Care Home: Keevan Lodge

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What the care home does well The home provides a good standard of care and support to a group of residents with a range of very complex and challenging needs. The people who live in the home receive support for their health from a range of experienced healthcare professionals. The staff demonstrate a good knowledge of the residents and are able to recognise their individual needs. The people who live in the home are supported to maintain positive contact with their relatives and to have a full lifestyle enjoying a range of community based activities. The staff team work well together and benefit from supervision and training to provide them with the skills needed to support the residents to a high standard. What has improved since the last inspection? The last key inspection took place on the 26 April 2008 and was followed up with a briefer random inspection on the 6 November 2008. The random inspection found that all the requirements and recommendations from the key inspection had been met. This included providing the staff with a number of training courses including training on supporting people with complex challenging behaviours, safeguarding vulnerable adults and a comprehensive induction for new staff. In addition staff all have a signed contract of employment. The manager has also accessed ongoing training including person centred planning. The management of resident`s monies was improved by ensuring each resident`s assessments included a record of how they were supported to manage their monies. Residents have been supported to express their views by holding regular residents meetings. They have also been encouraged to eat more healthy food. Medication management has improved by recording the temperature where medication is stored to ensure it is appropriate. Guidelines have also been put into place for residents who take medication "as required" so staff know when it should be administered. The manager has updated the homes statement of purpose. They are also keeping a record of fire drills including who was present and the time the drill took place to ensure all staff and residents have an opportunity to participate. What the care home could do better: One requirement was made at this inspection and this is to ensure that there are adequate numbers of staff available to ensure that staff are not working excessively long hours. It was also recommended that the work that has started on person centred assessments and plans are completed. The service user guide would also be more meaningful if photos of the home were included. It was also recommended that steps could be taken to improve the safeguarding of residents personal monies, including staff signing to say they have checked the monies and handed them over at the end of each shift and numbering the receipts to enable the record of expenditure to be found more easily. CARE HOME ADULTS 18-65 Keevan Lodge 98 Clive Road Enfield Middlesex EN1 1RF Lead Inspector Jane Ray Unannounced Inspection 13th May 2008 11:30 Keevan Lodge DS0000034275.V363873.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 Keevan Lodge DS0000034275.V363873.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. Keevan Lodge DS0000034275.V363873.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Keevan Lodge Address 98 Clive Road Enfield Middlesex EN1 1RF 020 8367 0441 020 8367 0441 saivancare98@yahoo.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Saivan Care Services Ltd Danwantee Bundhun-Ramsaha Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Keevan Lodge DS0000034275.V363873.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th November 2007 Brief Description of the Service: Keevan Lodge is a care home registered to provide residential services for three adults with a learning disability. The home is situated in a quiet residential street close to a supermarket, restaurants and a cinema. The Enfield Town Centre is approximately fifteen minutes walk away from the home. Each bedroom in the home has a shower, a wash hand basin and a toilet. The home has a separate bathroom and a toilet on the first floor. The kitchen/diner, a lounge and one bedroom are on the ground floor. The home is not accessible for people with physical disabilities. There is a large garden at the back of the home, which residents can use for sitting and relaxing when weather permits. The home was registered on 2nd August 2003 and has admitted three residents in the time it has been open. The registered manager is Ms Danwantee Bundhun-Ramsaha. The philosophy of the home is to to promote a positive image of people with learning disabilities and create and maintain a homely environment conducive to the delivery of care and providing comfort. The home has an aim of creating a warm and supportive environment within which quality care can be delivered according to individuals holistic needs. At the time of the inspection there were three residents living in the service. The current range of fees in the home is from £1030 - £1668 a week. A copy of this report can be obtained direct from the provider or via the CSCI website (web address can be found at page two of this report). Keevan Lodge DS0000034275.V363873.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 inspection took place on the 13 May 2008 and was unannounced. The inspection lasted for four hours and was the key annual inspection. The inspection looked at how the home was performing in terms of the key National Minimum Standards for Younger Adults and the associated regulations. The inspector was able to observe the support given to two of the current residents. The inspector was also able to spend time talking to the manager as well as the one care staff who was working. The inspector was also able to spend time speaking to one of the residents. The inspector did a tour of the premises and also looked at a range of records including resident records, staff files and health and safety documentation. The home had provided the inspector with a completed self-assessment questionnaire (AQAA) prior to the inspection. This inspection was also part of a national thematic exercise being carried out by the Commission looking in more detail at safeguarding vulnerable adults. What the service does well: What has improved since the last inspection? The last key inspection took place on the 26 April 2008 and was