Care Home: Leyton House 2

What the care home does well This is a new home and has been decorated and equipped to a good standard. The people living in the home are well motivated and are being supported by the staff in the home to have full and active lives, taking advantage of resources in the community such as adult education and voluntary work placements and this continues to improve as they settle into the home and the area. The written records are very well presented and well organised, and there is an effective quality monitoring system in place in the home. What has improved since the last inspection? This is the first inspection of the home. CARE HOME ADULTS 18-65 Leyton House 2 119 Leyton High Road London E15 2DE Lead Inspector Caroline Mitchell Unannounced Inspection 10th April 2008 10:30 Leyton House 2 DS0000070408.V361317.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 2 DS0000070408.V361317.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 2 DS0000070408.V361317.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Leyton House 2 Address 119 Leyton High Road London E15 2DE 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) 020 8539 4699 929 8539 4699 naushad@leytonhouse.co.uk 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 2 DS0000070408.V361317.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 4 Date of last inspection Brief Description of the Service: Leyton House 2 is a residential care home registered with the Commission for Social Care Inspection to provide accommodation and support for up to 4 adults with a mental disorder (MD). The home is near to Leyton Underground Station, close by to shops, other transport networks and local amenities, and is in keeping with other homes in the area. The home is owned and run by Leyton House Community Care, an organisation that runs a small number of other homes in the area, for people who have experienced mental health problems. The home has 4 bedrooms, each with en-suite facilities, a shared lounge, dining/kitchen, and paved rear garden area. There are 2 staff offices and further toilet facilities on the ground floor. The statement of purpose says that the aim of the service is “to provide service user who suffer from severe and enduring mental health problems a place to live, for as long as required, in a comfortable home with the opportunity of enhancing the quality of life.” The fees are normally around £1,200 for each placement per week, and the people who use the service are expected to pay for newspapers and magazines, hairdressing, dry cleaning, health care treatments such as chiropody, and clothing. Following “Inspecting for Better Lives” the provider must make information available about the service, including inspection reports, to the people who use the services and other stakeholders. Leyton House 2 DS0000070408.V361317.R01.S.doc Version 5.2 Page 5 Leyton House 2 DS0000070408.V361317.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was the first inspection of Leyton House 2 as it is a relatively new service, registered in October 2007. The inspection was undertaken on an unannounced basis. The inspection took 1 day to complete. The inspector was able to meet and speak with the responsible individual, the registered manager and a senior support worker, all of who were very helpful during the inspection process. At the time of the inspection there were 3 people living in the home and 2 were spoken with in private, and gave their views about the quality of the service in the home. The written records that were looked at as part of the inspection included the records the home keeps about the 3 residents, which included their care plans and risk assessments, contracts and pre-admission information, the personnel files for 3 staff, which showed the way that they were recruited and the training they have had to help them work with the residents, the record of concerns and complaints, the arrangements around storage, administration and recording medication, health and safety safeguards and a number of written policies and procedures. What the service does well: What has improved since the last inspection? What they could do better: The people who live in the home are young men who often choose a fast food diet and this is an area for the management team to focus on. A requirement and recommendations are made about this area, covering staff training in food hygiene and diabetes, and focussing on educating the people who live in the home about the importance of healthy eating. In terms of the records of staff recruitment as recommendation is made about renewing POVA checks that are more than 3 years old, and making sure that all staff records include a recent photograph. Leyton House 2 DS0000070408.V361317.R01.S.doc Version 5.2 Page 7 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 2 DS0000070408.V361317.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 Leyton House 2 DS0000070408.V361317.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has developed clear information to people understand what specialist services the home can provide. The home provides a statement of purpose that is specific to the individual home and the resident group they care for. It clearly sets out the objectives and philosophy of the service supported by a service user’s guide. The guide details what the prospective residents can expect and gives a clear account of the specialist services provided, quality of the accommodation, qualifications and experience of staff and how to make a complaint. Admissions are not made to the home until a full needs assessment has been undertaken. The service insists on receiving sufficient assessment information from care management and health care services. A skilled and experienced member of staff undertakes pre-admission assessments on behalf for the home. Admissions to the home only take place if the service is confident staff have the skills, ability and qualifications to meet the assessed needs of the prospective resident. Prospective residents are given the opportunity to spend time in the home. Residents are