Care Home: Integrated Care Services Limited

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What the care home does well The care home has a very warm welcoming atmosphere, and homely environment. Residents spoke of being satisfied and content with the care and support that they received. Comments from people using the service included `the `staff are helpful and nice`, and when asked if they were happy living in the care home, comments included `Yes very happy`, and I`m `happy here`. Residents` contact with relatives and others (as agreed by the residents) is fully supported and enabled by the care home. People using the service spoke positively of the contact that they had with family and friends. Comments included `I enjoy going out with my (family member)`, and `I speak on the phone with my (relative)`. A resident spoke of holidays that he/she had enjoyed last year with a relation. Staff are knowledgeable and understanding of the varied needs of people using the service. Staff were observed to interact with residents in a respectful, positive manner. Staff spoke of the home being a `friendly family environment`, and confirmed that there was good teamwork within the care home. Several care staff have achieved National Vocational Qualifications (NVQ) level 2 and/or 3 in care. Staff support residents to take part in a variety of preferred activities, which include accessing community facilities. People using the service informed me of the leisure pursuits that they enjoyed and regularly participated in. The manager is experienced, and keen to continue to put into place systems to improve and develop the service for people living in the care home. She responded promptly to issues raised during the inspection and has made several improvements with regard to the quality of the service since the unannounced inspection. What has improved since the last inspection? What the care home could do better: Care plans could be reviewed to ensure that it is evident that people using the service are fully involved in the development and the review of their plan of care, and that this information is recorded in a format that is accessible to each resident. The care plans could include more comprehensive recorded staff guidance to ensure that it is evident that care staff are consistent in carrying out their roles and responsibilities, and have a clear knowledge and understanding of how to meet the needs of people using the service. Records/record keeping could be improved and further developed to ensure that information with regard to the care and support of people using the service is clear and easily accessible. This includes staff training records, staff personnel files, and some risk assessments of people using the service. Staff `refresher` training could be improved, to ensure that it is evident that staff are maintaining and developing their skills to be able to provide continued care and support to people using the service. CARE HOME ADULTS 18-65 Integrated Care Services Limited 2a Tudor Gardens Kingsbury London NW9 8RN Lead Inspector Judith Brindle Key Unannounced Inspection 16th April 2008 09:30 Integrated Care Services Limited DS0000056792.V361105.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 Integrated Care Services Limited DS0000056792.V361105.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. Integrated Care Services Limited DS0000056792.V361105.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Integrated Care Services Limited Address 2a Tudor Gardens Kingsbury London NW9 8RN 020 8200 1158 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) Integrated Care Services Limted Mrs Moline Bamunuwatte Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Integrated Care Services Limited DS0000056792.V361105.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st May 2007 Brief Description of the Service: 2A Tudor Gardens is a registered home providing care and support to four adults with a learning disability. The registered owner is Integrated Care Services Limited. The registered manager is Mrs Moline Bamunuwatte. Mrs Bamunuwatte and her husband Mr Percy Bamunuwatte jointly run the Integrated Care Services company. They provide a similar service at one other local home. The home is located in a residential area of Kingsbury. The property is detached; there are two bedrooms, bathroom, lounge/diner and kitchen on the ground floor. Two more bedrooms, office/sleep-in room and bathroom/WC can be found on the first floor. There is parking space for two cars in the homes own drive, and a garden at the front of the property. There are a variety of local shops within walking distance. More shopping and leisure amenities are located in Wembley, Kingsbury or Harrow, which can be reached through public transport. Documentation/information about the care home is accessible to residents and visitors. The range of fees is £850-£1200. Further information with regard to fees is recorded in the service user guide, and can also be obtained by contacting the registered manager/owner of the care home. Integrated Care Services Limited DS0000056792.V361105.