Care Home: Homer Road (22A-B)

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What the care home does well At the time of this inspection visit, the home was appropriately meeting the assessed needs of the majority of people accommodated in the home with the exception of one service user, where it has been identified that he would benefit from moving into more suitable accommodation due to his increased mobility needs. The home appropriately utilises services offered by healthcare professionals such as occupational therapists, dieticians and others. Staff working in the home appropriately support service users to access a wide range of activities in the community. People who use the service are treated with dignity and respect by staff working in the home. Staff working in the home are offered a good level of training. They also receive appropriate level of support and supervision from the management team. The home benefits from a low staff turnover. A high number of staff working in the home have supported those living in the home for a number of years andare therefore familiar with their individual needs, communication methods, likes, dislikes and preferences. Staff working in the home are appropriately vetted before being allowed to work with vulnerable adults. What has improved since the last inspection? Since the last inspection the home has introduced a new care support plan for all service users incorporating the care manager`s review plan, as previously required. In addition the home has commenced "Circle of support" meetings for each service user in line with the Person Centred Planning. Staff working in the home have advocated on behalf of the people who use the service and wrote a letter of complaint to the Patient`s Advisory Liaison Service (PALS) of the City and Hackney Primary Care Trust regarding poor level of service offered by the residents` local General Practitioner. This has been resolved to the residents` satisfaction. There has been an improvement in the frequency of staff supervision and appraisals offered to staff working in the home. The majority of staff working in the home have obtained NVQ Level 2 or above. Since the last inspection the manager has reviewed the home`s health and safety risk assessment to evaluate the current health and safety risks to both service users and staff working in the home, as previously required. What the care home could do better: There is 1 statutory requirement, which remains unmet since the last inspection and must be met without any further delay: - The registered person must ensure that the home`s electrical wiring test is carried out. The following 3 requirements were made following this inspection visit: - The registered person must ensure that any outstanding maintenance issues in the home are resolved without any further delay, in order to ensure that the people who use the service live in a safe and well maintained environment. - The registered person must ensure that an application is submitted to the Commission for the home manager to become registered. - The registered person must ensure that the home`s fire alarm system and fire fighting equipment is serviced, in order to ensure the fire safety in the home.In addition the following good practice recommendations were also made: - It is recommended that the Criminal Records Bureau checks be undertaken every 3 years. - The home needs to ensure that the guidance in relation of the capacity of the people who use the service is followed to resolve the issue of unsigned contract agreements. CARE HOME ADULTS 18-65 Homer Road (22A-B) 22a-b Homer Road Hackney London E9 5GT Lead Inspector Robert Sobotka Unannounced Inspection 2nd April 2008 10:40 Homer Road (22A-B) DS0000035305.V361266.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 Homer Road (22A-B) DS0000035305.V361266.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. Homer Road (22A-B) DS0000035305.V361266.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Homer Road (22A-B) Address 22a-b Homer Road Hackney London E9 5GT 020 8525 4650 020 8502 3543 philipa.jones@heritagecare.co.uk www.heritagecare.co.uk Heritage Care 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) Vacant post Care Home 7 Category(ies) of Learning disability (7), Physical disability (7), registration, with number Sensory impairment (7) of places Homer Road (22A-B) DS0000035305.V361266.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th June 2007 Brief Description of the Service: 22 Homer Road is a registered care home that provides 24-hour residential care for adults with learning disabilities and/or physical disabilities. Homer Road opened as a care home on the 31st of March 2003. The premises are owned and managed by Peabody Trust and Heritage Care provide care. The home is situated in a residential area of Hackney within walking distance from local amenities and public transport links. All bedrooms in the home are single. The home has a garden at the rear of the building. The downstairs part of the house is wheelchair accessible. At the time of this inspection there was no registered manager in place, however a new home manager has been appointed and the inspector was informed that Heritage Care were in the process of applying for the home manager to become registered with the Commission. At the time of this visit there were 6 service users accommodated in the home. The current range of fees is between £1849.25 and £1893.63 per week. Homer Road (22A-B) DS0000035305.V361266.