Care Home: Fouracres Care Services

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What the care home does well The two residents were able to tell us that they like the home and that the staff have good relationships with them. The home provides a good standard of care and support to two people with a range of complex needs. Residents are supported to have their individual needs met by a key working and care planning system. They are offered access to a range of structured activities and support with education and employment aspirations which they said they really enjoyed. The home is comfortable and homely and the residents each have a single bedroom that is personalised to their taste. Residents are supported to maintain positive contact with their relatives. What has improved since the last inspection? All requirements made at the last two inspections in 2007 have been completed. The home has continued to improve the service offered to the residents there. The manager showed us improved care plans and risk assessments, improved daily recording of residents` wellbeing and improvements in their lifestyles. What the care home could do better: The owner of the home needs to carry out monthly monitoring visits and write a report on the home which must be sent to the manager every month. This is required so that the owner can ensure that the home is running smoothly. There was one staff member who had been employed with no Criminal Records check and with a reference that needed to be followed up to check the status of the referee. This person was therefore not yet assessed as suitable to work in the home. The home need to ensure that no new staff are allowed to work in the home before full checks on their suitability have been received. An immediate requirement was issued to ensure this staff member is supervised at all times until the results of the checks are received. CARE HOME ADULTS 18-65 Fouracres Care Services 47 Fouracres Enfield Middlesex EN3 5DR Lead Inspector Jackie Izzard Key Unannounced Inspection 21st October 2008 09:15 Fouracres Care Services DS0000053227.V372855.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 Fouracres Care Services DS0000053227.V372855.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. Fouracres Care Services DS0000053227.V372855.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fouracres Care Services Address 47 Fouracres Enfield Middlesex EN3 5DR 020 8292 4823 020 8216 1306 4acres@tiscali.co.uk 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) Mrs Philomena Chikwendu Okoron-Kwo Mr Simon Keith Atkins Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Fouracres Care Services DS0000053227.V372855.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th October 2007 Brief Description of the Service: Fouracres is a small home registered to provide a service to four adults who have a learning disability. Ms Philomena Chickwendu Okoron-Kwo owns the service. The registered manager is Simon Atkins. The service is an end of terrace house with three floors. The ground floor consists of a kitchen, lounge/dining area and one bedroom. On the first floor there are three further bedrooms and an office/sleep-in room. On the top floor in a loft conversion there is an office area. The home is located in a quiet residential area of Enfield, near to Brimsdown station and is a short distance from local shops and public transport. The stated aims of the home are to provide support to people with special needs in a safe and secure environment’. The weekly fees in the home range from £1268.78 to £1922.40 per week. The provider must make information available about the service, including inspection reports, to people living in the home and other stakeholders. Fouracres Care Services DS0000053227.V372855.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 3 star. This means the people who use this service experience excellent quality outcomes. The inspection took place on 21 October 2008 and was unannounced. The inspection lasted for one day. We were able to meet and spend time speaking to the two residents living in the home both in the presence of staff and privately. We were also able to meet and speak to the registered manager, a relative of one resident and a member of staff. We looked around the home and also looked at the two residents’ files, staff records and other health and safety documentation. We also used information provided by the manager to assess the home in completing the inspection. What the service does well: The two residents were able to tell us that they like the home and that the staff have good relationships with them. The home provides a good standard of care and support to two people with a range of complex needs. Residents are supported to have their individual needs met by a key working and care planning system. They are offered access to a range of structured activities and support with education and employment aspirations which they said they really enjoyed. The home is comfortable and homely and the residents each have a single bedroom that is personalised to their taste. Residents are supported to maintain positive contact with their relatives. Fouracres Care Services DS0000053227.V372855.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Fouracres Care Services DS0000053227.V372855.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fouracres Care Services DS0000053227.V372855.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be assured their needs and aspirations are assessed and known by the home and that there are clear terms and conditions which their representatives have agreed to. EVIDENCE: We inspected the assessments for both residents. These were comprehensive and addressed their needs and wishes in all areas of their lives. Changes in aspirations have been added to the records. Clear contracts with terms and conditions of the placement are in residents’ files. They have signed these along with their representative and the manager of the home. Fouracres Care Services DS0000053227.V372855.