Care Home: Gibson House

What the care home does well What has improved since the last inspection? What the care home could do better: There are no requirements or recommendations arising from this report. CARE HOME ADULTS 18-65 Gibson House 12 The Grange Bermondsey London SE1 3AG Lead Inspector Ms Rehema Russell Key Unannounced Inspection 26th February 2008 10:00 Gibson House DS0000060232.V358988.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 Gibson House DS0000060232.V358988.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. Gibson House DS0000060232.V358988.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gibson House Address 12 The Grange Bermondsey London SE1 3AG 020 7252 3762 0207 394 9316 dele@odyssey-csft.org www.odyssey-csft.org Odyssey Care Solutions for Today 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. Dele Salami Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Gibson House DS0000060232.V358988.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 8 18th January 2007 Date of last inspection Brief Description of the Service: Gibson House is a purpose built detached home which stands in its own grounds on a street which has a mix of residential and business (Council) buildings. It has bus stops and local shops a few minutes walk away, the buses giving access to nearby shopping centres and community facilities. Street parking is metered only. The building is spacious, providing accommodation for eight service users on two floors, with bedroom, bathroom, kitchen and lounge facilities on each floor. The home was formerly owned and managed by the local authority but is now managed by a voluntary organisation. Currently the home is operating as two separate units. The ground floor unit remains as a residential care home for 4 service users, whilst the upstairs unit is being developed as a respite unit and is not registered. Both units are fully self-contained. The ground floor unit consists of a large lobby, a large office, staff toilet and storage facilities, a dining room, a kitchen, a large lounge, 4 large bedrooms, two bathrooms both with toilet facilities and one with a shower as well as a bath, and storage cupboards. The local authority is redeveloping the surrounding area and there are plans to move service users to an alternative location within the next two years. Gibson House DS0000060232.V358988.R01.S.doc Version 5.2 Page 5 The service user part of the fee for a place at this home is £61.80. The home makes the Commission’s reports available in the reception area and office. On the day of the inspection there were 4 service users living at the home, with no vacancies. Gibson House DS0000060232.V358988.R01.S.doc Version 5.2 Page 6 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. This unannounced inspection was carried out by one inspector on Tuesday 26th February 2008. The manager provided the Commission with a very thorough, detailed and clearly written AQAA, which, together with the inspection, was used to inform this report. During the course of the inspection the manager and a support worker were spoken with in depth, all service users were observed, the ground floor unit was toured and documentation and records were looked at. All service users have severe learning disabilities and/or autism traits and none can communicate verbally so it was not possible to ask them their views about living at the home. However, all service users were observed and appeared happy and relaxed at the home and to relate positively to staff. What the service does well: • • • • • • • • • Provides very good information for service users and others so that they know exactly what care to expect and how it will be given Gives very good care and support to service users when they move into the home or out of it to live elsewhere Makes sure each service user has goals to achieve so that their lives are fulfilling, and reviews these goals regularly Helps service users to have as many choices as possible about the way they live and the things they do Helps service users to have a social life and to mix in the community Makes sure that service users’ healthcare needs are met Provides an attractive high quality environment for service users to live in Makes sure that staff are well trained and understand how to care for service users Makes sure that service users are protected from harm and unnecessary risks A service user’s relative wrote in the comments book “Wonderful! Full credit to management and staff the place is kept immaculate. Keep up the good works. Blessings and thanks”. Following a meeting with service users’ relatives, the Registered Provider fed back to staff that “relatives have noted significant improvements and were happy with progress made. Well done”. Gibson House DS0000060232.V358988.R01.S.doc Version 5.2 Page 7 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. Gibson House DS0000060232.V358988.R01.S.doc Version 5.2 Page 8 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 Gibson House DS0000060232.V358988.R01.S.doc Version 5.2 Page 9 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, 2, 4 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There is comprehensive and clear information available so that potential service users and their relatives and advocates can make an informed choice about the home. A full needs assessment is undertaken for new service users or those transferring from the home, which includes full consultation with relatives, advocates and other specialists. New service users or those moving out always have trial periods and visits to the new home. EVIDENCE: The Statement of Purpose is very thorough and informative, giving