provided with a statement of terms and conditions/contract. This sets out in detail what is included in the fee, the role and responsibility of the provider, and the rights and obligations of the individual. This is clear, easy to understand and gives a clear understanding of what residents can expect. Leyton House 2 DS0000070408.V361317.R01.S.doc Version 5.2 Page 10 EVIDENCE: We looked at the statement of purpose for the home. This was well set out and included clear reference to the relevant Regulations. The service user guide was well set out and included all the necessary information about the home to help people make a decision about whether the home would be able to meet their needs. The home is registered to care for 4 people and there were 3 people living in the home at the time of the inspection. We looked at he written records for all 3 of the people living in the home. There was evidence that managers from the home had undertaken pre-admission assessments and had written to the placing authorities, with a summary of the assessments and setting out how the home would meet people’s identified needs. Each person’s records included information the visits that had to the home prior to moving in. We also met and spoke to 1 prospective resident who explained that he was visiting as part of the pre-admission process. He said that things were going well as he already knew some of the people living in the home, having been in hospital with them. We noted that there were written contracts in place for each person. These set out the terms and conditions of people’s stay in the home and identified people’s bedrooms and included how much the service costs. Leyton House 2 DS0000070408.V361317.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are person centred and are agreed with the individual. Plans are written in plain language, are easy to understand and look at all areas of the individual’s life. They include reference to equality and diversity and address any needs identified in a person centred way. Staff have skills and ability to support and encourage residents to be involved in the ongoing development of their plan. Staff make the process interesting and use a variety of ways to help individuals make a worthwhile contribution. A key worker system allows staff to work on a one-to-one basis and contribute to the care plan. The plans are written with input from the person, and include a range of information that is important to them. This includes their skills and abilities and how they make choices in their life. They include information about people’s health, are kept up to date and focus on how individuals will develop their skills, and considers their future aspirations. The care plan is a working document reviewed regularly involving the person and their representatives, as appropriate. Reviews focus on asking what has worked for the individual, areas of progress and concerns and identify action points. Each care plan includes a comprehensive risk assessment, which is reviewed regularly. The management of risk is positive in addressing safety issues while aiming for improved outcomes for people. Where there are limitations, the decisions have been made with the agreement Leyton House 2 DS0000070408.V361317.R01.S.doc Version 5.2 Page 12 of all relevant professionals and are accurately recorded. The service is aware of current policy issues and good practice developments, and tries where possible to transfer this thinking into their daily work. The home ensures that residents are consulted regularly to gather information about their satisfaction with the home. They are involved in both the development and review of the service. EVIDENCE: We looked at the care planning arrangements for the 3 people who were living in the home and found that each person had a clear and detailed care plan in place. There was a clear monitoring process in place to make sure that the plans were reviewed on a regular basis. People’s individual needs are set out, taking their cultural backgrounds and needs into account. Each of the 3 people living in the home are subject to certain condition under the Mental Health Act. Outside of the restrictions placed on people by the Home Office, people are actively encouraged to make choices. The people living in the home were quite young and largely independent in most areas of their lives. 1 person said that they make choices in all areas of their lives outside of the restrictions placed on them by the Home Office. There was evidence that the care plans and risk assessments that were in place for people had been put together with the involvement of each person. They were signed by the person to indicate their agreement and involvement. Records reflected that there are regular 1-1 sessions undertaken with each person and their key worker and that this was contributing to the care planning process. The 2 residents spoken to said that they were involved in the care planning and risk assessment process. Another person’s file included their own written description of their relapse symptoms and what they thought the best interventions were, to prevent them from experiencing a mental health relapse. Clear risk assessments were in place for each of the 3 residents. These covered all the risks highlighted through the Care Planning Approach (CPA) process and included clear risk management guidelines. As with the care plans, we noted that there was a clear monitoring process in place to make sure that the risk assessments were reviewed on a regular basis. Leyton House 2 DS0000070408.V361317.