very notable. People have nutritious and attractive meals and snacks, at a time and place to suit them. EVIDENCE: There was lots of evidence that residents are encouraged to make decisions regarding how and where they spend their day and they are able to socialise with other residents and with staff. An activity programme is offered. On both days of the inspection the atmosphere in the lounge was very friendly with some residents engaging in activities while others chatted together. Forest Drive Rest Home, DS0000007239.V364136.R01.S.doc Version 5.2 Page 14 As noted in the last inspection report, life history books have been developed with the help of residents and their family and it was evident that staff put a lot of effort into making these very personal to the residents. Those seen were of an excellent standard and included pictures and photographs. The registered manager and staff are again commended for the effort that they have put into these. The registered manager displayed an enthusiasm and understanding of the benefit of undertaking this sort of life history work and the books are used both as the basis for reminiscence and also they have allowed staff to gain an in-depth knowledge of the people that they are caring for. In addition to the life story books for each resident there were a number of books of photographs that were used by staff to chat with residents and to help with memory work. They were very well presented and labelled and showed the kinds of activities that the residents are encouraged to be involved in. Recent pictures included a visit to the West End, a trip to a Museum, residents and staff dancing, residents and staff gardening, enjoying snow in the garden, a firework night party, several birthday celebrations, residents doing chair based mobility exercises in the lounge, a Halloween party, residents doing cooking and craft sessions, a visit by local school children, visits by a local choir, residents out shopping, various relatives visiting, a cheese and wine tasting and a cake and sherry tasting. At the time of the first inspection visit a delivery of craft materials, activities and games had just been received and at the second visit we were able to see the lovely ceramics that residents had been painting with the support of the staff. The registered manager said that the home had invested in lots of DVDs of Britain in the 1940’s, 50’s and 60’s and some 1950’s Radio Hour CD’s. Throughout the inspection we saw staff were engaging residents in conversation and activities at every oportunity. There were notices displayed around the home about the planned activities. There were nicely presented pictures of the staff and residents displayed around the home and the notice boards displayed details of day centres, clubs in the local area and religious groups such as the local Afro Caribbean church group. There were also pictures of, and contact details for the dentist, chiropodist, hairdresser and mobile clothing shop. Residents are encouraged to maintain contact with family and friends and it was evident from the numerous photos seen that many residents are able to do this. There is a quiet lounge where residents could take their families if they wished to be alone with them. We spoke to 2 residents’ relatives who were visiting and the feedback was very positive. They said that they were kept informed about the welfare of their relatives by the home and made to feel welcome. 1 person said that since moving into the home their relative had become much more alert and responsive and this was probably due to the very good level of stimulation they were experiencing in the home. 1 resident said her family visit her regularly. She said “ the food I good, I like the food.” We Forest Drive Rest Home, DS0000007239.V364136.R01.S.doc Version 5.2 Page 15 spoke with another resident, who was reading his newspaper. He also said the staff were good and the foods was good. The key workers do monthly reports of people’s patterns of engagement and activities and the food they eat. The registered manager monitors these and does a review 6 monthly; he said this helps in monitoring changes in people’s needs and deciding if there is a need for a different approach, or room for improvement. There was plenty of fresh fruit and vegetables as part of the menu. All of the residents that were spoken with said how much they enjoyed the food served in the home. Menus were seen and are varied and there is always a choice. Picture menus have been developed to help people who have difficulty understanding what is being offered to them. The menu board shows the additional snacks, such as soup and a sandwich, which can be served at any time of the day if a resident is hungry. We stayed for lunch and sat with residents and chatted. The meals were appetising and well presented and the atmosphere was relaxed and pleasant. The staff were very attentive, checking if residents were comfortable, happy with the food and offering lots of choices. Forest Drive Rest Home, DS0000007239.V364136.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. EVIDENCE: There is a complaints procedure and some residents said knew that they could raise any concerns with the registered manager or with other staff. The relatives we spoke to were clear who they would complaint to; although they said they had no concerns to raise at the time of the inspection. The registered manager showed us the record of concerns, complaints and compliments kept by the home. There were a small number of minor concerns recorded and the records showed that these had been responded to and resolved promptly. We also saw a thank you card and a letter recently sent to the home by a resident’s relative. At the last inspection a requirement made to make sure all staff had training and to improve the training so that all staff understand the steps that must be taken should they have any concerns relating to adult abuse. At this inspection we spoke to 2 staff members at length about this subject. They were both speaking English as a second language. However, they were clear about the concept of protecting residents from abuse and were able to explain the action they should take if they suspect or witness abuse. The registered Forest Drive Rest Home, DS0000007239.V364136.R01.S.doc Version 5.2 Page 17 manager showed evidence that he has been working on this area. He said that staff go through policies and “No Secrets” as part of induction and are asked questions to be clear they understand. The homes approach to residents’ rights and safeguarding people from abuse have been discussed at team meetings and supervision. “I just keep drilling it into them.” Records reflected that staff had either done the training or, in the case of newer staff, were booked to do it. The registered manager provided evidence that the next training session had been arranged to take place on 17th June. We looked at the adult protection procedure and the whistle blowing procedure, both were written very clearly. The registered manager showed us the Local Authority policy and procedure and tool kit for referral/alerting. Although he has not had to use it, he was clear what the process should be. The registered manager said there is management cover every day and he does unannounced nighttime monitoring visits. He talks about training when staff have done it, to make sure they understand. He said that most of the residents are able to say if something is wrong or they see something they don’t like and he talks to residents daily to see if they are OK. “Several do let you know what’s going on.” There was evidence that there are regular residents’ meetings and the complaints procedure is in the Service User Guide, a copy of which was in all residents’ bedrooms. Forest Drive Rest Home, DS0000007239.V364136.