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents’ changing needs are recorded in an individual plan for their care and they are supported by risk assessments which all staff have been made aware of. EVIDENCE: Both residents had a comprehensive care plan detailing their needs and wishes in all areas of their lives. These contain detailed guidance for staff regarding aspects of personal care, outlining what the resident can do for themselves. This is very positive as it encourages residents to develop independence wherever possible. Both plans had been reviewed twice in 2008 to ensure they were still relevant for the resident. Risk assessments were also comprehensive and include clear steps to follow if a resident should go missing form the home. Staff have signed the risk assessments as evidence that they have been informed about the content. One resident goes out alone and is supported to take risks as part of an Fouracres Care Services DS0000053227.V372855.R01.S.doc Version 5.2 Page 10 independent lifestyle. At the same time staff are clear what the risks are and actively support and educate the resident on issues such as keeping safe and appropriate behaviour in public. We were able to spend some time in the company of the manager and staff with a resident and to observe interaction by the manager and staff with both residents. Residents are treated as adults and spoken to with respect. Their opinions are sought and the manager showed a commitment to high standards of care and support to both residents. The manager and a resident were able to give examples of residents being consulted on issues affecting the home and we saw records of regular residents meetings. Each resident has an allocated key worker to support them with their plans and wishes. Fouracres Care Services DS0000053227.V372855.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13,14, 15, 16, 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents of this home are supported to live a good quality lifestyle where they are supported to take part in activities in the community, develop more independence and work towards their goals. EVIDENCE: One resident told us s/he has been supported to access adult education and has completed courses in gardening and computing. The manager said that this resident has also completed a preparation for work course. Currently staff are supporting this resident in finding employment. From discussion with the resident, the manager and viewing the records, it was evident that the resident was receiving a high level of support and encouragement from staff to meet his/her employment aspirations. Residents told us they regularly took part in activities they enjoyed. Both use a service in Enfield which provides supported leisure activities. Fouracres Care Services DS0000053227.V372855.R01.S.doc Version 5.2 Page 12 One resident enjoys a walk in the park group and drumming class. The other said s/he is enjoying an art class and showed us the art work s/he had produced. A recommendation made at the last inspection to organise more leisure activities in the winter had been met. The manager was able to tell us of events recently attended and planned for the next few weeks. At home, both residents said they liked music, television and spending time in their rooms. One said that she enjoyed health and beauty activities. During the inspection staff supported this resident with make up and a manicure. Other activities recorded as taking place were cinema visits, library, swimming and use of local gym. Residents are encouraged to take part in domestic tasks and develop their domestic skills. One resident said, “ they cook for me and tell me to water the plants,” and the other said “I tidy my room and they help me,” when asked what staff do for them. Staff support residents to maintain relationships with their relatives and one file included dates of family birthdays so that staff could support the resident to send birthday cards. One resident said, “I love my family and I like it here.” Both residents said that they liked the food and could eat meals they liked. Records of food provided showed the diet was varied and healthy. Residents have been provided with support to meet their religious needs. Both residents said they were very happy in the home and with their lifestyles. Both have relatives who see them regularly. The home encourages this. On the day of the inspection one resident was having a placement review when we arrived and we saw that the relative was present. The relative told us that this resident was happy in the home and that the manager had made improvements. Both residents have a contract outling their rights and responsibilities which is individualised. One resident is supported to keep a daily diary and the daily records kept by staff record what residents did, what they ate and any concerns. This was an effective way of monitoring their wellbeing. Fouracres Care Services DS0000053227.V372855.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Resident are well supported with their individual personal care, health and medication needs. EVIDENCE: Residents appeared very well presented with care taken with their personal appearance. This indicates a good standard of support with personal care. They are also encouraged to be independent where able in their personal care and detailed guidance is recorded for staff on how to do this. A resident who likes to wear make up is supported with this. Health care records were of a good standard. A health checklist shows what health professionals are involved with the residents and what appointments they have attended in the last year. This gives a useful overview of the person’s health. Records showed that both residents see dentist, opticians and their GP regularly. One sees a psychiatrist and the other a chiropodist. Fouracres Care Services DS0000053227.V372855.R01.S.doc Version 5.2 Page 14 The manager is trained to assess staff competency in administering medication. Both residents have a medication profile detailing the medication they take and the reason for it. Medication is stored safely and the records were completed appropriately. Both residents have some medication which is to be taken as and when needed. Clear written protocol is recorded for both residents to guide staff as to when, why and how this medication is given. Records showed that gender related health checks were attended by residents with support from staff. They are weighed regularly and have strategies in place to maintain a healthy weight for them. Fouracres Care Services DS0000053227.V372855.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have access to a user-friendly complaints procedure and they are protected by staff trained in safeguarding topics. EVIDENCE: There were two complaints recorded in the complaints book since the last inspection. These had been resolved. Residents have a user friendly version of the complaints procedure so that they can understand what to do if they want to complain. Staff have been provided with training in safeguarding procedures and evidence of this training was seen during the inspection. One member of staff confirmed to us that she had completed this training. There was a written safeguarding procedure in the home to guide staff. Procedures to protect residents were also in place, eg what to do if a resident goes missing, what support to provide to residents to help them change their behaviour or to reduce risks to their safety in the community. Fouracres Care Services DS0000053227.V372855.