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 the people who use this service experience good quality outcomes. This inspection took place over two days and was unannounced. The inspector spoke to some of the staff working in the home, including the recently appointed manager and he spent some time with the service users. He conducted a tour of the premises and viewed various records. Prior to this inspection the home was asked to complete the Annual Quality Assurance Assessment. Some of the information provided in the assessment has been incorporated into this inspection report. The aim of this announced inspection was to check the home’s progress towards full compliance with the National Minimum Standards for Younger Adults (18-65) and the Care Homes Regulations. The inspector would like to thank everyone who contributed to this inspection. What the service does well: At the time of this inspection visit, the home was appropriately meeting the assessed needs of the majority of people accommodated in the home with the exception of one service user, where it has been identified that he would benefit from moving into more suitable accommodation due to his increased mobility needs. The home appropriately utilises services offered by healthcare professionals such as occupational therapists, dieticians and others. Staff working in the home appropriately support service users to access a wide range of activities in the community. People who use the service are treated with dignity and respect by staff working in the home. Staff working in the home are offered a good level of training. They also receive appropriate level of support and supervision from the management team. The home benefits from a low staff turnover. A high number of staff working in the home have supported those living in the home for a number of years and Homer Road (22A-B) DS0000035305.V361266.R01.S.doc Version 5.2 Page 6 are therefore familiar with their individual needs, communication methods, likes, dislikes and preferences. Staff working in the home are appropriately vetted before being allowed to work with vulnerable adults. What has improved since the last inspection? What they could do better: There is 1 statutory requirement, which remains unmet since the last inspection and must be met without any further delay: - The registered person must ensure that the home’s electrical wiring test is carried out. The following 3 requirements were made following this inspection visit: - The registered person must ensure that any outstanding maintenance issues in the home are resolved without any further delay, in order to ensure that the people who use the service live in a safe and well maintained environment. - The registered person must ensure that an application is submitted to the Commission for the home manager to become registered. - The registered person must ensure that the home’s fire alarm system and fire fighting equipment is serviced, in order to ensure the fire safety in the home. Homer Road (22A-B) DS0000035305.V361266.R01.S.doc Version 5.2 Page 7 In addition the following good practice recommendations were also made: - It is recommended that the Criminal Records Bureau checks be undertaken every 3 years. - The home needs to ensure that the guidance in relation of the capacity of the people who use the service is followed to resolve the issue of unsigned contract agreements. 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. Homer Road (22A-B) DS0000035305.V361266.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 Homer Road (22A-B) DS0000035305.V361266.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, 3, 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users have information they need to make an informed choice about the home. The home was appropriately meeting the assessed needs of the majority of the people who use the service. The home needs to ensure that the guidance in relation of the capacity of the people who use the service is followed to resolve the issue of unsigned contract agreements. EVIDENCE: The home’s statement of purpose and the service users’ guide have recently been updated to include details of the new home manager and the service manager. There continues to be one vacancy in the home. There have been no new admissions to the home since 2003. The inspector was therefore unable to assess the standard relating to the home’s admission systems. It was the inspector’s view that the home was appropriately meeting the needs of the majority of the people who were accommodated at Homer Road. It was identified during the previous inspection visit that the needs of one of the service users have changed due to their reduced mobility and there were issues around going downstairs to access activities outdoors. Following the last inspection, the home had involved an occupational therapist who assessed the Homer Road (22A-B) DS0000035305.V361266.R01.S.doc Version 5.2 Page 10 service user. A review has also been carried out by the care management team, who recommended that an alternative placement should be sought with an easier access (ground level or a building with a lift access). The inspector was informed that a placement has been identified in the sister home and there were plans for the service user to move there in the near future. The issue of contracts between the service provider and each service user remains unresolved. Even though each service user has a contract, which included terms and conditions, these remain unsigned. The home needs to ensure that the guidance in relation of the capacity of the people who use the service is followed to resolve the issue of unsigned contract agreements. It was noted that there was a contract in place between the housing provider (Peabody Trust) and each service user. These have been signed by the home manager on behalf of each service user. Homer Road (22A-B) DS0000035305.V361266.