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. EVIDENCE: The registered manager showed us around the home. There was a nice, private and secure garden with water fountain and nice garden furniture. The paved areas have been well thought out so that residents can get around it with ease. The office is in a separate outbuilding and the registered manager said he has plans to use the other out building as a larger laundry room. The entrance to the home is welcoming, with photographs of the residents living in Forest Drive Rest Home, DS0000007239.V364136.R01.S.doc Version 5.2 Page 19 the home and the staff who work there, handrails and ramps are in place and a passenger lift. Most residents were sitting in the conservatory. This is the lounge and dining area and wraps around the back of the building. There was big clock in the conservatory, to help people be aware of the time. There was a large hatch through to the kitchen and they can see what’s going on and talk to the staff in the kitchen. The 24-hour menu board showed what snacks were available outside of the regular mealtimes. There is another small, enclosed patio with table and seating and the registered manager said that sometimes it is used for special meals for residents. There is another quiet lounge leading off the main area. This is where people can have a quiet moment or see their relatives. It has a TV and music centre. We saw most of the residents’ bedrooms and each was nicely decorated, and most had lots of their personal items displayed and lots of family photographs. Residents’ pictures were on their bedroom doors. At the last inspection it was recommended that consideration should be given to replacing bed linen to make it more comfortable for residents. The registered manager said they’d recently put new mattress protectors on all of the beds and replaced a lot of the beds, bed linen and duvets. We also noted that people’s bed linen was individually labelled. There is a small room for staff to write up daily records, and where they can keep their coats and bags securely. The staff notice board had posters showing the training scheduled. There is a hairdressing room, which leads onto a wheelchair accessible wet room with a toilet. The registered manager said that a button flush on the toilet to see if it easier for residents to manage. The door frames for toilets are all the same colour to help residents recognise them and there were pictures of toilets on the doors. Most of the radiators were covered. 1 bathroom, needs a radiator cover, so it was not in use at the time of the inspection. The registered manager said this did not cause difficulty, as there were several other bathrooms and toilets available. There is a library room. It was nicely decorated and there was an old fashioned gramophone. It is opposite a small room that is equipped to make drinks. The home is registered to provide care to people who are physically frail and who may have a diagnosis of dementia. During the planning and development of the extension thought and attention was given to the layout and design of the communal areas in order to ensure that people are able to walk round both the house and the grounds in safety. At the last inspection a concern was raised about the fact that the door from the conservatory, a designated fire exit, is locked and all staff members have a key. Advice has been taken from the Fire Safety Officer who agreed that it is acceptable, due to the confusion of some of the residents. At the last inspection the registered manager was required to make sure that Forest Drive Rest Home, DS0000007239.V364136.R01.S.doc Version 5.2 Page 20 If residents wish to keep their bedroom doors open, an automatic closer is fitted so that the door shuts in the event of a fire. He was required to make sure that there is an operational call system in all residents bedroom and in communal areas so that assistance can easily be summoned, and he was also required to make sure that there is a procedure in place so that routine maintenance is dealt with in a timely manner. At this inspection we found that the registered manager has dealt with all of these issues. Automatic closures have been fitted where necessary, the call bell system was in place, and staff were regularly monitoring whether they were working, and the registered manager showed us the plan for maintaining the home. This is clear and addresses all of the necessary repair, replacement and maintenance issues. The registered manager says he uses local contractors. During the tour of the building we noted that the home was in a good state of repair, clean and free from offensive odours. Forest Drive Rest Home, DS0000007239.V364136.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. EVIDENCE: In the AQAA the registered manager told us that, “On recruitment we take 2 references, work history, CRB, photo, a duly filled application form and disclosure of any adverse medical problems into account.” At this inspection we looked at the personnel files for 3 staff and noted that each person had completed a written application. The home had received CRB details in respect of each person, and POVA 1st where this was necessary, prior to them starting work. There was evidence of their right to work in this country. The home had received 2 written references for each staff member and a recent photograph was included in their file. However, although the home had received at least 2 written references for each staff member, some were not on headed notepaper or verified as from their last employer. A requirement is made about this. The application for 1 staff member had some unexplained gaps in employment and in response to this issue, the registered manager showed us a newly modified application form, which now makes it clear that all gaps in employment must be accounted for. Forest Drive Rest Home, DS0000007239.V364136.R01.S.doc Version 5.2 Page 22 Staffing levels were good at both visits. At the last inspection it was recommended that staffing levels should be increased to provide more opportunity for staff/resident interaction. Since the last inspection the registered manager has introduced extra care hours in the morning, from 7am to 10 am and in the evening, from 5 pm to 8 pm. Many of the residents were self-caring and needed only prompts, but some needed direct personal