clear and comprehensive information about all aspects of life and service at the home. People reading this will have a clear picture of how a service user will be cared for at the home and how all services will be delivered. The Service User Guide is in a format that is suitable for service users’ cognitive needs. It has picture illustrations of each area it talks about and these are not just general picture symbols but actual photographs of the people, facilities and activities at the home. As all service users have lived at the home for many years it would not be useful to check the assessment process at the home using documents that refer to many years ago. However, as the home is in the process of being relocated and some service users have already moved on to another home, the Gibson House DS0000060232.V358988.R01.S.doc Version 5.2 Page 10 way in which these service users were helped to move out of this home and into another was looked at. It was found that the home followed a very thorough and person-centred process in ensuring that the two transfers to another home were successful and that the disruption and possible distress to all service users was kept to a minimum. A full needs assessment was undertaken and the manager and staff devised transitional plans that involved visits to the new home, consultation with service users’ families, advocates and the multi-disciplinary team and trial periods at the new home. Each service user was accompanied by a member of staff they knew for the whole of their first day at the new home, and meetings were held with the manager of the new home to discuss their needs and behavioural strategies. In addition, the manager ensured that there was a review of the placement that included compatibility in the new home, visited the transferred service users at their new home and arranged return trips to this home for visits and lunch. Gibson House DS0000060232.V358988.R01.S.doc Version 5.2 Page 11 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, 8, 9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users assessed and changing needs and personal goals are reflected in their individual care plans and person centred plans. Staff support service users to make choices and decisions about their lives and to participate in all aspects of life in the home by interpreting their behaviours and using specialist communication methods. Risk assessments and working guidelines are present and support service user’s safety and independence. EVIDENCE: Two of the four care plans were seen. These were comprehensive and gave full details of the services user’s needs, aspirations and goals, and how these were to be fulfilled. There is a client profile with all relevant information, detailed information on the service user’s background, behaviours and indications and strengths and needs, detailed and clear support guidelines, records of weekly activities, daily logs and monthly summary records. There is also Person Centred Plan which outlines gaols and how they will be achieved, which is Gibson House DS0000060232.V358988.R01.S.doc Version 5.2 Page 12 reviewed 3 monthly with new goals set. Care plans give a comprehensive and detailed outline of individual service users’ needs and goals and how these are to be achieved, and all are written according to person centred principles. All documentation is regularly reviewed, dated and signed, and support workers confirmed that they have full input into care plans and reviews, particularly if they are the keyworker. Care reviews are carried out six-monthly, to which family, advocates and social workers are invited, and review monitoring meetings are carried out annually. Observation, inspection of records and discussion with staff indicated that staff support service users to make as many decisions about their daily lives and participate in as many aspects of life at the home as possible. Service users have very limited cognitive and communicative abilities but staff use a variety of methods to assist service users to make decisions and influence the running of the home. This includes interpreting body language and behaviours, using objects of reference, having a huge range of photographs of meals so that menus can be chosen, ensuring that service users are present at their care reviews and interim community care assessments regarding the future of the home, and consulting with family members, advocates and specialists who know the service user. In addition a Communication Passport has been developed for each service user in conjunction with the speech & language therapist. These documents are all person centred, using pictures and simple language to explain what the service users likes to do, things they like and things they don’t, how they communicate, how they make choices, and how to care for them under “please do” and “please don’t” lists. Best interests meetings are held with all stakeholders as appropriate, for example when the capacity to consent is needed for medical treatment. One support worker explained that she could interpret the responses of the service user at the home who has profound learning disabilities because she has known and worker with her for so many years. She also explained how the home enables the same service user, who will not open doors, to access her bedroom as and when she wishes. Risk assessments were present in care files and were very thorough. There are 6 main areas – daily routine, behaviour, medical conditions, outside, miscellaneous & vulnerability – and each is broken down into many sub areas such as getting up, mealtimes, bathing/showering, intimate personal care, violence, self-injury, compulsive