followed up with a briefer random inspection on the 6 November 2008. The random inspection found that all the requirements and recommendations from the key inspection had been met. Keevan Lodge DS0000034275.V363873.R01.S.doc Version 5.2 Page 6 This included providing the staff with a number of training courses including training on supporting people with complex challenging behaviours, safeguarding vulnerable adults and a comprehensive induction for new staff. In addition staff all have a signed contract of employment. The manager has also accessed ongoing training including person centred planning. The management of resident’s monies was improved by ensuring each resident’s assessments included a record of how they were supported to manage their monies. Residents have been supported to express their views by holding regular residents meetings. They have also been encouraged to eat more healthy food. Medication management has improved by recording the temperature where medication is stored to ensure it is appropriate. Guidelines have also been put into place for residents who take medication “as required” so staff know when it should be administered. The manager has updated the homes statement of purpose. They are also keeping a record of fire drills including who was present and the time the drill took place to ensure all staff and residents have an opportunity to participate. 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. Keevan Lodge DS0000034275.V363873.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Keevan Lodge DS0000034275.V363873.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,2,3,4 and 5 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home can be assured that their individual needs will be assessed and that the staff have the skills and ability to meet these needs. New people moving to the service will have access to information in an appropriate format to tell them about the home. EVIDENCE: We inspected the statement of purpose and this document had been updated to provide specific information about the home and the resident group they care for. This document is clear and would be useful for care professionals and relatives who could need information about the service. A service user guide has also been prepared using a specific pictorial language designed to be accessible for people with a learning disability. This document might benefit from including photos pf the home. We looked at the case notes for the three people who live in the home. They all had assessments that formed part of their individual care plans that covered their current individual needs and provided a good basis for the care plan Keevan Lodge DS0000034275.V363873.R01.S.doc Version 5.2 Page 9 goals. For two of the three residents this assessment had been written in a person centred format, but for the final person this needed to be completed. We discussed the current needs of the people who live in the home with the manager and care staff. They have very specific individual needs linked to their learning disability, mental health and complex behaviours. The staff spoken to had a very good understanding of the individual needs of the residents. In addition it was observed that the staff were supporting the residents with great skill and sensitivity. The training records of the staff team were inspected and they had received training on supporting people who have complex challenging behaviours. There have been no new people moving to the home since the last inspection. The homes policies and procedures include guidance on how to support new residents to move into the home. One resident said, “I remember coming to visit the home several times”. The AQAA prepared by the home stated that all the residents had a completed contract between themselves and the home clearly stating what the service will provide. The previous inspection reports confirm these contracts are in place. Keevan Lodge DS0000034275.V363873.R01.S.doc Version 5.2 Page 10 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): Standards 6,7,8 and 9 were inspected. People using 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 home can be confident that they will be supported to have an individual care plan and risk assessments. This will facilitate the residents to make choices in their daily lives. EVIDENCE: We inspected care plans for the three people currently living in the home. We also spoke to the manager and care staff about the care plans. All of the people whose records were inspected had comprehensive care plans in place. These were clearly laid out and covered all aspects of each persons needs and were written using appropriate language. They had been signed by the resident to confirm that they had been discussed with them. The care plans had all been reviewed in the last six months. All the residents had been Keevan Lodge DS0000034275.V363873.R01.S.doc Version 5.2 Page 11 supported to have an annual care plan review meeting with their care manager. It was noted that some actions had been agreed at these meetings that had not been incorporated into the care plans such as organising a prepaid funeral or arranging a referral for a chiropody service. These goals should be included so that their progress can be monitored. Each resident had a named key worker and co-key worker. The staff and manager were asked about their role as a key-worker and this showed that the support they provided was very comprehensive including helping with personal shopping, attending healthcare appointments, ensuring all the residents personal care needs were met, organising leisure activities and updating care plans. Since the last inspection the manager and most of the staff have attended training on person centred planning. The manager showed me the work that has started to put the residents care plans into a person centred format. This work needs to be completed. We read the risk assessments for the three people who live in the home. It was possible to see that an effort had been made to identify areas of personal risk and look at how this can be managed without placing unnecessary restrictions on people. The risk assessments had been prepared using one main format that was clear and easy to follow. It was also possible to observe the actions from the risk assessments being implemented in the home, such as ensuring that sharp knives are locked away. Each person living in the home had individual