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a strong commitment to enabling residents to develop or maintain their skills, including social, emotional, communication, and independent living skills. People are supported to identify their goals, and work to achieve them. People have the opportunity to develop and maintain important personal and family relationships, and are able to access information and specialist guidance about issues such as intimate relationships. The staff practices promote individual rights and choice, but also consider the protection of individuals in supporting them to make informed choices. The service respects peoples’ human rights with fairness, equality, dignity, respect and autonomy underpinning the care and support being provided. Residents are involved in meaningful daytime activities of their own choice and according to their individual interests, diverse needs and capabilities. They have been fully involved in the planning of their lifestyle and quality of life. Education and occupational opportunities are encouraged, supported and promoted. People are attending local colleges, and also voluntary employment. People can access and enjoy the opportunities available in their local community, such as using public transport and local leisure facilities. They are involved in the domestic routines of the home. They take responsibility for their own room, menu planning and cooking meals, Leyton House 2 DS0000070408.V361317.R01.S.doc Version 5.2 Page 14 with the support that they need. They are able to enjoy the food they prefer and like. An area for improvement is in encouraging people to vary their menu and eat a more balanced and nutritious diet. EVIDENCE: The responsible person told us that the people who live in the home are monitored closely due to the nature of their forensic histories, that the home is geared towards being a step towards a more independent life. The people living in the home are quite young, relatively independent, active and quite well motivated. Each person has a schedule of tasks, setting out what they are doing, in terms of household tasks, leisure, educational and social activities, both in the home and in the community. Records reflect that people are quite motivated and usually do stick to their planned schedules, which encourage people to be active, to take responsibility for keeping the house clean, to develop their daily living skills such as shopping and cooking, to be involved in the experience of work, learning and education. In discussion with the people who live in the home it was evident that they believe that if they prove themselves to be responsible, able to cope in the community and able to work within the restrictions placed upon them by the Home Office, they will be able to move on to a more independent setting. 1 person said that they want to be a chef, wanted to go to college to enable them to progress with this aim and that they were currently doing voluntary work placements to gain experience in this area. They were clear that their aim is to move on from the home, to be more independent and their placement in the home was helping with this. Another told us that they were interested in fashion design and was attending college. Peoples’ schedules included a range of activities in the community including attending colleges, community groups that are geared to the needs of people from ethnic minority groups, a local gym, bowling, pool and the cinema. 1 person attends church. Staff said Andrew recently started the discussion group. Although the home was relatively newly registered, and people had only recently moved in, their schedules had a good balance of meaningful activities and there was evidence that these were continuing to develop. There was evidence that people are supported to maintain relationships with their families and friends. 1 person’s schedule included a weekly visit to their family, another person had photographs of their partner displayed in their bedroom and was talking about visiting them that day. The managers told us that 1 person is considering getting in contact with a family member who they have not previously had contact with, and another person sees a number of family members on a regular basis. We noted that there was evidence in people’s written records that people had received support around relationships and sexual health. Leyton House 2 DS0000070408.V361317.R01.S.doc Version 5.2 Page 15 The home provides clear written guidance about the rules of the house, along with support to people to understand these. People had signed a copy to indicate that they understood them and this was kept on their written records. As previously stated the 3 people living in the home were subject to specific restrictions to their personal freedom, monitored by the Home Office under Section the Mental Health Act. These were recorded as part of the CPA process. Outside of these restrictions, and throughout people’s care plans there was reference to encouraging people to make decisions. 1 person told us that, apart from a curfew imposed upon them by the Home Office, the rules of the house were reasonable and that their right to make decisions was respected and encouraged. People shop for and prepare their own meals, with support appropriate to their assessed needs. Each person has their own food cupboard in the kitchen. The registered manager said that locks are going to be added, so that people can have the option to lock them. The home provides the staples, like potatoes, rice, milk and bread and people are supported to shop for the food that they prefer on an individual basis, being provided with a food allowance for this. The home keeps daily monitoring records of what people are eating, to help to make sure that they get reasonably balanced diet and a monitoring record of people’s weight. We looked at these as part of the inspection. People’s weights were reasonably stable. It was evident that it is a challenge for the home to properly monitor people’s diets, as people are often out at mealtimes. It was also evident that it is a challenge to make sure that people get a balanced diet, as they tend to prefer foods that are quick to prepare, or fast food and take-aways. In order to help with this the manager has introduced a communal breakfast and a communal dinner once a week. In order to make sure that healthy eating is better promoted it is recommended that advice be sought from the appropriate health care professionals regarding educating the people who live in the home about the importance of including fruit and vegetables in a balanced diet. Leyton House 2 DS0000070408.V361317.