Care Home: Leyton House

What the care home does well The home provides a personalised service for the people living in the home, some of whom have complex needs. One person told us "I am alright living here, the staff are OK, I like it here" and another person told us "this is a safe place for me to be". Staff are working hard to help people living at the home develop their skills and confidence to live more independently within the community, which people told us they appreciated. The home also works well with relevant community based health and social care professionals to assist this happen. The home is domestic in scale, comfortable and meets the needs of the people living there. What has improved since the last inspection? At the last key inspection three requirements were made and we were pleased to see that these had all been complied with. The required improvements made were in the following areas: to review the arrangements for residents` medication when the person is spending some time away from the home, to avoid the risk of possible error; to improve the way that routine concerns are recorded and dealt with and to more systematically seek the views of other health and social care professionals. The latter two improvements were required to help the home further develop its overall quality monitoring systems. A good practice recommendation to review the risks that staff may face when working on their own in the home had also been acted upon. CARE HOME ADULTS 18-65 Leyton House 117 High Road Leyton London E15 2DE Lead Inspector Peter Illes Announced Inspection 6th June 2008 09:30 Leyton House DS0000071104.V365211.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 Leyton House DS0000071104.V365211.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. Leyton House DS0000071104.V365211.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Leyton House Address 117 High Road Leyton London E15 2DE 020 8539 4699 020 8257 7810 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) Leyton House Community Care Naushad Mahomed Care Home 4 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (4) of places Leyton House DS0000071104.V365211.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Male whose primary care needs on admission to the home are within the following category: 2. Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 4 29th August 2007 (prior to new registration) Date of last inspection Brief Description of the Service: Leyton House is a privately operated care home, registered to provide personal care and support to four male younger adults who have mental health needs. The registered provider also operates a number of other registered care homes in East London. The home is a converted terrace house with accommodation provided on two floors. The ground floor contains an entrance hall, one bedroom, lounge, kitchen/ diner with access to a rear yard, a shower room/toilet and an office. The first floor contains three further bedrooms and a bathroom/ toilet. The home is situated on the High Road in Leyton and is close to shops, public transport links and a range of other multi-cultural amenities in the area. A stated aim of the home is to empower people to live, for as long as is required, in a comfortable home with the opportunity of enhancing their quality of life. The home aims to achieve this by providing support and stimulation to help residents maximise their potential physically, intellectually, emotionally and socially all within a homely atmosphere. At the time of the inspection, the weekly fee was from £950 per week. Information about the service, including inspection reports, is available on request from the registered manager/ provider. Leyton House DS0000071104.V365211.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 home has been registered with the Commission and operating for a number of years however, in January 2008 it was registered as a “new” home with the Commission. This because the registered provider formed a limited company, which is legally a “new” provider organisation. The registered manager, staff and residents remain the same. As this was the first key inspection, since the new provider company was registered with the Commission, it was announced with the registered provider being informed in advance, and took approximately six hours. The registered manager was available throughout the inspection and the responsible individual and another manager from the provider organisation also attended to support the registered manager for the majority of the inspection. Four people were living in the home and there were no vacancies, one new resident had been admitted since the last key inspection. The inspection was undertaken by the lead inspector although terms such as “we”, “our” and “us” are used where appropriate within this report to indicate that the inspection activity was undertaken on behalf of the Commission. The inspection activity included: meeting and speaking independently with two of the people living in the home; detailed discussion with the registered manager and responsible individual; independent discussion with the deputy manager who was the support staff on duty at the time; independent discussion by telephone with a healthcare professional from L.B. of Newham. Further information was obtained from a current Annual Quality Assurance Assessment (AQAA) submitted by the home, a tour of the premises and documentation kept at the home. What the service does well: The home provides a personalised service for the people living in the home, some of whom have complex needs. One person told us “I am alright living here, the staff are OK, I like it here” and another person told us “this is a safe place for me to be”. Staff are working hard to help people living at the home develop their skills and confidence to live more independently within the community, which people told us they appreciated. The home also works well with relevant community based health and social care professionals to assist this happen. Leyton House DS0000071104.V365211.R01.S.doc Version 5.2 Page 6 The home is domestic in scale, comfortable and meets the needs of the people living there. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Leyton House DS0000071104.V365211.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 Leyton House DS0000071104.V365211.