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. The unannounced key inspection took place throughout seven hours during a day in April 2008. There were no vacancies at the time of the inspection. I was pleased to meet and spend a significant part of the inspection with the people living in the home. The manager, who is also joint owner (with her husband) of the care home, was present during most of the inspection. The manager’s husband (the other owner) was present during the feedback session of the inspection. Talking with people using the service, staff and observation were significant tools used in this inspection. Documentation inspected included, the care plans of people using the service, risk assessments, staff training records, staff personnel files, and some policies and procedures. The inspection included a tour of the premises. Two people using the service kindly showed me their bedrooms, and spoke of being ‘happy’ with their rooms. Assessment as to whether the requirements and recommendations from the previous key inspection (1st May 2007) had been met also took place during the inspection. 25 National Minimum Standards for Adults, including Key Standards, were inspected during this inspection. Prior to this unannounced key inspection the manager supplied the Commission for Social Care Inspection (CSCI) with a completed Annual Quality Assurance Assessment (AQAA) document. The AQAA is a self- assessment of the service provided by the care home that is carried out by the owner and/or manager. It focuses on the quality of the service, and how well outcomes are being met by people using the service. It also includes information about plans for improvement, and it gives us some numerical information about the service. Reference to some aspects of this AQAA record will be documented in this report. Other information received by the Commission for Social Care Inspection about the service since the previous key inspection was also looked at. This included what the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. Also relevant information from other organisations, and what other people might have told us about the service. Integrated Care Services Limited DS0000056792.V361105.R01.S.doc Version 5.2 Page 6 The inspector thanks the people living in the care home, staff, and the manager for their assistance in the inspection process. What the service does well: What has improved since the last inspection? The requirements from the previous key inspection had been met by the service. There has been significant improvements to the décor of the care home. These include redecoration of communal areas including the kitchen, and also bedrooms of the people using the service. Integrated Care Services Limited DS0000056792.V361105.R01.S.doc Version 5.2 Page 7 More mobility aids have been put in place within the care home. These include installing a ‘grab rail’ on the wall of the stairway, and new bath chairs have been installed in the bathrooms. 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. Integrated Care Services Limited DS0000056792.V361105.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 Integrated Care Services Limited DS0000056792.V361105.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): Standard 1 and 2 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective people using the service have the information that they need to make an informed choice about where to live, and they can feel confident that their needs will be assessed before moving into the care home. EVIDENCE: The care home has information including a statement of purpose and a service user guide about the home to enable prospective residents to make an informed choice about whether the care home could meet their needs. The service user guide is in written, and pictorial format, and includes information about the service provided by the care home, the complaints procedure, and fees. The manager confirmed that residents have been supplied with a service user guide, and that each person using the service is provided with a contract of statement of terms and conditions. The home has an admissions policy/procedure. The home has not had any admissions since the previous key inspection (1st May 2008). Annual Quality Assurance Assessment (AQAA) information, and the care plan of the most recently admitted resident, confirmed that the manager ensured that each Integrated Care Services Limited DS0000056792.V361105.R01.S.doc Version 5.2 Page 10 prospective resident has their needs initially assessed prior to their admission. This is to ensure that it is evident that the care home can meet their needs. The assessment could be further developed to include more emphasis with regard to the equality and diversity needs of prospective residents, (See Individual Needs and Choices outcome section). The manager confirmed that the prospective resident is listened too and has their needs, aspirations and choice understood before moving into the care home. I was informed that introductory visits to the care home by prospective residents are encouraged. Integrated Care Services Limited DS0000056792.V361105.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): Standard 6, 7, and 9 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People using the service each have a plan of care. There could be some development in the care plans to ensure that it is evident that they are working documents, ‘person centred’, and that care plan information is more accessible to people using the service, and to staff. People using the service are supported and encouraged to make decisions and choices, and are supported to take risks as part of an independent lifestyle. Some risk assessments could be further developed and improved. EVIDENCE: All four care plans of the people using the service were assessed. The care plan information was located within a significant amount of documentation, much of which could be considered for archiving. The care plans include some comprehensive information with regard