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents. Staff are aware that the way in which support is given is a key issue for younger adults. Individual plans clearly record people’s personal and healthcare needs and detail how they will be delivered. Residents are encouraged to manage their own healthcare including visual, and oral care. They have access to GPs, various services through community mental health teams all NHS healthcare facilities in the local community. Regular appointments are seen as important and there are systems to ensure they are not missed. The home fully respects the rights of people in the area of health care and medication. They recognise and work with the decisions made by the individual regarding any refusal to take medication, or any specific requests about how their healthcare is managed. Staff members are very alert to changes in mood, behaviour and general wellbeing and fully understand how they should respond and take action. The home arranges training on health care topics that relate to the health care needs of the residents. The home has developed efficient medication policy, procedure and practice guidance. Staff all have access to this written information and understand their role and responsibilities. Quality assurance systems confirm that policy is put into practice. Medication records are seen as key to the efficient management of health care matters, the home consistently keeps them up to date. Care staff have the required medication training. The homes policies, procedures and guidance support and inform practice. Leyton House 2 DS0000070408.V361317.R01.S.doc Version 5.2 Page 17 EVIDENCE: It was evident from discussion with the people living in the home, with the staff, and from observation that 2 people are more independent in their personal care, and interested in their personal appearance, and that 1 person needs reminders and prompts. Care plans reflected this. People were individual in their dress, which was appropriate to their age and cultural backgrounds, and well presented when they were going out. We looked at the records of peoples’ health care needs and found that the home keep good, clear records of peoples’ health care appointments and input from health services. The responsible individual said that there is good support for residents from the community health team in the area. 1 person is diabetic. Records showed that he attends a diabetic clinic on a regular basis, supported by a staff member. The registered manager and the responsible individual are both qualified nurses and aware of the long-term health risks associated with diabetes. However, as the care staff have not had training in this area and a recommendation is made about this. We looked at the arrangements for administration, storage and recording medication in the home. The home uses a monitored dosage system and medication was stored appropriately. Clear records are kept of the medication coming into, and leaving the home. Very clear guidance is kept about the use of each of the medicines that people are prescribed and the possible side effects, along with specimen signatures of all of the staff who administer medication. Training has been provided to staff. Leyton House 2 DS0000070408.V361317.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an open culture that allows residents to express their views and concerns in a safe and understanding environment. Residents and others involved with the service say that they are happy with the service provided, feel safe and well supported by an organisation that has their protection and safety as a priority. The service has a complaints procedure that is clearly written and easy to understand. The complaints procedure is supplied to everyone living at the home and is displayed in the home. Residents and others involved with the home understand how to make a complaint and are clear about what will happen if a complaint is made. The home keeps a full record of complaints and this includes details of the investigation and any actions taken. The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. Staff working at the service know when incidents need external input and who to refer the incident to. There is a clear system for staff to report concerns about colleagues and managers. Staff training in safeguarding is arranged by the home. Other training around dealing with physical and verbal aggression is also made available. EVIDENCE: Both of the residents who spoke to us as part of the inspection were able to advocate for themselves and said that they had no complaints to make about the home, that they know how to make a complaint and were confident that they would be taken seriously and their concerns acted upon. The complaints procedure was displayed on the wall for residents and there was additional guidance for staff, about responding to concerns and complaints in the policy file. How to make a complaint is also included in the statement of purpose and Leyton House 2 DS0000070408.V361317.R01.S.doc Version 5.2 Page 19 the service user guide. We looked at the record of complaints and found that it was well presented. No complaints had been recorded. However, some minor concerns raised by residents had been recorded, along with evidence of how they had been responded to. We saw the records of the meetings that residents have each month and it was evident that they are encouraged to use this as an additional way of raising any concerns that they might have. The 2 residents spoken to said that they felt safe and secure living in the home. We observed 1 person locking the door to their room when they went out. The registered manager said that each of the bedrooms had locks on the doors, along with lockable cabinets in their rooms, and that each person kept their own keys. We looked at the homes policy and noted that the Local Authority policy was available along with the guidance “No Secrets”. The registered manager said that staff have had training in safeguarding people and this confirmed by the staff training records. Staff have attended additional training about the Mental Capacity Act and are waiting for their training certificates for this. 2 of the 3 staff records that we saw included evidence that the staff members had some training about dealing with challenging and violent behaviour. Leyton House 2 DS0000070408.V361317.