behavioural guidelines as part of their individual profile, assessment and care plan and these were clearly written and gave guidance to the staff. These guidelines do include the withdrawal of privileges as a last resort such as stopping people from going on community trips. The staff interviewed said that these sanctions are only used once other positive interventions have been tried and not been successful. The records show that these guidelines have been discussed and agreed with other care professionals as part of the review process. Where there are incidents of serious challenging behaviours a detailed record is kept to explore any triggers that may have led to the outburst. The three residents assessments and care plans clearly stated what arrangements were in place to support them to manage their personal finances including who acts as their appointee and how they can access their monies. We observed two of the three people living in the home and their interaction with the staff. It was positive to note that they were being facilitated to make choices including what they wanted to do when they went out. The staff were observed to be very aware of both verbal and non-verbal communication. The manager explained that a referral has been made for one resident to have an Keevan Lodge DS0000034275.V363873.R01.S.doc Version 5.2 Page 12 advocate as she has no relatives to support her in making some decisions including how she might wish to spend her money. The residents are also supported to hold regular residents meeting and these take place every six weeks. The record of these meetings was inspected and a number of issues relating to aspects of living in the home had been discussed including the menu, the holiday and activities. The manager also explained that one resident is now helping with the staff interview process and is able to sit on the panel and ask a question. Keevan Lodge DS0000034275.V363873.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): Standards 11,12,13,14,15,16 and 17 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home are supported to develop their independent living skills and are also enabled to follow their own routine. The home has made progress in supporting the residents to enjoy a wide range of communitybased activities. EVIDENCE: We were able to read in the resident’s daily reports, which reflect how they were being supported by staff to develop their independent living skills in line with their individual needs. For example one person was being supported to have a bath with as little staff input as possible. Keevan Lodge DS0000034275.V363873.R01.S.doc Version 5.2 Page 14 We spoke to the staff and looked at the resident’s activity programmes to get an understanding about the activities that are taking place. The manager explained that one of the residents goes to college twice weekly and studies horticulture. This resident also takes part in an art class arranged through MIND. Two of the residents take part in activities organised by the home and are supported to access a wide range of community based activities such as shopping, restaurants, local parks and the library. Some residents attend a local evening social club once a week and one member of staff said that one resident really enjoys the table tennis. On the day of the inspection the two residents who were at home went out for lunch. The daily logs show that all the residents are going out almost every day for different activities. In terms of holidays the manager explained that the residents have looked at some brochures and chosen a holiday by the sea and this has now been booked. The AQAA identified that the residents have different ethnic and cultural backgrounds. One person is a practising Hindu and the home have discussed this with his relatives and ensure he eats an appropriate diet and is not offered alcohol. A member of staff takes him to his temple once a week. The other residents do not attend a place of worship and their wishes and those of their relatives have been addressed in their assessment. The manager explained that two of the people living in the home have close contact with their relatives, who either come to visit them or they are supported to go home. One relative had completed a questionnaire as part of the homes internal quality assurance exercise and this was very positive. The manager explained that one of the residents has a good friend who he has met through his college course. The manager explained that she has encouraged him to invite his friend over or to make a social arrangement but so far this has not taken place. The daily records read during the inspection indicated that the people living in the home were able to follow a routine of their choice and that people get up at different times according to their individual wishes and needs. It was very positive to note that the residents were supported in a very person centred and individual manner. The three residents in the home all have very different taste in terms of the food they enjoy and tend to have separately prepared meals. A record is kept of what food each person has eaten. The issue of healthy eating is raised a resident meetings and in key worker sessions and it was observed that there was lots of fresh fruit and vegetables in the home. In addition each resident is supported to have their weight checked each month. It is recognised that the residents do not always choose to eat a healthy diet but the staff try to steer them towards making better choices. Keevan Lodge DS0000034275.V363873.