behaviours, mobility, crossing roads, using transport, family, social situations, over-trusting, sexuality etc. Each risk is assessed by the staff team as a whole on a scale of 1 – 6 and if the rate is higher than 3 a support guideline is devised. All risk assessments and all guidelines are reviewed every six months, and further risk assessments are done for specialist or one-off situations. For example, holiday risk assessments were seen on file. Gibson House DS0000060232.V358988.R01.S.doc Version 5.2 Page 13 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): 11, 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. Service users are supported to undertake a range of daily activities, which assist their personal development, ensure they are part of the local community, help them access a range of leisure facilities and are age, peer and culturally appropriate. Personal and family relationships are encouraged and supported, service users’ rights are respected and they are given a healthy and nutritious diet. This results in service users having a suitable and enjoyable lifestyle. EVIDENCE: There is a weekly timetable on a large board in the office which lists the activities planned for each service user each day. Activities listed for the week of the inspection included personal skills development (tea making/makaton/spoon feeding), cooking, gym, walks, sensory room, communication programme, shopping, tidying room, video session, hand Gibson House DS0000060232.V358988.R01.S.doc Version 5.2 Page 14 massage, pub outing, intensive communication, magazine reading and manicure. There is a daily log in each service user’s file where the activities actually undertaken are recorded for each morning and afternoon so that these can be monitored. The home has its own transport and this is used to take service users to day centres, appointments and trips out. Service users are supported to access a full range of community facilities, such as the cinema, cafes and restaurants, local shops, social clubs, the gym, parks and pubs. Cultural interests are also supported, such as one service user being taken to Chinatown for the Chinese New Year and two service users being taken to Caribbean restaurants. All four service users attend a specialist day centre for three days each week, but for different periods so that it is not an institutional activity but suited to the individual’s preferences/need. On the morning of the inspection, one service user had been taken to the day centre earlier, two were taken slightly later in the morning, and one service user was at home doing skills development. Last year, all service users went on holiday together to Centre Parcs and one service user had a second holiday with the day centre to Southend. Staff are pro-active in supporting and facilitating contact with family and friends. For example, one service user’s relative used to visit once a week but staff have now facilitated the service user visiting her once a month in order to save her the long journey she has to take to get to the home. A similar arrangement has been made with another service user whose relative used to always come to the home, and a goal has been set for this service user to be able to arrange lunch with another relative. Staff also facilitate friendships, for example arranging meetings with the two service users who have moved out of the home, and arranging for one service user to visit someone she used to live with years ago after finding an old photograph which showed them both together. Routines are kept flexible so that service users’ individual moods, preferences and behaviours can be respected. All four service users go to bed between 9 – 11 pm but at different times according to their choice. Similarly, one service user chooses to get up at 7am each morning but the others get up later, between 8 –8.30am. Service users were observed to choose where they wanted to be in the home, one service user choosing to spend time in the office to be near the manager or stepping just outside into the garden, another to be in the main lounge. Two service users are given “reassurance time” each morning when staff explain exactly what their timetable is for the day. This is because the two service users have autism and so if they know what their routine is going to be they do not get distressed. Two service users are able to choose what meals they would like on the menu via a large range of photographs of various meals. Staff know from experience the type of meals that the other two service users prefer as they have cared for them for a number of years, and can interpret their behaviours to tell if they like any new foods that are introduced. Service users generally have Gibson House DS0000060232.V358988.R01.S.doc Version 5.2 Page 15 lunch out at cafes during the week and eat in the home each evening. The evening meal is a full meal, varied and nutritious, with a healthy dessert and a basket of fresh fruit always available. Gibson House DS0000060232.V358988.R01.S.doc Version 5.2 Page 16 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. Staff give personal support to service users in a way that preserves their dignity and rights, and service users’ physical and emotional health needs are met. Staff store, administer and record medication correctly. EVIDENCE: Observation and speaking with staff indicated that service users are treated with dignity and respect. It was evident that staff were fond of service users and that service users felt relaxed in their company. The manager described the individual personal support needs of each service user and how these are met by the home. Many examples were given