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): 1&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. Up to date information is available to prospective residents and other interested people to make an informed choice about living in the home. People’s needs are properly assessed before they move into the home to ensure that staff can meet their needs. People’s needs are regularly reviewed once they are living in the home to assist staff be aware of any changes in these needs. EVIDENCE: The home has a satisfactory statement of purpose and service user guide that were seen. These documents give clear information about the home and the services it offers and includes details of the recent change made in relation to the registered provider. One new person had been admitted to the home since the last inspection and their file was inspected. This showed a range of up to date assessment information that had been made available to the home before the person was admitted. This included a comprehensive assessment and care plan from the place the person was living before moving to this home and minutes of a recent care planning approach (CPA) review meeting. The latter is a review Leyton House DS0000071104.V365211.R01.S.doc Version 5.2 Page 9 meeting including relevant health and social care professionals, which is required by law for some people with mental health needs. The person’s file also included an in-house pre-admission assessment carried out by the registered manager before the person moved in. The file showed details of the admission process and had a record and an evaluation of an initial visit with an external worker and an overnight stay before the person was admitted. Approximately six weeks after admission the placement was reviewed at another CPA review meeting and the person was judged to making good progress at the home by that meeting. The files of the other three residents were also inspected and showed that their needs were reviewed on a regular basis to allow staff to properly address their changing needs. This included records of monthly key worker sessions with the individual and regular CPA meetings. We were pleased to see that the home kept their own records of decisions made at the CPA meetings to ensure these could be acted upon whilst waiting for the formal minutes of the CPA meeting to be received. The residents concerned had signed the records of the assessment reviews to evidence that they had been involved in the meetings and residents spoken to independently confirmed this. We spoke independently by telephone to an external healthcare professional who was supporting one of the residents. She stated that she had recently reviewed her client at the home and was satisfied with the care and support the person was receiving. She went on to say that the staff were both helpful and carried out the actions agreed on the person’s care plan and that the home was always clean and pleasant when she visited. Leyton House DS0000071104.V365211.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): 6, 7, 9 & 10 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 are consulted when their needs are assessed and both people’s needs and preferences are recorded in their care plans to assist staff in meeting these. People are supported to maximise their independence by making as many decisions as possible for themselves. People are also supported and guided to take appropriate risks in their daily lives to assist them to safely achieve their aspirations. People can be confident that personal information about them is handled sensitively. EVIDENCE: The care plans for the four people living at the home were inspected. These were current, based on up to date assessment information, including from multidisciplinary meetings with health and social care professionals, and were being reviewed at least every three months. Care plans were focussed on Leyton House DS0000071104.V365211.R01.S.doc Version 5.2 Page 11 people’s individual needs and preferences and included promoting their independence. This included by encouraging them to cook independently, to be more independent with budgeting and to further develop their domestic skills within their daily routines. We were pleased to see that the home had started using the Commission’s recently published key equality and diversity prompts when reviewing people’s care plans. The plans showed information about people’s needs and preferences in relation to their culture, religion and their sexual identity and how they were being supported to meet these. Residents spoken to independently confirmed that they were involved in reviewing their care plans and in a range of one to one meetings including with their key worker. Some residents have complex needs and have some limitations imposed, for example regarding visitors to the home. However, these are properly documented on their care plans and evidence seen that the restrictions had been discussed and agreed with the individual. Residents spoken to independently indicated that staff were helpful in giving them information and in supporting them generally. One resident said “I am alright living here, the staff are OK, I like it here”. Another resident said “I am looking to move on but when the time is right”. Residents are supported to look for employment and to access educational facilities if they wish. All residents manage their own finances. All four files inspected contained up to date risk assessments that recorded identified risks that had been identified for the individual. The risk assessments identified each individual risk; factors leading to risk behaviour; indicators that risk may occur and gave risk management guidance to assist staff in reducing the identified risk. Evidence was seen that risk assessments are reviewed regularly; including the person concerned signing their assessment. Residents and staff spoken to independently confirmed that residents are fully involved in the process. The home has a policy in place on confidentiality, which makes clear under what circumstances a confidence may be broken, e.g. the health, safety and of residents and others. Residents sign a “Permission to share information” sheet, which gives the home permission to share confidential information with appropriate persons. Leyton House DS0000071104.V365211.