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, 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements have been noted in the home’s care planning process in relation to each person living in the home. Appropriate risk assessments were in place and people living in the home are supported to take risks as part of an independent lifestyle. Confidentiality was being maintained. EVIDENCE: At the previous inspection visit it was identified that although each person had a care plan in place, some of them did not fully correspond with care plans provided by the service user’s placing authority and as a result further improvements were required to care plans to ensure that they include goals and expectations from the placing authority, so that staff are fully aware of each service user’s assessed needs. Since the last inspection the home manager has ensured that each person’s care plan has been reviewed and updated, as previously required. Four out of the six care plans were reviewed during this inspection, all of which were found to be up-to-date. They included information in relation to each service user’s Homer Road (22A-B) DS0000035305.V361266.R01.S.doc Version 5.2 Page 12 sexuality and other equality and diversity issues such as cultural and religious needs have also been taken into consideration and recorded in individual care plans. The home manager stated that each service user’s care plan is reviewed with the presence of care managers, advocate and families at review meetings and any changes are recorded and actioned. As previously mentioned, the home has recently commenced “Circle of support” meetings for each resident in line with the Person Centred Planning. Following direct and indirect observation, discussion with staff working in the home and review of the daily logs, the inspector was satisfied that people who use the service are given appropriate support to make choices and decisions about their daily lives and activities. They are given clear information about options relating to daily choices, such as food choices and activities on offer. Those living in the home have access to the advocacy service. Input from family/relatives is also sought when it is not possible to obtain service user’s opinion. Service users are unable to contribute to the development and review of policies and procedures, due to their severe learning and physical disabilities. Service user’s finances are managed by staff working in the home. During this inspection visit, a random sample of service users’ finances was checked and these were found correct. There is an outstanding issue in relation to some of the service users’ money, which is still being held by the City and Hackney Primary Care Trust. The home manager was being able to demonstrate that this issue is still being dealt with on a senior level between Heritage Care and the East London and City NHS Financial Consortium. In the Annual Quality Assurance Assessment, the home manager stated that staff always support service users to take responsible risks as it is their fundamental right to make informed choices that entails a degree of risk and that the right of service users to take risks would be supported following the completion of risk assessments. A random selection of risk assessments was also checked as part of this inspection visit and they were found to be up-to-date. The inspector was satisfied that confidentiality was being maintained. All confidential documents were kept in the staff room and locked when not in use. Information kept on computers was password protected. Each member of staff was assigned with a password to access relevant information on computers. Homer Road (22A-B) DS0000035305.V361266.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): 12, 13, 15, 16, 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service benefit from a good range of activities offered by the home and are supported with personal development and maintaining personal friendships/relationships. Appropriate food arrangements were in place. EVIDENCE: Following the review of documentation, discussion with staff working in the home, direct and indirect observation, the inspector was satisfied that staff support service users in accessing and engaging in leisure activities and personal development. Some of the people who use the service attend local day centres for people with learning disabilities. Service users are also supported by staff to access leisure activities in the community. Regular visits to leisure centres, cinemas and other places of interest are organised. Each care plan viewed included an activity timetable. Homer Road (22A-B) DS0000035305.V361266.R01.S.doc Version 5.2 Page 14 Individual activities or specific hobbies or interests identified are recorded in individual care plans and any specific activities that service users may require are actively encouraged and met as much as possible. Annual holidays are also organised for all residents. Staff working in the home encourage and support service users in maintaining friendships and family relationships. Relatives are invited to participate in reviews and also to act as advocates on behalf of service users. Visitors are welcome in the home. The visitors’ book was being maintained. Documentation such as care plans showed that relatives are consulted on various aspects of care, as and when required. There were sufficient food supplies in the