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that is appropriate to the specific needs of the people who live there. The home is a very pleasant, safe place to live and the bedrooms have en-suite facilities. Residents are encouraged to personalise their bedrooms. All the home’s fixtures and fittings meet the needs of individuals and can be changed if their needs change. The environment promotes the privacy, dignity and autonomy of residents. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in private. The bathrooms and toilets are in sufficient numbers and of good quality. The home is well lit, clean and tidy and smells fresh. There is a good infection control policy and staff are encouraged to work to the home’s policy to reduce the risk of infection. EVIDENCE: 1 person showed us their bedroom. They said that they were happy with it and “it’s better than where I was before”. The room was well furnished and equipped and the resident had lots of their own personal items around such as personal photographs and a computer, which they said had broadband. There Leyton House 2 DS0000070408.V361317.R01.S.doc Version 5.2 Page 21 are 4 bedrooms for residents and each has en-suite facilities. During the tour of the home we noted that on the ground floor, the kitchen/diner was clean and well equipped, and there was a nice lounge. There were 2 office spaces on the ground floor and an additional toilet. Outside there is a communal back garden that had recently been paved. The home is relatively newly opened and the décor, furniture and equipment in good condition. The home was clean and no unpleasant smells were noted. There is a cleaning rota for staff and the residents’ activity schedules include time for being involved in household chores. The home has a clear written policy about infection control. Leyton House 2 DS0000070408.V361317.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 34, 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have confidence in the staff who care for them. Rotas show well thought out and creative ways of making sure that the home is staffed efficiently. Accurate job descriptions and specifications clearly define the roles and responsibilities of staff. People who use the service report that staff working with them are very skilled in their role and are consistently supportive. There are consistently enough staff available to meet the needs of the people using the service, with more staff being available at peak times of activity. All staff receive relevant training that is focussed on delivering improved outcomes for residents. The home puts a high level of importance on induction and training and staff report that they are supported through training to meet the individual needs of people in a person centred way. There is a good recruitment procedure that clearly defines the process to be followed. This procedure is followed in practice with the home recognising the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individuals. There are clear contingency plans for cover for vacancies and sickness and there is little use of any agency or temporary staff. Staff meetings take place regularly and proper written records are kept of these. Leyton House 2 DS0000070408.V361317.R01.S.doc Version 5.2 Page 23 EVIDENCE: Both of the residents who spoke to us said that the staff were supportive. We looked at the written records for 3 staff and found that each person had completed a written application, and been provided with a clear written job description. There was evidence that they had 2 written references and those that were from previous employers included a company stamp, or were on headed notepaper. Where people were from other countries proof of their right to work in this country was included. Each person had an enhanced Criminal Records Bureau (CRB) check. However 1 of the 3 had been applied for more than 3 years ago and did not include a Protection Of Vulnerable Adults (POVA) check. It is good practice to re-apply for CRB checks 3 yearly and recommendation is made about this. The registered manager gave us a copy of the planned rota. This showed that the manager is on duty from Monday to Friday and there is usually 1 other staff member on duty on an early shift, which is from 8 am to 8.30 pm, and 1 waking night staff at night, who arrives at 8pm and works until 8.15 in the morning. This is sufficient staff cover to meet the needs of the residents, as they are relatively independent in a lot of areas of their lives. There is a management on-call system, so that staff are clear who to call for support or in an emergency. When discussing how the home addressed the needs of the residents from different ethnic backgrounds, the responsible person said that a new staff member has been recruited recently, and is waiting for the full preemployment checks to be done. This person is of a similar background to 2 of the 3 residents. The responsible individual said that the senior support workers have completed training at NVQ level 3 and are enrolled to do NVQ level 4 and that 2 of the newer support workers are enrolled to do NVQ level 3. The 3 staff whose records we had most of the necessary core training. However, 1 of the 3 staff records that we looked at did not include evidence that the staff member had received food hygiene training and a requirement is made about this. The staff records showed that there is a very clear and thorough induction process for new staff. This shows the training and induction that is provided to staff in all aspects of working with the residents and in the home for a 6-week period and includes an element of assessment of people’s competence. Leyton House 2 DS0000070408.V361317.