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 & 17 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 living at the home are encouraged and supported to participate in a range of activities including within the wider community. They also enjoy contact with relatives and friends to the extent that they wish. People are supported to be as independent as possible including to enjoy healthy and nutritious meals. EVIDENCE: All four residents travel independently in the community and have a Freedom Pass to help with this. Evidence was seen that two people have a structured activity programme outside of the home and staff are encouraging the other two to explore more community activities. One person stated that they had confirmed arrangements in place to attend college soon and intended to study maths and English; another resident undertakes part-time work. One person is Leyton House DS0000071104.V365211.R01.S.doc Version 5.2 Page 13 also involved in skills development through a local voluntary organisation including self-advocacy and mental health awareness. Both residents and staff spoken to independently stated that staff interacted with residents in recreational activities within the house such as playing cards and watching television/ DVD’s. The home and provider organisation arranges trips and outings for residents. This has included a recent trip to Madam Tussauds, bowling and playing pool. The registered manager stated that the home was planning further outings with residents including trips to Thorpe Park theme park, the London Dungeon and a trip to the seaside. We were told that the provider organisation has a mini-bus that can be used were appropriate to facilitate such outings. Residents spoken to independently and records seen, including of residents meetings, evidenced that residents are involved in making decisions about outings and holidays. Residents that wished to enjoyed a week’s holiday at Clacton in 2007 organised by the provider organisation and discussions were currently taking place about a holiday destination for this year. Residents and staff both stated that last year’s week’s holiday to Clacton had been enjoyable. People living at the home originate from different ethnic communities and evidence seen that their needs and preferences, including in such areas as food and places of worship, were discussed with the person and recorded. People are supported to make their own decisions about their culture and religion and how they wish to pursue these. Residents are able to maintain contact with family and friends to the extent that they wish. People spoken to confirmed that visitors are welcome and that they are able to see visitors in private if they so wish. However, some restrictions are in place for individuals although evidence was seen that these had been recorded in their care plan and had been discussed, including at wider review meetings with health and social care professionals. Evidence was also seen in people’s care plans and from records of key worker sessions that people are supported and counselled regarding their sexual identity and how to promote this positively including such issues as sexual health, personal relationships and contraception. Residents have access to a telephone and are given their own mail to open. When people are first admitted to the home an assessment is undertaken regarding their ability to undertake their own catering arrangements and what support is needed for them to be as independent as possible in this area. Following this each resident is provided with £20 a week to manage their own shopping. The individual has the responsibility (with staff support where necessary) for planning their menu, buying the food, cooking it and budgeting. In addition to the £20, the home provides some basics, including tea, coffee, sugar, milk, bread, butter, cooking oil, cereals and rice. The home also provides weekly communal meals on one evening a week and on Sunday lunchtime for all residents. Residents spoken to stated that this system worked Leyton House DS0000071104.V365211.R01.S.doc Version 5.2 Page 14 well for them, including both the amount of money to shop with and being able to cook their own food. Leyton House DS0000071104.V365211.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 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 living in the home receive appropriate personal support in accordance with their needs. They are also supported in meeting their physical, mental and emotional healthcare needs, including by accessing relevant health care professionals. The medication administration procedures within the home safeguard people living there. EVIDENCE: All four people are independent with regard to their personal care and staff spoken to stated that individuals did not normally require even verbal prompts in this area. Residents spoken to independently indicated that staff were sensitive to any specific support needs they may have and during the inspection residents spoken to were appropriately dressed and presented. The home has developed good working relationships with mental health services and this assists in keeping people well. All four residents are Leyton House DS0000071104.V365211.R01.S.doc Version 5.2 Page 16 registered with a GP and evidence seen of appointments being made and kept. Satisfactory records of appointments with other health care professionals were seen on the files inspected and these included the reason for the appointment and any other follow up action needed. The records showed evidence of appointments with mental health specialists, general hospital outpatient departments, dentist and optician. We were particularly pleased to see that residents were supported to attend dental services on a regular basis and that dental hygiene was given a priority by the home. The home had a satisfactory medication policy that was seen along with written information about a range of different medications used by residents. These explained the reasons the specific medication may be prescribed and any side effects that may occur. Evidence was seen that staff had received training in the safe administration of medication and staff spoken to confirmed this. One person was being supported to be more independent with their medication at the time. Medication for that person was recorded as received in the home, the person given a week’s supply that they kept in a locked cupboard in their room with the person telling staff when they had taken each dose, which was then recorded by staff. Medication and medication administration record (MAR) charts were inspected for two other people living in the home. These were accurate, indicating medication was being given as prescribed and there were no mishandling or missed doses. Up to date records were seen of medication being received into the home and when medication was disposed of. At he last inspection a requirement was made that medication practices are reviewed of medication leaving the home to ensure the safety of residents. This was in relation to staff giving medication to people for when they went on visits or planned stays away from the home, this is known as “secondary dispensing”. Evidence was seen that the policy for how medication is given to people for when they are going to be away from the home had been reviewed. Evidence was also seen that the prescribing Doctor had supplied a letter to the home confirming that he has agreed to secondary dispensing taking place in these circumstances. Leyton House DS0000071104.V365211.