home. Food was mainly prepared by staff, but those who lived in the home also had an opportunity to assist in food preparation in accordance with their wishes, assessed abilities and risk involved. The home manager stated that all dietary needs and choices are catered for by ensuring that nutritious and varied balanced meals are available at flexible times. Staff offer a choice of meals to the people who use the service, which meets their dietary and/or cultural needs according to their individual preferences as agreed in their care plans. At the time of this inspection, all food was appropriately stored and labelled once opened. Records of fridge/freezer temperatures were being maintained. There was a pictorial menu on display on each kitchen. Records of food offered/served were maintained on individual basis for each person who uses the service. The inspector observed two service users having lunch on the first day of his visit and he was satisfied that staff supporting service users during lunchtime ensured that speech and language guidelines were followed and that meals were unhurried. The home manager showed the inspector a newly drawn up menu, which had more varied selection in dishes including Afro-Caribbean and Jewish dishes. Homer Road (22A-B) DS0000035305.V361266.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was appropriately meeting needs of the people who used the service. Medication systems were well managed. EVIDENCE: All people living in the home required assistance and support in attending to their personal care. Care plans viewed contained appropriate guidelines for staff on how to provide personal care to each person. They also included individual moving and handling guidelines. The home manager stated that service users are always supported with personal care with maximum privacy, dignity, independence and control over their lives. They are supported with personal care in private, and intimate care is given by a person of the same gender. He stated that staff always offer service users an opportunity to choose their own clothes and that the service user’s appearance reflects their personality. Staff always allow those who use the service to choose the times when they want to go to bed or get up in the morning, as agreed in each individual’s care plan. Following a review of documentation in relation to the healthcare needs of service users, the inspector was satisfied that the needs of the majority of the Homer Road (22A-B) DS0000035305.V361266.R01.S.doc Version 5.2 Page 16 service users’ were appropriately met. Weight of service users was being maintained in accordance with individual care plans. There was evidence that dietician’s input was sought when required. The home appropriately utilised local healthcare facilities, such as dentist, optician, chiropodist, audiologist, occupational therapist, community nurse, continence nurse and other professionals. Each person living in the home was registered with a General Practitioner. Staff always support service users to attend outpatient and other appointments. Medication systems were found to be satisfactory. Record of medication entering the home, administered to each person using the service and disposed of was maintained. Medication is only administered by a “designated responsible person”, which have been assessed as suitably trained and knowledgeable in administering medicines. The inspector crosschecked the home’s medication supplies, which were found to be correct. All medicines were appropriately stored. Medication stocks are checked during each handover. Guidelines were in place for each medication administered to those using the service on how it should be administered, including guidelines on why and when any PRN (as required) medication should be given. Homer Road (22A-B) DS0000035305.V361266.R01.S.doc Version 5.2 Page 17 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. An appropriate complaints system was in place. Those living in the home are protected from abuse. The inspector was satisfied that the organisation has taken reasonable steps to resolve the ongoing situation regarding service user’s finances. EVIDENCE: There have been two complaints about the home since the last inspection. Following the review of the records, the inspector was satisfied that any complaints were now appropriately dealt with, as previously required. It was noted that service users might not be able to raise any concerns and/or to make complaints due the level of their disabilities. The home manager stated that keyworkers would always provide appropriate support to service users and they would provide help to access the local advocacy team. The home had an appropriate adult protection protocol in place. The acting manager stated that all staff have attended adult protection training since the last inspection. Accidents/incidents records were checked during this inspection visit. These were appropriately maintained and there was evidence that both documents were monitored by the home’s management team. The situation of people who use the service not being able to access some their finances remains unresolved. It was noted however that the Chief Executive of Heritage Care has contacted the Director of Finance of the local NHS trust in Homer Road (22A-B) DS0000035305.V361266.R01.S.doc Version 5.2 Page 18 order to resolve this issue. The inspector was informed that service users have limited access to the money held by the local NHS Trust and that some have successfully recovered some of their funds. Homer Road (22A-B) DS0000035305.V361266.R01.S.doc Version 5.2 Page 19 