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): Standards 18,19 and 20 were inspected. People using 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 home are supported in a manner that protects their privacy and dignity. Each person is supported to access professional healthcare input based on their individual needs. EVIDENCE: We observed during the inspection that the staff were supporting the people living in the home to receive personal care in a manner that preserved their privacy and dignity. It was observed that the residents were appropriately dressed and that their clothing was very suitable for the weather and the activities they were attending. The manager and care staff explained about how relatives buy clothes for some of the residents and key-workers support other residents. The residents were also well groomed in terms of their personal care including haircuts. Keevan Lodge DS0000034275.V363873.R01.S.doc Version 5.2 Page 16 We looked at the healthcare records for the three people living in the home. They had all been supported to access a range of healthcare professionals including the GP, dentist, optician, psychiatrist, community psychiatric nurse and other appointments according to their individual needs. One resident has had some heart problems and has been seen by the cardiologist. One resident has epilepsy and the home, the community learning disability nurse and a psychiatrist closely monitor this. Assistance with emotional needs including input for anger management has also be accessed where needed. We looked at the medication, administration records and staff training records. The home uses a blister pack system. Since the last inspection the home has purchased a new medication cupboard. The medication administration records show clearly when medication is received in the home and a separate book records medication returned to the pharmacist so a clear audit trail is available. The medication administration records were completed correctly. Each resident had a profile and these appeared accurate and reflected the medication on the medication administration record. Where the resident takes “as required” medication there is a protocol in place stating when this should be administered. The manager explained that when residents go on a home visit they take the blister pack with them so the medication, can be administered by the relatives. The training records were inspected and all of the staff had completed the medication training. The home manager is completing a six monthly audit and these records were observed. It was noted that the temperature of the medication cupboard was monitored. Keevan Lodge DS0000034275.V363873.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): Standards 22 and 23 were inspected. People using 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 home have access to an appropriate complaints procedure and can express their views. Procedures and training on safeguarding vulnerable adults are in place to protect the residents. Systems to ensure residents personal monies are being managed appropriately could be made more robust. EVIDENCE: The AQAA stated that there have been no written complaints since the last inspection. The organisation has two complaints procedures, one designed for the service users and the other for relatives and care professionals. Both these documents are clear and are displayed in the home. The home has a format available to record any complaints that are received and how the matter is resolved as well as the timescale. Copies of the organisations procedures and social service procedures for safeguarding vulnerable adults are available in the home. I looked at the staff training records and these show that all of the staff had received safeguarding vulnerable adult training. On the day of the inspection the staff were participating in some in-house training including some refresher training on safeguarding issues. Keevan Lodge DS0000034275.V363873.R01.S.doc Version 5.2 Page 18 We spoke to the care staff about the safeguarding adults procedure and whistle blowing and they displayed a good knowledge of the procedures and the importance to speaking to the manager about issues that arise. We also looked at the training records to see if the staff had been trained on how to appropriately support people who have complex challenging behaviours. These show that all staff have received this training. This helps to ensure that staff respond appropriately to residents if they are distressed. The staff member spoken to showed a very good understanding of how to support people with complex behaviours and the importance of knowing each person and good communication in diffusing a potentially aggressive situation. We checked the personal finances for two residents including their cash record, cash and receipts. Two of the people living in the home are supported by relatives to manage their personal monies and the home just needs to account for spending money they hold on behalf of that person. The third person is supported by the manager and has two building society accounts. In the home there is an individual finance record for each person. Their cash is held in a lockable drawer. All expenditure is recorded and receipts are available. The receipts are not however numbered and were hard to match up to expenditure. The staff all have access to the monies but there is no recorded handover between shifts of the monies and so if money were missing it would not be possible to identify when this had happened. Keevan Lodge DS0000034275.V363873.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): Standards 24 and 30 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people who use this service can usually feel confident that they are living in a well maintained home. The home is kept clean and hygienic and is a pleasant environment for the people who live here. EVIDENCE: The home is a terrace house that is well decorated, well maintained and which continues to provide an overall pleasant environment to meet the current service users needs. Since the last inspection a number of improvements have taken place including decorating throughout the home and repairing a shower in one of the upstairs en-suite bathrooms. Keevan Lodge DS0000034275.V363873.R01.S.doc Version 5.2 Page 20 The house has satisfactory laundry facilities and storage for chemical cleaning materials. The home was seen to be clean and tidy during the inspection. Residents had been supported to make their bedrooms homely and personalised. One resident who enjoys gardening has been supported to plant flowers in the front and rear gardens and these look very attractive. The manager explained that they are planning to add a conservatory to the rear of the home and create an additional space for activities. Keevan Lodge DS0000034275.V363873.