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 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 living at the home are able to express their views and concerns and have these acted on appropriately. The home’s safeguarding adults policy and procedures assist in protecting people from abuse. EVIDENCE: The home has a satisfactory complaints procedure that was seen in the Service User guide and a copy was displayed in the home’s dining room. Residents spoken to felt confident that any complaints they made would be properly dealt with by the home. One resident said, “staff will sort out any concerns” and confirmed that any issues the person was not happy or clear about could also be raised at the monthly residents meetings. At the last inspection a requirement was made that all complaints and concerns whether informal, verbal or written are recorded and investigated. This requirement was being complied with. The home’s complaints book was inspected and a record seen of five concerns that had been dealt with since the last inspection. Although none of these five concerns were particularly serious the records showed that all had been acted on promptly, proper feedback given to the complainant on the outcome of the investigation and any action that the home had taken as a result of the investigation. No complaints have been made to the Commission since the last inspection. Leyton House DS0000071104.V365211.R01.S.doc Version 5.2 Page 18 The home has a satisfactory safeguarding adults policy and also a copy of the L.B. of Waltham Forest’s policy, the local authority for the area the home is located in. There have been no allegations or disclosures of abuse made to the home or to the Commission since the last inspection. Evidence was seen that staff had undertaken training in safeguarding adults and staff spoken to were able to describe what action needs to be taken should an allegation or disclosure of abuse be made to them. One resident told us “this is a safe place for me to be”. The home has a satisfactory whistle blowing policy that gives details of managers within the provider organisation and external bodies that may be contacted in relation to this. The home does not hold any money on behalf of residents. Leyton House DS0000071104.V365211.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28 & 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. People live in a home that is comfortable, well decorated, well maintained and that meets their current needs. People who live in the home, staff and visitors benefit from the building being kept clean and tidy. EVIDENCE: The home is a converted terrace house with accommodation provided on two floors. The ground floor contains an entrance hall, one bedroom, lounge, kitchen/ diner with access to a rear yard, a shower room/toilet and an office. The first floor contains three further bedrooms and a bath room/ toilet. The home is situated on the High Road in Leyton and is close to shops, public transport links and a range of other multi-cultural amenities in the area. Leyton House DS0000071104.V365211.R01.S.doc Version 5.2 Page 20 During a tour of the home it was noted that the home and its furniture and fittings were comfortable and domestic in nature. The responsible individual confirmed that the home was able to call on the services of the provider organisation’s handy person and staff spoken to stated that this worked well. The home has a no smoking policy and is working hard to support residents to comply with this. One resident spoken to independently, when asked about the physical environment of the home, said “I’ve got everything I need” One resident showed us their bedroom, which they had personalised. The resident stated that they had everything they needed and liked their room. Residents have a key to their room and a key to the door of the home unless there is a specific restriction imposed regarding this. As stated in the Individual Needs and Choices section of this report, where restrictions are placed on a resident these are well documented and evidence seen that they are discussed with the person concerned. None of the current residents had needs in relation to continence. The home’s laundry facilities were suitable to meet the current residents needs and in scale for the home. Cleaning materials and other potentially hazardous material are kept locked when not in use. The home was clean and tidy during the inspection and free from unpleasant smells. The responsible individual stated that people living in the home were encouraged and supported by staff in keeping their rooms clean and evidence to support this was seen in documentation inspected. Leyton House DS0000071104.V365211.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 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. A staff team with a range of qualifications and competencies, in sufficient numbers, support people living in the home. The home’s recruitment policy assists in protecting people living in the home. People are supported by staff who have access to a range of appropriate training. Staff also receive formal supervision and appraisal to assist in further meeting the needs of people living in the home and in their own personal development. EVIDENCE: The home employs a registered manager, a deputy manager, a senior support worker, four support workers and the provider organisation has identified bank staff that work when required. All the staff have either achieved or are working towards qualifications that will assist them to further enhance the lives of residents and to further their own career development. The registered manager is a registered general nurse and is currently undertaking his Registered Manager’s Award; the deputy manager has achieved the national vocational qualification (NVQ) level 3 in care and is currently working towards Leyton House DS0000071104.V365211.R01.S.doc Version 5.2 Page 22 level 4; the senior support worker has also achieved NVQ level 3 in care and is currently working