to the resident’s needs. This includes Integrated Care Services Limited DS0000056792.V361105.R01.S.doc Version 5.2 Page 12 reference to health, social, religious and personal care needs, and goals to meet those needs. The care plans should include timescales to meet the resident’s agreed aspirations, and goals. More comprehensive guidance could be in place to ensure that it is evident that staff are aware of how to support residents in meeting their needs. The care plans could be more ‘person centred’ (evidence that the resident is central to their plan of care and that it s development is led and owned as far as possible by the person using the service), and it be more evident that the care plans are working documents. The care plans showed evidence of having been reviewed generally six monthly. More frequent review (monthly) was discussed with the manager who agreed to instigated this. A resident when asked by me if they were aware of their care plan replied ‘not sure’. Residents should know of their care plan, fully participate in it, and have the opportunity to sign it. It should be evident that if needed (i.e. if the person using the service has difficulty reading and/or understanding their care plan) the care plan is fully explained to them. The manager spoke of her plans to review and to improve the format of the care plans. This is strongly recommended. ‘Daily’ records are maintained of each resident’s progress. Annual Quality Assurance Assessment (AQAA) information supplied to the Commission for Social Care Inspection (CSCI), and discussion with the manager informed me that the manager has an understanding of equality and diversity needs of the people using the service. She recognises the importance of promoting them and incorporating them in the service provided by the care home. Two residents attend church. Recording of the equality and diversity needs of residents could be improved in care plans. . Annual Quality Assurance Assessment (AQAA) informed me that the care home service is led as much as possible by people using the service. Residents who kindly spoke with me informed me of the choices that they made. This was demonstrated during the inspection, when a person using the service made the choice not to attend the day resource centre. This decision was respected by staff. It was evident that people using the service see the home as their home, and are supported to be involved in the home as much as they are able. A resident opened the front door to let me in and checked my ID badge. She/he was observed to be kept informed of the day-to-day activities happening in the home during the inspection. Residents were observed to make numerous choices during the inspection. It was clear from talking to residents, staff, and from observation that care staff had a good understanding of the needs of privacy and respect. Residents were observed to lock their bedroom doors as, and when they wished, and move freely within the care home. I was informed by staff and residents that routines are flexible, and residents are listened too. Records, and residents confirmed that they had the opportunity to attend residents meetings to communicate their views and wishes. A resident confirmed that he/she had recently attended a residents meeting, and also spoke of staff listening to Integrated Care Services Limited DS0000056792.V361105.R01.S.doc Version 5.2 Page 13 him/her. Annual Quality Assurance Assessment (AQAA) information informed me that a key worker system and practices had been developed within the last twelve months. A staff member spoke of his/her role as key worker. Giving residents the opportunity to be involved in one to one key worker meetings to discuss their plans and progress was also discussed with the manager. The management of resident’s ‘monies’ was discussed with the manager. Some residents’ finances are managed by the person’s relatives. Two people using the service manage their own finances. Receipts of expenditure were available for inspection. Records confirmed that people using the service were receiving their entitled benefits/allowances. A risk assessment was in place with regard to a resident ‘handling money’. Annual Quality Assurance Assessment (AQAA) informed the Commission that ways the service has improved within the last twelve months is that residents have been supported ‘to take reasonable and fully thought out risks’. Also the ‘care home has maximised the ability of people using the service to be as independent as they are able in meeting their personal care needs’. It was evident that the management of risk is positive in addressing safety issues whilst aiming for improved outcomes for people. Risk assessments inspected, varied in detail and clarity with regard to recorded staff guidance to ensure that any identified risk that people using the service undertake, is minimised, whilst ensuring that residents are supported to be as independent as they are able. There was some evidence of mobility risk assessments, and risk of falls as well as risk of certain behaviour, and risk with regard to carrying out some household duties, and talking to strangers. There should also be more evidence that the people using the service are fully involved in all risk assessments that concern them. Risk assessments were discussed with the manager. She confirmed that they would be further developed and improved. Following the inspection the registered manager supplied the Commission for Social Care Inspection (CSCI) with copies developed and improved of risk assessments. These included mobility, falls, use of stairs, and bathing risk assessments, which included improved guidance for staff and the resident to follow to ensure that the identified risk is minimised. It is recommended that risk assessments continue to be further developed and reviewed. Assessment of the night needs (including the risk of there not being a ‘wake’ night staff member on duty at night) of people using the service was discussed with the manager. Following the inspection the manager informed the Commission for Social Care Inspection (CSCI) that three (one resident declined the offer of a call bell) residents had been given access to a bell to enable them to call the ‘sleep in’ staff member at night. It should be recorded in the resident’s care plan if he/she has declined a call bell. Integrated Care Services Limited DS0000056792.V361105.