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): Standards 32,33,34,35 and 36 were inspected. People using this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. There are not yet enough staff working in the team and this has meant that some staff are working very long hours. The staff are receiving relevant training and are supported by regular supervision sessions. This enables them to work to a high standard and deliver good care. EVIDENCE: We checked the rota for the home and this showed that there is a team of ten staff working in the service. During the day there are two staff on duty and at night there is one waking member of staff. The manager is shown as being part of the rota. Since the last inspection one carer has joined the team and no staff have left, which represents a very low staff turnover. According to the rota some staff were working very long hours as they were starting work at 5pm and then doing a waking night till 9am, which is a total shift of 16 hours. The manager explained that she has recruited three new part time staff to work in the afternoon and that she was reviewing whether the residents still Keevan Lodge DS0000034275.V363873.R01.S.doc Version 5.2 Page 22 needed waking night staff. The long staff hours are not acceptable as the staff members could become very tired and not be able to work effectively. The manager and care staff explained that staff team meetings take place on a monthly basis. The record of these meetings was inspected and it could be seen that they discuss a range of operational issues. The staff spoken to said that the team was working well together and that there was open communication between team members. They also felt confident to raise any concerns with the manager. The AQAA prepared by the home stated that out of the ten current staff, six have completed an NVQ in care and two are working towards this qualification. We looked at the recruitment records for the whole staff team including the one member of staff who had started working at the home since the previous inspection. It was found that all the staff had two references, ID with visa where needed, POVA check and a CRB disclosure. The staff had completed and signed contracts of employment. We inspected the training records. We looked at the induction records for all the staff and they all had a completed the skills for care induction programme and a record was available. The staff confirmed that this induction had taken place and that they had been well prepared for the job. Each member of staff has a record of the training they have received and the manager has also prepared an overview of the training received by the whole staff team to enable future training to be planned. We looked at the record of supervision sessions and a supervision format. All the staff had received regular individual supervision about every two months. The format used for supervision is appropriate and includes a record of any action agreed. Keevan Lodge DS0000034275.V363873.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): Standards 37,39 and 42 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People using this service can be assured that a permanent manager who can provide effective leadership is available. Health and safety measures are in place to safeguard the people living in the home. The quality improvement system in the home seeks the views of the residents, relatives and other stakeholders. EVIDENCE: The manager has many years of experience as a qualified nurse in working with people who have a learning disability. The manager has also completed the NVQ level 4 in the management of care. The manager knows the people who live in the home very well and has supported them to make significant Keevan Lodge DS0000034275.V363873.R01.S.doc Version 5.2 Page 24 progress in their lives. The manager participates in ongoing training to keep her practice updated and since the last inspection has attended training on person centred planning. The annual quality assurance exercise has taken place and through the use of questionnaires has sought the views of residents, relatives and other care professionals. These questionnaires were inspected and the feedback was very positive. The home notifies the Commission of any serious incidents such as when a resident needs to go to hospital. In terms of fire safety we looked at the fire safety risk assessment and this was complete. The service has a brief emergency plan but also has a comprehensive fire safety policy. The fire alarm and fire extinguishers had been serviced. The fire alarm records show the alarm is checked weekly and the fire drills take place at this time. The training summary prepared by the home showed that fire safety training has been completed for all of the staff. The AQAA showed that all the health and safety maintenance checks had taken place. The staff training records show that the staff have completed the health and safety training including food hygiene, moving and handling, first aid and infection control and that refresher training takes place when needed. Keevan Lodge DS0000034275.V363873.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 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 2 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 x LIFESTYLES Standard No Score 11 3 12 3 13 4 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 x 3 x 3 x x 3 x Keevan Lodge DS0000034275.V363873.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA33 Regulation 18(1) Requirement The registered person must ensure that there are sufficient numbers of staff available to ensure that staff do not need to work excessive hours to provide cover for the home. Timescale for action 30/06/08 Keevan Lodge DS0000034275.V363873.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. 3. Refer to Standard YA1 YA2 YA6 Good Practice Recommendations The registered person should consider using photos to make the service user guide more meaningful for the residents. The registered person should complete the person centred assessment for the final resident. The registered person should complete the person centred plans for each of the residents. They should also ensure that these are updated to include any actions agreed at the review meeting. The registered person should take additional steps to safeguard the residents personal monies including numbering receipts so they can be easily identified and ensuring staff record they have handed over each residents monies at the end of each shift and that the monies are correct. 4. YA23 Keevan Lodge DS0000034275.V363873.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection London Regional Contact Team 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Keevan Lodge DS0000034275.V363873.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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