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, 26, 27, 28, 29, 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The premises were meeting the needs of majority of the people who used the service; however further improvements are required to the building. EVIDENCE: The home provided adequate living space for the service users accommodated at Homer Road. None of the service users living in the home were on respite/emergency/short-term placement. There was one wheelchair user living in the home at the time of this inspection, who occupied the room on a ground floor. The staff office is now located upstairs in order to meet the changing needs of one of the service users who lost his ability to walk and use of stairs and as a result his bedroom was relocated to the ground floor. Only the ground floor of the building is wheelchair accessible. The premises were generally well maintained, however some issues required improvement. There has been an ongoing issue with tiles in the kitchen located on the first floor, which required attention. In addition some routine checks Homer Road (22A-B) DS0000035305.V361266.R01.S.doc Version 5.2 Page 20 such as an electrical wiring check, fire detection and fire fighting equipment service were overdue and must be carried out without delay. The inspector was informed that the home has experienced substantial delays in responding to carrying out repairs and substandard work from the housing provider. The home manager felt that there has been no improvement in the Peabody Trust’s obligations to carry out planned maintenance and renewal programme for fabric and decoration of the premises. The newly appointed service manager informed the inspector that she has been liaising with the housing provider and hoped that all outstanding work would be rectified within two months. As previously mentioned, the home was no longer fully able to meet the needs of one service user accommodated in the home, due to his decreased mobility needs. The inspector was informed that an alternative accommodation has been identified for this person in the sister home, which has a lift. The inspector viewed all 6 bedrooms occupied by those using the service. They were found to contain all furniture and fittings in accordance with the National Minimum Standards. One bedroom was vacant. The home has a sufficient number of toilets, bathrooms and shower facilities. Homer Road is a purpose built building; those people who needed specialist equipment (i.e. hoist) have been assessed by occupational therapists. Satisfactory equipment was in place and available throughout the house. The home had satisfactory arrangements in place for repairing and maintenance of specialist equipment. The home had an appropriate clinical waste disposal arrangement in place with a weekly collection service. Appropriate laundry facilities were in place. The laundry room was adequately ventilated. The home has a sluicing facility to meet the needs of the people who use the service and have continence needs. The home was found to be clean and hygienic at the time of this unannounced inspection. Homer Road (22A-B) DS0000035305.V361266.R01.S.doc Version 5.2 Page 21 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. People who use the service are supported by appropriately trained staff. Improvements have been noted to the language and terminology used by care staff when writing various documents in the home. The inspector was satisfied that appropriate recruitment practices were now in place. EVIDENCE: The inspector viewed duty rosters as part of this inspection. These showed that there were sufficient numbers of staff on duty to meet the needs of those accommodated in the home. There are usually 4 staff working in the home during daytime (2 members of staff on each floor). In addition there is usually 1 or 2 people working flexible hours during the day (including the home manager and the senior support worker). There is one person sleeping in and one waking night staff in place during night. There was a mix of gender to provide personal care. There is always an assessed designated person on each shift, who is in charge of the medication. Staff working in the home at the time of this inspection visit felt that the current staffing levels were satisfactory to appropriately meet the needs of the people accommodated in the home. Homer Road (22A-B) DS0000035305.V361266.R01.S.doc Version 5.2 Page 22 According to the Annual Quality Assurance Assessment completed by the acting manager there were 7 full-time and 5 part-time staff employed in the home. Members of staff come from different cultures and backgrounds. Staff training records showed that Heritage Care provide a wide range of courses to its staff. The majority (90 ) of permanent care staff working in the home have obtained their National Vocational Qualifications (NVQs). Two other staff working in the home had nursing qualifications. All staff have attended mandatory training, such as Basic Food Hygiene, First Aid, Manual Handling, and Fire safety training. Similar training is required from bank staff before they are allowed to work in the home. At the last inspection visit, the inspector noted that some of the written language used by staff was inappropriate and required improvement. An improvement has been noted in the written language in various documents, sych as care plans, monthly keyworking reports and daily notes. The inspector was therefore satisfied that the recommendation that those staff whose first language is not English are supported with their writing skills to use appropriate and respectful language