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 12,13,14,15, 16, and 17 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the care home have the opportunity to take part in a variety of preferred activities including those promoting personal development, and are supported to maintain contact with family/significant others. The people living in the care home have their rights respected, and their responsibilities are recognised in their daily lives. Meals are varied and wholesome, and meet cultural/religious needs. EVIDENCE: People using the service kindly informed me of the various activities that they participated in and enjoyed. Some residents attend a day resource centre for a few days per week. A person using the service spoke of enjoying this facility and spoke of friends that he/she had, and that he/she takes pleasure in participating in drama sessions. Another resident spoke of the clubs that she/he regularly attended, and of some of the planned events. Access to the Integrated Care Services Limited DS0000056792.V361105.R01.S.doc Version 5.2 Page 15 community by people using the service was evident from talking with residents, who spoke of going out for meals, and shopping. Comments included ‘I like going shopping, and buying clothes’. During the inspection, this resident accompanied staff shopping. I was informed that the previous evening, several residents had attended a dance session at a community venue. Annual Quality Assurance Assessment (AQAA) information recorded that the service has improved during the last 12 months by ‘supporting and enabling residents to manage their own time in the way that they wish’. As well as ‘facilitating people using the service to be involved in volunteering outside the home’. I was informed that a resident carries out (with staff supervision) some voluntary work in a charity shop. Other recorded activities included meals out, walks, going out with friends and family, and having the opportunity to go on holiday. A person using the service spoke of enjoying some television programmes and he/she kindly showed me the various exercises that he/she did regularly during each day. Another resident spoke of looking forward to their birthday. Two people using the service spoke of having attended a variety of college course. Certificates of these were available for inspection. Records confirmed that a resident was recorded on the electoral register. It was evident from speaking to people using the service and to staff that residents are supported to maintain important personal and family relationships, inside and outside the care home. People using the service spoke of the contact that they had with family and friends. Comments included ‘I like seeing my (relative), I go on holiday with them’. One person using the service said that he/she had spoken to their relative on the telephone during the previous evening. A resident showed me the mobile phone that he/she had. Records informed me that relatives and other play an active part in the home, and in the support that they provide to the relative living in the care home. This includes attendance of care plan review meetings. Correspondence recorded in a resident’s care plan file confirmed that a relative was happy with the care and support that a person using the service received. It was evident that the home respects the rights of people using the service, with fairness, respect, equality and dignity. A resident spoke of his/her involvement in the domestic routine of the home, and of taking responsibility for his or her own room. Residents informed me that they enjoyed the meals provided by the care home. A person using the service spoke of ‘sometimes helping’ to prepare meals. She/he spoke of regularly making their packed lunch. A resident was knowledgeable about ‘healthy eating’. Food eaten is recorded. Staff and residents spoke of having choice with regard to meals. I was informed that meals are varied and decided on a daily basis, and that each evening staff ask residents what they wished to eat the next day. A variety of fresh, frozen, Integrated Care Services Limited DS0000056792.V361105.R01.S.doc Version 5.2 Page 16 tinned and dried foods were accessible in the care home during the inspection. Fresh fruit was available. A person using the service was offered fruit during the inspection. Lunch was unrushed, and people using the service chose where to eat (one person ate his meal in his/her bedroom), and what to eat. The meals provided at lunch were judged to wholesome and nutritious. Drinks and snacks were offered regularly to residents during the inspection. Integrated Care Services Limited DS0000056792.V361105.