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in an environment which provides suitable space and facilities and is homely and comfortable. EVIDENCE: We were able to inspect all the rooms in the home plus the garden. The standard of hygiene was good throughout the home. There are suitable laundry facilities for residents to use. Residents’ bedrooms were personalised with their own televisions, DVD players and other possessions. One resident said that s/he had chosen the décor for the bedroom and was really happy with it. The other said how much s/he liked to spend time in the bedroom. The rooms were comfortable and well furnished. The lounge and bathrooms were also suitable for the residents and homely in appearance. Fouracres Care Services DS0000053227.V372855.R01.S.doc Version 5.2 Page 17 The kitchen was dated and tiles needed replacing but the manager explained that a refurbishment of the kitchen had been delayed pending a decision as to whether to build an extension to the home. The home has a spacious concrete garden which is being developed. There is a shed designated as a smoking area and the manager had plans to make the garden a more attractive place for residents to use. There are currently two offices in the home. One bedroom opens onto an office. The manager said this may be changed in the future. The other office is in a loft extension and the ladder is not safe for residents to use. For their own safety they are not allowed in this office at any time. Fouracres Care Services DS0000053227.V372855.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35, 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from staff who are trained and supervised but may not be protected by the home’s recruitment practices as one staff had not been properly vetted for suitability at the time of the inspection. EVIDENCE: We looked at staff training and supervision records and found that staff were well trained and supported to carry out their duties. Training records were up to date and showed relevant training was planned and provided. The manager works alongside staff as a role model and advises them on best practice in meeting the residents’ needs. We spoke with one staff member who said s/he was happy working in the home and was supported by the manager. S/he was able to tell us the training s/he had attended and had previous experience of working with people with learning difficulties and additional needs. We also asked both residents for their views on the staff. They both indicated that they had good relationships with staff. Fouracres Care Services DS0000053227.V372855.R01.S.doc Version 5.2 Page 19 One said, “They are good. They help me a lot,” and that “they are helping me to find a job.” The other said that s/he liked staff and was able to tell us what type of activities staff supported him/her to do; tidying bedroom, going to an art class and painting nails. We inspected a sample of staff files to check if staff had been vetted before starting work to ensure they were suitable people to work in a care home. One staff member did not have a current Criminal Records Bureau check ( this had been applied for) and had one reference that had not been verified by the manager. This staff member was working alone with residents and should not be as s/he had not been assessed as suitable to do so. A requirement is made that this staff member work under supervision at all times until these outstanding checks are in place and are satisfactory to show that the person poses no risk to residents. The manager agreed to ensure the supervision of this staff member with immediate effect. Fouracres Care Services DS0000053227.V372855.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a well run home where their best interests are safeguarded and their health and safety promoted. EVIDENCE: The manager of the home is qualified and experienced to carry out his duties. We were able to speak with the manager at length during the inspection and found him to be knowledgeable and competent. The residents also made positive comments about the manager. One said, “Simon helps me a lot,” and the other said s/he liked him adding, “he has grey hair and he never smokes.” Both residents were quite clear that they were happy living in this home and wanted to stay there. A relative praised the manager, saying that he made Fouracres Care Services DS0000053227.V372855.R01.S.doc Version 5.2 Page 21 improvements in the home and that his/her relative living at the home was receiving a good service there. The manager’s record keeping was of a high standard. Information provided to us in a self assessment of the home completed by the manager was comprehensive. We found that the information provided was accurate and that the manager had a clear sense of which areas were to be improved. Staff were also satisfied with the guidance and support provided by the manager. Residents views are listened to and recorded and acted on. The provider has not been completing and sending to the manager the required monthly reports on the conduct of the home. A requirement is made to do so as these reports are the providers’ way of monitoring that the home is running smoothly. A sample of health and safety records were inspected and the self assessment document provided us with more information about health and safety issues in the home. There were no health and safety concerns noted. The home was seen to be appropriately insured. Fouracres Care Services DS0000053227.V372855.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 4 x LIFESTYLES Standard No Score 11 X 12 4 13 4 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 x 3 X 3 X X 3 x Fouracres Care Services DS0000053227.V372855.R01.S.doc Version 5.2 Page 23 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 YA34 Regulation 19 Requirement The registered persons must ensure that a staff member without all the required checks in place works under supervision until the checks are received in the home. This is an immediate requirement. This is to protect residents from risk of unsuitable staff being employed. The registered persons must 30/11/08 ensure that no staff/volunteers are allowed to start work in the home before all the required checks on their suitability have been received in the home. The registered persons must 20/12/08 ensure that the home is visited every month on an unannounced basis by the provider or her representative, and a report made on the conduct of the home. A copy of the report must be sent to the manager every month and be available for inspection in the home. DS0000053227.V372855.R01.S.doc Version 5.2 Page 24 Timescale for action 21/10/08 2 YA34 19 3 YA39 26 Fouracres Care Services RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Fouracres Care Services DS0000053227.V372855.R01.S.doc Version 5.2 Page 25 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. 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