of how dignity and privacy is upheld and how staff support service users to be as independent as possible. For example, the manager had one service user’s epilepsy medication changed to one whose administration better preserves the service user’s dignity, also ensuring that all staff were trained in the protocol for the new medication. A best interests meeting was arranged last year in order to bring a service user who was dying back to the home so that she could die with dignity and comfort in her own home. The manager has also ensured the privacy of the whole group by covering glass panels in doors that are shared with the upstairs unit, Gibson House DS0000060232.V358988.R01.S.doc Version 5.2 Page 17 or where it would be possible for anyone to inadvertently see into the home. Personal physical care is given by same gender staff, and culturally appropriate personal care is facilitated by a staff group that is mixed in terms of gender, cultural background and religious beliefs. All service users were observed to be well groomed and dressed with their appearance reflecting their age and personality. Documentary evidence demonstrated that the healthcare needs of service users are assessed and action taken to address them using the full range of healthcare facilities as appropriate. Each service user has a healthcare action plan, which is person-centred, very detailed and illustrated throughout with photographs and pictures. Each time the service user sees the general practitioner or healthcare professional their keyworker writes up signed and dated notes, so that the home has a record of what happened and any results. This is good practice. Each care file also has a health care checklist with details of when appointments are due, and these are also recorded in the home’s diary and on the activities board. Recent appointments included the podiatrist, dentist, general practitioner, hospital eye specialist and multidisciplinary team. Previous records showed involvement from the speech & language therapist, psychologist, physiotherapist and occupational therapist. Evidence of best interests meetings with the social worker, advocate, relatives and other stakeholders was also seen. The storage, administration and recording of medication was checked and no problems were found. The medication file is very detailed. It has a photograph of each service user in front of their medication administration record (MAR chart), a copy of each prescription, training pictures and an explanation of who to administer epilepsy medication, and “as needed” medication with signatures of the support worker, manager and general practitioner. This is all very good practice and ensures the safety and protection of service users. Funeral plans were present on each service users file, signed by the next of kin. As previously mentioned, a best interest meeting was held when a service user was dying in hospital last year with the result that the service users was brought home to die in privacy, dignity and comfort in familiar surroundings. Gibson House DS0000060232.V358988.R01.S.doc Version 5.2 Page 18 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. Staff interpret service user’s views and choices about the service and act upon them to improve their quality of life and ensure they are happy. Service users are protected from abuse, neglect and self-harm. EVIDENCE: The complaints procedure and leaflet was seen. Service users cognitive disabilities are such that they would not be able to understand the concept of complaining, but staff are sensitive to their moods, sounds and body language and use these to interpret their happiness or unhappiness with situations. For example, one service user would not get on to the minibus to travel to the day centre. Through observation and interpretation the manager realised that the service user wanted to sit in a certain position in the minibus and also wanted to go to the day centre later in the morning. This was put into practice and the service user is now happy to go to the day centre. Similarly, another service user’s behaviour indicated that he was in pain. Whilst the hospital was investigating this the manager suggested to the occupational therapist that the service user might need a higher chair and a larger bed. These were obtained and the service user has now been taken off painkillers as he no longer needs them. In these ways, even though service users cannot use a complaints system, staff are able to advocate on their behalf to solve problems. The home has received no formal complaints and keeps a comments book for visitors to use. Comments received are quoted in the Summary section at the beginning of this report. Gibson House DS0000060232.V358988.R01.S.doc Version 5.2 Page 19 There is an adult protection policy and procedure and all staff have had adult protection training and updated Safeguarding training. Clear and detailed guidelines are written following all risk assessments and there have been no adult protection issue at the home. The support worker spoken with was fully aware of Protection of Vulnerable Adults procedures and gave a full and correct outline of the procedure to be followed in the event of suspicion of abuse. Gibson House DS0000060232.V358988.R01.S.doc Version 5.2 Page 20 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, 25, 26, 27, 28, 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home provides a high quality physical environment, that is safe and secure, comfortable and attractive. Service users’ bedrooms promote their independence and individuality, toilets and bathrooms provide privacy and meet individual needs, and shared spaces are spacious