in their written reports and daily notes has now been met. There have been no new staff employed in the home since the last inspection. The inspector checked a random selection of staff personnel files during this visit and he was satisfied that each file contained all information required by law. The home manager stated that staff Criminal Records Bureau disclosures were kept in the Heritage Care office in Loughton. These were not viewed on this occasion and will be viewed at the next inspection. A database of all CRB checks undertaken was available online and was accessible on the organisation’s intranet site. The recommendation that the Criminal Records Bureau checks be undertaken every 3 years remains unmet. The home manager was able to demonstrate that all relevant documentation in relation to staff immigration status and being allowed to work in the United Kingdom has now been obtained. This recommendation has therefore been met. Staff supervision and appraisal records were also checked during this inspection visit and these were found appropriately maintained. Staff who spoke with the inspector felt that they were well supported by the home management. At the time of this inspection there was one vacancy for the post of Senior Support Worker and the process to recruit for this post was underway. Homer Road (22A-B) DS0000035305.V361266.R01.S.doc Version 5.2 Page 23 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, 40. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is appropriately managed, however an application for the home manager to become registered with the Commission must be submitted within given timescale. Good quality assurance systems were in place. Some of the health and safety checks were overdue. EVIDENCE: There has been a change in the home management since the last inspection. The previous registered manager has moved on to manage another project run by Heritage Care. The acting manager was successful in interviews and has been confirmed as the home manager. This has brought some stability to the home team and staff felt that the new home manager has put a lot of effort to ensure that care plans are up-to-date and that the majority requirements and recommendations from the last inspection have been met. Homer Road (22A-B) DS0000035305.V361266.R01.S.doc Version 5.2 Page 24 The home manager has had five years management and supervisory experience in the care setting. He has obtained National Vocational Qualification in Care Level 2 & 3 and was pursuing NVQ Level 4 Registered Managers Award. There has been a change in the service manager since the last inspection. She has communicated with the Commission to outline her proposal to resolve any outstanding building maintenance issues. Reports from monthly-unannounced visits from the registered provider were available for inspection and are forwarded to the Commission on a monthly basis. Since the last inspection the home has produced a Service Development Plan, which included a staff training plan. The inspector was satisfied that the majority of health and safety checks were being carried out on a regular basis. This included fire safety checks, monitoring fridge/freezer temperatures, and portable appliances checks. It was noted however that the home’s fire alarm and fire fighting equipment service was overdue. Both tests must be carried out without delay. The requirement in relation to the home’s electrical wiring certificate remains unmet and must be met without delay. The home’s health and safety risk assessment has been reviewed since the last inspection, as previously required. The home was adequately insured for its stated purpose. Homer Road (22A-B) DS0000035305.V361266.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 X 3 3 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 2 X Homer Road (22A-B) DS0000035305.V361266.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes 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 YA42 Regulation 23(2)(c) Requirement The registered person must ensure that the home’s electrical wiring test is carried out. (Previous timescale of 01/09/07 was not met.) The registered person must ensure that any outstanding maintenance issues in the home are resolved without any further delay, in order to ensure that the people who use the service live in a safe and well maintained environment. The registered person must ensure that an application is submitted to the Commission for the home manager to become registered. The registered person must ensure that the home’s fire alarm system and fire fighting equipment is serviced. In order to ensure the fire safety in the home. Timescale for action 01/05/08 2. YA24 23 (2)(b), 23(2)(d) 01/06/08 3. YA37 Care Standards Act 2000 23(4)(a), 23 (4)(c)(iv) 01/07/08 4 YA42 01/06/08 Homer Road (22A-B) DS0000035305.V361266.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 Refer to Standard YA34 YA5 Good Practice Recommendations It is recommended that the Criminal Records Bureau checks be undertaken every 3 years. The home needs to ensure that the guidance in relation of the capacity of the people who use the service is followed to resolve the issue of unsigned contract agreements. Homer Road (22A-B) DS0000035305.V361266.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection London Regional Contact Team 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 Homer Road (22A-B) DS0000035305.V361266.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. Re-publishing this information is in breach of the terms of use of that website. 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