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 18,19, and 20 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People using the service have their personal care and healthcare needs met. Some staff guidance with regard to meeting specialist health needs could be improved. Systems are in place to ensure that medication is stored and administered safely to people using the service. EVIDENCE: Staff spoke of care and support being provided to residents in a flexible and consistent manner, which meets their changing needs. It was clear that staff respected the privacy of residents during the inspection. A resident spoke positively of the support he/she received from staff with their personal care needs. During the inspection it was observed that personal support is delivered by staff in response to the individual, and varied needs and preferences of people using the service. Staff were observed to support residents when they wished to use the bathroom facilities. People are supported and helped to be independent. Integrated Care Services Limited DS0000056792.V361105.R01.S.doc Version 5.2 Page 18 Residents have access to healthcare services. Treatment and care for residents from the GP, dentist, optician, and chiropodist is recorded. Records confirmed that residents receive additional specialist support from other health care professionals, which include physiotherapists and occupational therapists, as and when needed by them. Attendance at specialist clinics and hospital clinics were also documented. A resident had received bereavement counselling. Annual Quality Assurance Assessment (AQAA) document, informed me that specialist equipment/aids are obtained for residents, if needed by them. The weight of people using the service is monitored. Care plans could be further developed in recording measures/guidance with regard to the diabetic health care needs of people using the service. The issue of ensuring that there is clear recorded staff guidance in the management and care of the diabetes and/or epilepsy and ensuring that staff know what to do if symptoms develop, was discussed with the manager. Following the inspection the manager supplied the Commission with a copy of a recorded protocol to be followed by staff if a resident had a seizure. She confirmed that staff were aware of this guidance and that this information was easily accessible. The home has a good record of compliance with the receipt, and administration of medication. The home has a medication policy/procedure. I was informed that a new medicine cupboard had been purchased within the last 12 months. This medicine storage cabinet needs to be secured to a wall. The manager should ensure that the new medicine cabinet meets appropriate legislation, and that she acquires a controlled drug (CD) cupboard, which meets up to date legislation if/when there are controlled drugs in the home. Staff confirmed that they received medication administration training from a pharmacist. The manager spoke of the procedure in place for ensuring that staff are assessed as competent to administer medication, which includes how medicines are used, and the principles behind all aspects of the homes’ policy on handling medicines, and records. The manager spoke of her plans to develop this assessment, and confirmed that she monitors the competence of staff who administer medication. Following the inspection, the manager supplied the Commission for Social Care Inspection (CSCI) with a copy of some recorded guidance with regard to staff administering medication safely, and of recorded staff medication administration assessment information. Receipt of medication and medication administration records were recorded appropriately. The manager should obtain an up to date British National Formulary medication reference book that’s accessible to staff. Integrated Care Services Limited DS0000056792.V361105.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Complaints are taken seriously and handled objectively. Recording of residents ‘concerns’ could be better. Residents are protected from abuse, neglect and self-harm. EVIDENCE: It was evident from observation and from talking with residents that the care home has an open culture that enables residents to express their views and concerns in a safe and understanding environment. A resident confirmed that he/she felt safe in the home. The home has a complaints procedure is displayed and is recorded in written/pictorial format. It includes timescales for the manager to respond to complaints. The complaints record/log confirmed that there had been no documented complaints since the previous inspection. Staff spoke of residents on occasions communicating general ‘complaints/ concerns, generally about other resident’s behaviour, and confirmed that these issues were generally recorded in the ‘daily’ progress records of people using the service, and resolved promptly. All ‘concerns/complaints’ should be recorded in accordance with the complaints procedure. The Annual Quality Assurance Assessment (AQAA) document supplied to the Commission recorded that relatives are aware of the complaints policy, and that the manager recognises the importance of learning from ‘critical comments’. Integrated Care Services Limited DS0000056792.V361105.R01.S.doc Version 5.2 Page 20 The home has a protection of vulnerable adults policy, and the Local Authority safeguarding adult’s procedure. These policies and procedures are available and give clear specific guidance to those using them. I was informed that protection of vulnerable adults training for most staff was carried out in March 2008, and that further training was planned. A staff member spoke of having received safeguarding adults training during study for an NVQ level 3 qualification in care. Staff confirmed that they knew what action (including recording and reporting) to take in response to a suspicion and/or allegation of abuse. The care home has a whistle blowing policy. Integrated Care Services Limited DS0000056792.V361105.