and comfortable. The home is clean and hygienic throughout. EVIDENCE: The home stands in its own grounds and there is an entry phone system that ensures service users’ safety and protection. The premises is suitable for its stated purpose and is accessible, safe and well maintained. It is comfortable and homely and staff have made all areas attractive and welcoming. The home was purpose built and does not resemble an ordinary house in that the corridors are very long and the office is far away from the living areas – this will probably be rectified when the home moves to another premises. Gibson House DS0000060232.V358988.R01.S.doc Version 5.2 Page 21 The home exceeds individual room space requirements as all bedrooms are over 12 square metres. The home is fully wheelchair accessible, although there are currently no service users who have mobility problems. All bedrooms have décor, furniture and fittings of high quality. They have all been decorated and furnished to suit the individual requirements, preferences and, where appropriate, cultural interests. For example, one service user has a lot of ornamentation, soft toys and framed pictures of her family in her bedroom, whereas another service user has a Chinese carpet on the wall, a Chinese wallpaper border, framed Chinese chime inscriptions and a new red flooring which matches the ornamentation and is an important colour for his culture. For a third service user, who cannot have framed pictures on his wall due to his behaviours, the manager had arranged for an artist to paint various murals on his walls, reflecting his interests. All four bedrooms were seen and all are beautiful. They are clean and comfortable and very well maintained. There are two communal bathrooms, both with bath, toilet and separate shower area. Staff have also made bathrooms very attractive – they have decorated the plain white tiles by high quality stickers or hand paintings of fish and shells. Both bathrooms have new flooring, one has a new shower, the other has new shower curtains, and both were meticulously clean. One bathroom has been designated for the two female residents and has lovely flowers on display. Both bathrooms are very spacious but could easily have looked functional/institutional without the care and attention staff have given them. Shared space consists of the kitchen, dining room and lounge. The dining room is large and is connected to the kitchen by a door and a large open service hatch. The kitchen was very clean and well ordered, with a new high quality work surface, dishwasher and separate larder which has a freezer unit. The lounge has a very attractive carpet, newly framed pictures, some of which display positive images for service users’ cultural backgrounds, high quality leather sofas and very attractive cushions. Service users were observed to be using the lounge as they wished and appeared happy and relaxed in it. The home was found to be very clean and hygienic throughout. There is a separate laundry room, far away from the kitchen area and along the long corridor that leads to the reception area. It is well equipped and staff have labelled individual service users’ clothes so that there is never a mix-up with the laundry. Gibson House DS0000060232.V358988.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. All staff are qualified, and the home has exceeded the recommended training target for support workers. The staff team is competent and effective, appropriately trained and well supported. The recruitment policy and practice ensures the protection of service users. EVIDENCE: All support workers, except one night support worker who has a nursing qualification, have attained NVQ Level 3. The home has therefore far exceeded the recommended training target of 50 of support workers having NVQ Level 2. Evidence from documentation and from speaking with staff indicated that they have the qualities suitable for caring for people with very challenging behaviours, including patience, approachability, flexibility, commitment and motivation. They also displayed the specialist skills necessary such as communication, dealing with aggressive behaviour, understanding of cultural and religious backgrounds and sensitivity towards service user’s moods and characteristics. Gibson House DS0000060232.V358988.R01.S.doc Version 5.2 Page 23 Over the past two years the manager has worked hard to obtain stability and motivation in the staff group. This had been achieved. All support staff had obtained qualifications to NVQ Level 3, no staff had left the home in two years and staff were feeling motivated and committed to their work. The staff team reflects the gender/cultural composition of service users, has the skills and knowledge to communicate with service users and works effectively with various specialist teams and professionals to improve the service given. Staff were observed to be approachable and comfortable with service users, to be interested in their welfare and motivated to provide them with active and fulfilling lives. There have been no new staff at the home for the past two years but the manager described the recruitment procedure he will follow when he recruits to the 3 positions that are now vacant. The recruitment procedure described is based on equal opportunities principles and covers all of the checks and procedures necessary to ensure the safety and protection of service users. The manager said that because of the high care needs of service users he would ensure that all staff recruited had prior experience of working with people with challenging behaviour, which is good practice for this home. The home has an annual training & development