towards level 4; two of the support workers have achieved NVQ level 3 in care and the other two support workers are working towards NVQ level 2 in care. The staff rota was seen, was up to date and accurately reflected the staff on duty on the day. One support worker covers the early shift, 8am to 5.15pm, one support worker covers the late shift, 5pm to 10.15pm and one support worker covers the night shift, 10pm to 8.15am, on a waking basis. The registered manager is in addition and is not included on the rota. There is also an on call manager available to the home, including at night time. At the last inspection a good practice recommendation was made that an appropriate risk assessment is put in place for staff to identify the level of risks they may be exposed to and that staffing levels are reviewed to ensure members of staff are protected at all times. The responsible individual stated that a risk assessment had been undertaken and that if there was any concern that a resident was becoming unwell, anxious or other concerns identified that additional staff would be deployed at the home. The registered manager confirmed this was the case. The home’s policy on staff working alone had also been reviewed and a copy of this seen. This provided a 24-hour contact point for staff on duty to call for assistance should an unexpected situation develop and staff on duty needed assistance quickly. The registered manager stated that staff carried the home’s cordless phone with them, especially at night. The home had appointed two new support workers since the last inspection. Their staff files were inspected and showed evidence that the home had obtained all the required documentation to evidence a robust recruitment procedure including: proof of identity with a photograph, two written references; evidence that the person had an enhanced criminal records bureau (CRB) clearance and protection of vulnerable adults (POVA) check that had been applied for by the home and had been received before the staff members started working there. Evidence was seen that staff receive a satisfactory induction when first employed and that the home provides ongoing training and refresher training. Evidence was also seen that the home had provided a range of other training for staff since the last inspection including on the Mental Capacity Act, mental health awareness, safe administration of medication, first aid training basic oral hygiene and safeguarding adults. The staff member spoken to confirmed that they had been involved in refresher training and found it helpful. The home also had a training resource folder that was seen and is available to staff. The home is also developing an overall staff training matrix to assist the registered manager identify what training staff have undertaken and to assist planning when future refresher training is needed. Leyton House DS0000071104.V365211.R01.S.doc Version 5.2 Page 23 Staff are provided with individual supervision at least every two months and receive an annual appraisal. Evidence of this was seen in documentation kept in the home and from staff spoken to. Leyton House DS0000071104.V365211.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 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. Residents’ benefit from the effective management systems used in the home and their views are sought regarding the quality of life they experience. Health and safety procedures assist in protecting people living at the home, staff and visitors. EVIDENCE: The registered manager is a registered general nurse and is currently completing his registered managers award (RMA). Feedback from both residents and staff spoken to independently was positive. Feedback from an external healthcare professional stated they felt the home was well managed, Leyton House DS0000071104.V365211.R01.S.doc Version 5.2 Page 25 which they appreciated. The responsible individual and another manager from the provider organisation attended the home for the majority of this announced inspection. We were informed that the managers within the provider organisation support each other when required an examples of this were discussed. The home has a number of ways of monitoring the ongoing quality of the service offered to residents. An effective key worker system is in operation, detailed records of monthly key worker sessions were sampled and residents spoken to knew who their key worker was. One person indicated that their key worker sessions helped them to be able to discuss personal issues in a safe environment. The home also holds regular residents meetings and records of these sampled showed that residents were consulted and discussions took place on a range of areas that affected people’s every day life. The home also seeks more formal feedback from residents through sixmonthly satisfaction questionnaires. Feedback from these is then collated into a report. Both recent satisfaction surveys and the report were sampled. These provided very positive feedback about the home. At the last inspection a requirement was made that stakeholders are also consulted with when the home reviews the quality of care. The home was working hard to comply with this by issuing satisfaction surveys to health and social care professionals although we were told that so far only one has been returned. The healthcare professional that had returned the questionnaire had been positive although had suggested that a quarterly report on the resident they dealt with would be helpful. The registered manager said that this had been put in place. At this inspection a range of satisfactory health and safety documentation was seen. This included: a gas safety certificate, electrical installation certificate and portable appliance test. The home’s fire log was inspected and showed a current fire risk assessment, that the fire fighting equipment had been serviced, weekly safety checks on fire equipment were being carried and that fire drills were being undertaken every three months. Leyton House DS0000071104.V365211.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 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 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 3 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 3 3 X 3 X 3 X X 3 X Leyton House DS0000071104.V365211.R01.S.doc Version 5.2 Page 27 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Leyton House DS0000071104.V365211.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Leyton House DS0000071104.V365211.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!