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24, 26 and 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The environment of the home is safe, homely, and comfortable. The premises are suitable for the care home’s stated purpose in meeting the needs of the people who live there. Some minor maintenance issues could be attended to. EVIDENCE: The care home is located close to a variety of local shops and amenities. Kingsbury and Harrow are within a few minutes drive from the home. Public transport facilities include train, and bus services. The inspection included a tour of the premises. The home is well maintained, and the environment promotes the privacy, dignity and autonomy of residents. Several areas of the care home have been redecorated since the previous key inspection, which has led to the environment seeming to be more bright and clean. The kitchen, stairway, other communal areas, and residents’ bedrooms have been repainted. I was informed by the manager that the residents had Integrated Care Services Limited DS0000056792.V361105.R01.S.doc Version 5.2 Page 22 been fully involved in this programme of redecoration. Some kitchen cupboards are worn, and could be maintained or replaced. A resident spoke of having chosen the colour of his/her bedroom. Comments from him/her and other residents included ‘ I like my room’, ‘I am happy with my bedroom, I have lots of things’. Resident’s bedrooms were individually personalised, and included items such as a television, computer, music systems, pictures, and photographs. The lighting, and flooring in the kitchen have also been improved. A grab rail has been provided for the staircase, to improve access up the stairs for residents and others. New electric bath seats have been installed. The Annual Quality Assurance Assessment (AQAA) document informed us that an occupational therapist was involved in assisting the manager to access and provide these, and other suitable equipment for the care home. A number of grab rails have been put in place in the home. A resident spoke of their plans to obtain a new wheelchair, he/she commented ‘I will be happy when I have my new wheelchair’. A staff member reported that new covers had been provided for the lounge suite. There could be a mirror mounted on the wall above the sink, in the ground floor bathroom, to support residents when meeting their personal care needs including shaving, etc. The home is warm, clean and odour free. The laundry facilities are located away from food storage and food preparation areas. Staff were observed to wear protective clothing as, and when needed. The manager spoke of plans to ensure that staff receive ‘refresher’ infection control training. This is recommended. Integrated Care Services Limited DS0000056792.V361105.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34 and 35 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff are supervised, and receive some training to ensure that they are competent, and skilled to enable them to carry out their roles and responsibilities to ensure that the needs of people using the service are met. Staff training could be further developed. People using the service are supported and protected by the care home’s recruitment policy and procedures. EVIDENCE: The staff rota displayed was for the other care home. This was removed during the inspection and I was shown the correct rota. The rota and staff confirmed that there was generally one staff member on duty when there were only two residents at home during the day, and two staff on duty when all the residents are at home. At night there is a ‘sleep in’ staff member on duty. The manager confirmed that she regularly works alongside staff, and spoke of herself being very flexible in providing staff support by working on shift as and when needed. She spoke of recent examples of her having participated in Integrated Care Services Limited DS0000056792.V361105.R01.S.doc Version 5.2 Page 24 community activities with people using the service. Care staff confirmed that they felt that there were sufficient staff on duty. This informed me that the staffing structure is based around delivering outcomes for residents. People have confidence in the staff who care for them. People using the service were positive about the staff. A resident spoke of a staff member that he/she particularly liked. The Annual Quality Assurance Assessment (AQAA) recorded that there is always sufficient staff on any given shift, and that there was not a big staff turnover. Care staff spoken to had worked for several years in the care home, and spoke positively of the atmosphere in the home, and confirmed that they enjoyed their jobs as care workers. Comments included ‘It is very friendly here’, ‘It’s like a family’. It was evident that staff communicate positively amongst themselves, and with residents. A staff communication book recorded a number of entries from staff, and confirmation that messages had been read, and appropriate action taken. We (Commission for Social Care Inspection) were informed from records and staff that staff meetings take place. The home has a recruitment and selection policy/procedure. Three staff personnel files were