care. They were all able to move around the home with minimal assistance. The appointment of extra staff has enhanced the lives of the residents, enabled an increase in the range of activities that they are offered and allowed more time for resident/staff interaction. There is one member of waking staff on duty at night with another one “on call”. This person is usually the deputy manager, who lives on the premises, and is called if assistance is needed. We saw very clear monitoring records, which were kept by the night staff about the checks they were doing and care provided, along with accident and incident records. No particular incidents had taken place, or concerns had arisen since the last inspection. The registered manager showed us records of regular unannounced night visits that he undertakes as part of monitoring if residents needs are being met and that they are kept safe. He was clear that staffing would be increased at night if residents needs changed to required more night time support. We met a trainer in food safety from Waltham Forest College who was visiting as the home as it is working towards “Safer Food Better Business” from Food Standards Agency. She was monitoring the progress made and said that she was impressed by the staff in the home as they were producing very good records, which demonstrated their awareness well. Staff training is in place however; much of this is undertaken using videos followed by a written “multiple choice” test. A recommendation is made about making sure that staff receive training from a good mix of sources. The registered manager said he talks to staff to make sure that they have a clear understanding the training and remember it in the future. He has offered support to the people who need it regarding written and spoken English by helping them to find appropriate courses and encouraging them to attend. The registered manager said that, since this was noted at the last inspection, he is making sure that he appoints people with a good understanding of the English language. At the last inspection the registered manager was required to make sure that Training must be improved so that more staff have achieved at least NVQ level 2, in order to ensure that residents are receiving the best possible care and support and to make sure that the methods for delivering staff training be improved to ensure that staff understand it. At this inspection we found that the staff who have not completed training to NVQ level 2 are either doing the course or booked to do it. 1 person is starting training at NVQ level 3. Forest Drive Rest Home, DS0000007239.V364136.R01.S.doc Version 5.2 Page 23 The staff we spoke to said they were happy and well supported by the managers in the home. The registered manager rewards good performance and gives staff incentives, such as presents at birthdays and when they have stayed a certain time with the home. This helps to retain staff’s interest and keeps a consistency for residents. Forest Drive Rest Home, DS0000007239.V364136.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 37, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have confidence in the care home because it is led and managed appropriately. If residents or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. Forest Drive Rest Home, DS0000007239.V364136.R01.S.doc Version 5.2 Page 25 EVIDENCE: Met the deputy. Seems very well organised. The registered manager has run the home for some years and is very knowledgeable about the client group, including those people with dementia. The residents were obviously very comfortable with him and engaged him in conversation constantly. We spoke to at least 4 staff and all said there are regular meetings for staff so that they are aware of what is happening the home and also with residents so that they can air their views and influence that care being provided. If the resident is not able to manage their own affairs the home encourages their relatives to take responsibility for financial management although, in a number of cases the home manages residents’ finances. There is a system in place to account for all monies received or spent on behalf of residents and a sample of these accounts were checked during the inspection. They were easy to understand and accurate. There is a quality assurance programme in place and questionnaires are sent both to relatives also to the residents. At the last inspection the registered manager was required to make sure that results of surveys undertaken to monitor the satisfaction of residents are collated and used to influence the service that they receive. At this inspection there was evidence available to show that the results of theses questionnaires are collated and action taken to address any concerns. It is worth noting that the feedback that the home were receiving was generally very positive. The way in which the daily records about residents are set out also provides very good monitoring information that the registered manager uses as part of the quality monitoring process. At the last inspection the registered manager was required to make sure that untoward incidents and accidents are monitored as part of the audit to show that the home is sufficiently well staffed. At this inspection records of accidents and incidents occurring in the home were seen and were recorded appropriately. Records of any incidents affecting the wellbeing of residents are being forwarded to The Commission as required. As noted in NMS 28 of this report, records of any untoward incidents are kept and monitored as a part of the audit process to provide evidence that there are sufficient members of staff on duty to support residents. The Annual Quality Assurance Assessment document states that all equipment and services are appropriately maintained. We saw several very clear, wellwritten policies and procedures and the quality of the written records was generally very good. Forest Drive Rest Home, DS0000007239.V364136.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X 3 3 Forest Drive Rest Home, DS0000007239.V364136.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO 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 OP9 Regulation 13 (2) Requirement The registered person must make sure that the system for returning unused medication to the pharmacist is improved to make sure the correct amounts are being returned. The registered person must make sure that the references supplied for job applicants are properly verified. Timescale for action 30/06/08 2. OP29 17, 19 (1) (c) Schedule 2 30/06/08 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. Refer to Standard OP30 Good Practice Recommendations It is recommendation that the registered person makes sure that staff receive training from a good mix of sources, both in the home, and though external trainers. Forest Drive Rest Home, DS0000007239.V364136.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Forest Drive Rest Home, DS0000007239.V364136.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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