plan and an individual training file for each member of staff. The training & development plan for 2007/8 was seen and included updated training on basic areas such as health & safety and food hygiene, as well as NVQ Level 3 & 4, makaton and records & reports. In addition, the manager had arranged for dementia training so that staff would be prepared should service users with downs syndrome develop the early dementia that is a common trait. An example of an individual training folder was seen and evidenced a job description, code of conduct, regular supervision sessions with a signed supervision contract, supervision records, a learning & development calendar, generic competencies framework and training certificates. Staff confirmed that they are able to select courses they feel are relevant to their work from the training list supplied by the Registered Provider and from the local authority. Apart from documentary evidence seen, staff also confirmed that they receive regular, monthly supervision and attend fortnightly staff meetings. Keyworker issues are discussed in both forums, but in particular detail during supervision, and staff said they felt supported by these meetings and able to discuss their views or any problems. Gibson House DS0000060232.V358988.R01.S.doc Version 5.2 Page 24 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, 38, 39, 41, 42 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is well run with good leadership and support for staff. The Registered Provider and staff use a variety of methods to find out whether they provide a good quality service and whether service users are happy with it. Service users are safeguarded by the record keeping and health & safety practices at the home. EVIDENCE: The manager is fully qualified and experienced to run the home. In addition to the NVQ Level 4 and Registered Managers Award, he has a Certificate in Management Studies, Diploma in Management Studies and a Bachelor of Science degree in Psychology. He has 16 years experience of working with people with learning disabilities, 10 of which have been as a manager. He is in the process of registering with the Commission. Gibson House DS0000060232.V358988.R01.S.doc Version 5.2 Page 25 Observation and verbal evidence demonstrated that the manager runs the home in an open, positive and inclusive way. He has been at the home for two years and in that time has worked hard to obtain stability and motivation in the staff group. One support worker who has worked at the home for over 6 years said about the last two years “teamwork has been brilliant, the best since I’ve been here”. Staff said that they had learned a lot from the manager’s understanding of challenging behaviour issues and his commitment and enthusiasm to providing service users with the best quality of life possible. In addition, documentation and organisation had also been improved. The Registered Provider operates an externally verifiable quality monitoring and assurance system that has been specifically devised for small organisations. In addition monthly Regulation 26 visits and reports are carried out and there is a person centred plan audit once every six months by a manager from another of the Registered Provider’s establishments. These processes provide quality assurance feedback to the Registered Provider, whilst the manager obtains further feedback via regular supervision, staff meetings and weekly paperwork and medication checks. Due to service user’s very limited cognitive and communication abilities it is not possible for the Registered Provider to gain service user feedback about their experience of living at the home, but all stakeholders, including family members, are invited to service users’ six monthly care reviews and to the annual review monitoring meetings. In addition, the Registered Provider has a simple service user survey in picture form and the manager keeps a comments book for visitors. Quotes from the comments book and a relatives meeting were positive and are cited in the Summary section at the beginning of this report. On a daily basis, staff obtain feedback about service users’ satisfaction by interpretation of their behaviours and moods. A range of records were seen and found to be well kept, accurate and up to date. Service user records are kept in the staff office and confidential information is kept in a locked cupboard. Evidence provided from the Annual Quality Assurance Assessment and at the home demonstrated that the full range of health and safety services and checks are carried out to ensure the health, safety and welfare of service users. This includes health & safety checks, gas and electricity, portable electrical equipment, fire call points and alarms, regular fire drills, emergency call equipment and the heating system. Gibson House DS0000060232.V358988.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 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 4 2 4 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 4 26 4 27 4 28 4 29 N/A 30 3 STAFFING Standard No Score 31 X 32 4 33 4 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 3 4 X LIFESTYLES Standard No Score 11 3 12 N/A 13 3 14 4 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 3 4 4 4 X 3 3 x Gibson House DS0000060232.V358988.R01.S.doc Version 5.2 Page 27 No 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. Standard Regulation Requirement Timescale for action 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 Gibson House DS0000060232.V358988.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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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