inspected. Though this documentation included evidence that required and appropriate recruitment procedures had been carried out, it was not easy to access this information from these files, due to way that the records were filed. These files should be reviewed to ensure that information is recorded clearly and is accessible. Records confirmed that required enhanced Criminal Record Bureau checks (a check to ascertain whether a prospective staff member has a criminal record) had been carried out. The Annual Quality Assurance Assessment (AQAA) records that staff induction training meets National Minimum Standards and that four (out of eight staff) had qualified up to/and/or with regard to a National Vocational Qualification (NVQ) in care level 3. The Annual Quality Assurance Assessment (AQAA) informed the Commission for Social Care Inspection (CSCI) that the care home ‘could do better’, with regard to providing more staff training and development. Training recorded were inspected. These included some training certificates, but were rather unorganised, and there was no evidence of an up to date staff training and development plan or of recorded individual staff training and development records. Care staff confirmed that they had received training, some of which had been completed during previous employment. Much of the statutory (1st Aid, food and hygiene training, and health and safety training) training had been included in the NVQ level 2 and 3 care training courses. It needs to be more evident that all care staff are receiving the statutory and specialist training, including ongoing ‘refresher’ training that they require to ensure that they are skilled and competent to carry out their roles and Integrated Care Services Limited DS0000056792.V361105.R01.S.doc Version 5.2 Page 25 responsibilities in providing care and support to people using the service. Staff training was discussed with the owners of the care home. The manager spoke of ensuring that herself and care staff receive training in understanding the Mental Capacity Act 2005. Staff spoke of receiving the support and supervision that they need to carry out their jobs. Records confirmed that staff 1-1 supervision is carried out but that this varies in frequency. The manager should ensure that all staff receive regular recorded supervision meetings at least six times a year, and should record when and why a planned staff supervision meeting did not take place. Integrated Care Services Limited DS0000056792.V361105.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37,39 and 42 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Health and safety and welfare of people using the service is promoted and protected by a competent manager who is keen to achieve positive outcomes for residents and staff. Arrangements are in place to ensure that effective quality assurance and quality monitoring systems are in place to monitor and improve the quality of the service provided by the care home. EVIDENCE: The manager has the required qualification and experience, to run the care home and meet its stated aims and objectives. She has had several years experience in a management role in supporting and caring for adults with a Integrated Care Services Limited DS0000056792.V361105.R01.S.doc Version 5.2 Page 27 learning disability, and she is also an joint owner of the service. She has achieved the Registered Manager’s Award qualification, and has recently completed a health and safety course and protection of vulnerable adults training. Following the unannounced inspection she informed the Commission for Social Care Inspection that she had completed a food safety training course in 2007 and ‘risk assessment in a care setting’ training in March 2008. The manager gave examples of how she keeps up to date with relevant legislation, and how she ensures that the care home provides a service that meets the individual care and support needs of people using the service. She confirmed that she was ‘on call’ at all times. We (CSCI) were informed by the manager and joint owner that a combined business plan for this service and the other care home is completed regularly, and was informed that an annual development plan for the service was completed in 2007. The manager completed the Annual Quality Assurance Assessment, documentation and spoke of this being a useful tool with regard to assessing the service and for developing plans to continue to improve the service. The AQAA contained clear and relevant information, and let us know about changes the home has made and where they still need to make improvements. There was evidence from the AQAA and other records that people using the service had been asked for their views of the service by completing a feedback questionnaire. These questionnaires should be supplied to other stakeholders including relatives/significant others, and health and social care professionals. The manager confirmed that she and other staff have regular contact (via telephone, letter and email,) with the family and friends of residents. The home has a health and safety policy. A health and safety poster was displayed as required. Annual Quality Assurance Assessment (AQAA) information confirmed that the manager has an understanding of the importance of promoting and protecting the health, safety and welfare of people using the service, and included information that confirmed all policies and procedures had been recently reviewed. The manager confirmed that health and safety practices were closely monitored. Certificates of worthiness in regard to servicing of