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, 41, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has the required experience and is competent to run the home. The manager has a clear understanding of the key principles and focus of the service, based on organisational values and priorities. They provide an increased quality of life for residents with a good focus on equality and diversity issues and promoting human rights, especially in the areas of dignity, respect and fairness. There is also a focus on person centred thinking, with residents involved in shaping service delivery. There is an ethos of being open and transparent in the running of the home. The service has sound policies and procedures. The staff team are positive in translating policy into practice. The home works to a clear health and safety policy. Regular random checks take place to ensure the staff are working to the policies. Records are of a good standard and are routinely completed. Residents are aware of safety arrangements and have confidence in the safe working practices of staff. The management team provide a quality assurance and monitoring process to ensure efficient running of the home. People are supported to manage their own money and have access to their records whenever they wish. Leyton House 2 DS0000070408.V361317.R01.S.doc Version 5.2 Page 25 EVIDENCE: We met and spoke to the registered manager, the Director of the Company, who is also the responsible individual, and a Senior Support Worker. The manager is a qualified Nurse said that his training included dealing with challenging and violent behaviour. He is undertaking the Registered Manager Award (RMA) training at NVQ level 4. He was registered to manage the home with the Commission for Social Care inspection in October 2007, when the home was registered. Both he and the responsible individual came across as experienced and committed to providing a person centred service, which encourages residents to take responsibility, learn independence skills and helps to prepare them for a more independent setting. They were clear about what is expected of the residents in terms of their behaviour, in relation to the conditions placed on them by the Home Office and keen for them to succeed in achieving a good quality of life. The people living in the home are independent in managing their financial affairs. There was evidence that there was a well-established quality assurance system in place, despite the short time that the home has been operating. The responsible individual said that he spends a lot of time in the home and the residents said that they were used to having around. Records of meetings and surveys showed that the management team were proactive in monitoring the quality of records, systems and of practice, and had various, creative methods of gaining and including the opinions of the people living in the home. The registered manager said that 2 communal meals had been introduced, on the request of the residents, and people would often sit and discuss aspects of the home during these meals. We looked at the minutes of the resident and the staff meetings and these showed that residents and staff are able to use these meetings as a platform for open discussion. The home also consults and works well with the other professional that are involved in the residents’ lives, such as members of community health care teams. The home uses Croner, to provide their policies and procedures. Croner is a company that provides information and guidance on employment legislation, management and best practice. We looked briefly at these and found them to be pertinent, comprehensive and well organised. A satisfactory financial reference was received with the application to register, from Barclays Bank PLC and a copy of the current insurance certificate was seen. A letter from the local planning department confirming that planning permission would not be required was submitted as part of the application for registration. In terms of health and safety we saw the records of the in-house monthly audits that were in place and had last been done in April 2008 and health and safety monitoring records are kept of water and fridge temperatures. Additionally, there was clear, well organised written evidence that all of the necessary checks of fire, gas and electrical equipment had been done by Leyton House 2 DS0000070408.V361317.R01.S.doc Version 5.2 Page 26 appropriate contractors. A fire safety visit was undertaken by the local fire service (LFEPA) and the report, dated May 2007, stated that the premises were deemed to comply with the Regulatory Reform (Fire Safety) Order 2005. We also noted that an Environmental Health department visit was undertaken in August 2007. Leyton House 2 DS0000070408.V361317.R01.S.doc Version 5.2 Page 27 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 3 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 X 34 2 35 2 36 X 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 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X 3 3 X Leyton House 2 DS0000070408.V361317.R01.S.doc Version 5.2 Page 28 N/A 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 YA35 Regulation 17 18(1)(c) Requirement Timescale for action 04/07/08 2. YA34 17 17 Sch. 2 The registered person must make sure that evidence is included in staff personnel files that that all staff involved in food preparation have been provided with food hygiene training. The registered person must 04/06/08 make sure that all staff records include a recent photograph. 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 YA17 Good Practice Recommendations It is recommended that advice be sought from the appropriate health care professionals regarding educating the people who live in the home about the importance of including fruit and vegetables in a balanced diet. It is recommended that staff be provided with training regarding diabetes. It is recommended that any POVA checks that are more than 3 years old be re-applied for. 2. 3. YA19 YA34 Leyton House 2 DS0000070408.V361317.R01.S.doc Version 5.2 Page 29 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. 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