electrical and gas safety systems in the care home were up to date. Fridge and freezer temperatures are monitored. The home has a fire risk assessment. Fire safety guidance is displayed in the home. Required fire safety checks are carried out and regular fire drills take place. The recording of fire drills and the names of those who participate in these drills could be better recorded. Fire extinguishers and other fire safety equipment had been serviced in 2007. Appropriate door opening safety mechanisms were in place on doors that to allow doors to be open during the day to ensure residents can access rooms without difficulty during the day. Annual Quality Assurance Assessment (AQAA) records informed me that food safety records are maintained. Ist Aid guidance displayed in the kitchen should be reviewed to make sure that it meets up to date guidance. Integrated Care Services Limited DS0000056792.V361105.R01.S.doc Version 5.2 Page 28 The home has an accident/incident reporting policy. Incidents are recorded appropriately. The employers liability insurance is displayed and up to date. Integrated Care Services Limited DS0000056792.V361105.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 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 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X 3 X X 3 X Integrated Care Services Limited DS0000056792.V361105.R01.S.doc Version 5.2 Page 30 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. 1 Standard YA19 Regulation 12(1)(a) 13(1) Requirement There needs to be evidence that people using the service who have particular diabetic needs have clear recorded staff guidance to ensure that staff know what to do if symptoms develop. The medicine storage cabinet needs to be secured to a wall, to ensure that it cannot be removed from the care home. There needs to be an up to date training and development plan and training record, for each staff member to provide recorded evidence that staff receive training (including specialist and ‘refresher’ training) that is focussed on delivering outcomes for residents, and provides evidence that they have the skills and competences to carry out their roles and responsibilities in providing care and support to people using the service. Timescale for action 01/06/08 2 YA20 13(2) 01/06/08 3 YA35 18(1)(c) 01/07/08 Integrated Care Services Limited DS0000056792.V361105.R01.S.doc Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA6 Good Practice Recommendations The care plans could be more ‘person centred’ (evidence that the resident is central to their plan of care and that its development is led and owned as far as possible by the person using the service) and it be more evident that the care plans are working documents, and that the information is accessible as possible to people using the service. Equality and diversity needs of residents could be more evident in care plans. The care plans should include agreed timescales to meet the resident’s goals and plans. The resident’s care plans should be reviewed monthly (more often in response to changing needs). People using the service should have the opportunity to be involved in one to one key worker meetings to discuss their care plan, progress, and other issues. People using the service should have the opportunity to sign their care plan and that it be evident that if needed (i.e. if the person using the service has difficulty reading and/or understanding the care plan) the care plan is fully explained to them. It is recommended that risk assessments continue to be further developed and reviewed, and there should be evidence that the people using the service are fully involved in their risk assessments. Recorded night needs risk assessments for each resident should be in place, and these be reviewed with regard to residents changing needs. It should be recorded in the resident’s care plan if he/she has declined a call bell. The manager should ensure that the new medicine cabinet meets appropriate legislation, and that she acquires a controlled drug cupboard (CD), which meets up to date legislation if/when there are controlled drugs in the home. DS0000056792.V361105.R01.S.doc Version 5.2 Page 32 2 YA9 3 YA20 Integrated Care Services Limited 4 YA22 5 YA24 All ‘concerns’ should be recorded in accordance with the complaints procedure, to ensure that there is evidence that complainants have been listened to, and that appropriate action has been taken to resolve concerns/complaints. There could be a mirror mounted on the wall above the sink, in the ground floor bathroom. Some kitchen cupboards are worn, and could be maintained or replaced Staff should receive ‘refresher’ infection control training, to ensure that staff develop and maintain their skills with regard to keeping residents safe. The staff personnel files should be reviewed to ensure that information is recorded clearly and is accessible. The manager should ensure that all staff receive regular recorded supervision meetings at least six times a year. Feedback questionnaires about the service should be supplied to stakeholders which include, relatives/significant others, and health and social care professionals. The recording of fire drills and the names of those who participate in these drills could be better recorded. Ist Aid guidelines displayed in the kitchen should be reviewed to make sure that up to date guidance is met. 6 7 6 7 8 YA26 YA34 YA36 YA39 YA42 Integrated Care Services Limited DS0000056792.V361105.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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