Care Home: Longdown Road (9)

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What the care home does well The home provides a welcoming and warm atmosphere. The material and social environment combine to provide a safe and supportive home for service users. Staff support individual service user independence and choices. Care plans and activities include participation in a wide range of activities reflecting the diverse needs and interests of service users. Care plans are detailed and a number of documents are designed in a userfriendly format. The home is now developing a person centred planning (PCP) format which should make care plans more accessible to service users and support their involvement in the process. The quality of relationships, between staff and service users, and between the home and external agencies, are good, and support the provision of good quality care to individual service users living in the home. What has improved since the last inspection? New radiators have been installed thus creating a more comfortable home for service users. A new bathroom has been fitted in one of the downstairs rooms which improves the quality of the environment for that service user. A `Quality Team` from Head Office do three monthly audits and during the week of this inspection visit had carried out a review of the home against the CSCI KLORA (`Key Lines Of Regulatory Assessment`) guidance What the care home could do better: Ensure that the home can provide evidence of full conformance to the Regulations in staff recruitment to minimise risk to service users. Carry out an assessment of the risks associated with boxes of latex gloves available in areas used by service users and of the security of ground floor windows, taking action where necessary. CARE HOME ADULTS 18-65 Longdown Road (9) 9 Longdown Road Epsom Surrey KT17 3PT Lead Inspector Mike Murphy Unannounced Inspection 23rd November 2007 10:00 DS0000060921.V353030.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 DS0000060921.V353030.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. DS0000060921.V353030.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Longdown Road (9) Address 9 Longdown Road Epsom Surrey KT17 3PT 01372 748 153 0208 544 8901 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) CMG Homes Ltd Mrs Denise Rush Care Home 9 Category(ies) of Learning disability (9), Learning disability over registration, with number 65 years of age (9) of places DS0000060921.V353030.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th October 2006 Brief Description of the Service: The house was converted from a hotel into a residential home for up to nine residents. The service is owned by Care Management Group and provides accommodation for 9 residents with learning disabilities. The home comprises of two large lounges, one open plan into the dining area. A large fully fitted kitchen with access to the patio area, which has been decked, and a wellmaintained secluded garden to the rear of the house. A therapy/sensory room on the first floor is furnished to meet the needs of the residents. There is a visitor’s room/interview room on the second floor as well as a staff room with en-suite facilities. All bedrooms are single occupancy and have en-suite facilities. There are a number of toilets and bathrooms available throughout the home. The ground floor has two bedrooms and six bedrooms on the first floor and one bedroom and sitting room on the second floor. There is no mechanical access to the first and second floor so all residents must be physically able to use the stairs. There is ample parking at the front of the building. The fees at the time of this inspection ranged from £1,100- £1,300 per week. DS0000060921.V353030.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by one inspector towards the end of November 2007. The inspection included discussion with the registered manager, staff and service users, observation of practice, a visit to the home, a brief conversation with a visiting community psychiatric nurse, consideration of information provided by the manager in advance of the inspection, consideration of CSCI survey forms returned in connection with the inspection, examination of records (including care plans and staff records), and a tour of the home and garden. The organisation has thorough systems for assessing the needs of prospective service users. Good arrangements are in place for assisting new service users to settle down in the home. The home endeavours to meet the diverse needs and interests of its service users. The home’s approach to care planning is thorough. At the time of this inspection it was developing person centred care plans (‘PCP’s’). Key workers and support staff work closely with service users in assessing needs, planning care, providing care as required, liaising with external agencies, and supporting service users to access a range of services and amenities in the locality. Service users participate in a range of activities, both in the home and in the local area. These include use of the shopping and leisure facilities in Epsom, outings to London, holidays on the South and East coasts and to Disneyland near Paris, and, over the Christmas period, plans to see a pantomime in Epsom and a carol service in Dorking. The home is a pleasant detached building in a quiet road in Epsom. It meets the needs of its current residents but will need some investment in the not too distant future in order to meet the needs of people requiring increasing support. In particular to lift access to the upper floors and appropriate equipment for bathing and moving and handling will be required. Current levels of staffing are satisfactory and the organisation offers a good programme of staff training. The home’s recruitment practice is generally satisfactory but greater attention to detail is necessary. The qualities and skills of staff and managers are acknowledged by respondents to the CSCI survey carried out in connection with this inspection. Overall, this is a well managed home, providing a service which is valued by stakeholders. DS0000060921.V353030.R01.S.doc Version 5.2 Page 6 What the service does well: 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. DS0000060921.V353030.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 DS0000060921.V353030.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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of prospective service users are carefully assessed before admission to ensure the home can meet the person’s needs. EVIDENCE: New referrals are sent to an assessment team based at the company’s offices in Wimbledon, South West London. A member of the team arranges to meet the person and conduct an assessment of their needs. A decision is then made with regard to which of the organisation’s homes would be best suited to meet the person’s needs. Arrangements are made for the person to visit the home with their care manager and the person who carried out the assessment on behalf of the organisation. If all parties agree that the home might be suitable further meetings are arranged. The referring care manager identifies a source of funding for the place. There then follows a transition process which involves further visits by the prospective service user to the home, visits to the prospective service user’s DS0000060921.V353030.R01.S.doc Version 5.2 Page 9 current place of residence by home staff, and a brief admission in which the prospective service user is accompanied by a carer and advocate. If it is then agreed by all parties that the process should move forward to a trial admission then a three month stay is arranged. A review is held at six weeks and again, at the end of the trial period, at twelve weeks. During the trial period a care worker from the person’s previous care service keeps in touch with him or her. This is considered to have advantages and disadvantages. On the one hand the person is reassured by ongoing contact with a familiar person and is supported during the transition. On the other hand, however, it can leave the person unsettled as to whether the admission is permanent, and potentially, extend the time taken for the person to settle down in the home, adapt to the new environment and form relationships with current residents and staff. The file of one service user admitted since the last inspection was examined. This provided evidence of the above process. The file included an excellent pre-admission assessment report – detailed, comprehensive and informative – and information on the transition process followed by that person. DS0000060921.V353030.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 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A comprehensive care plan is in place for each service user. Care plans include details of service user preferences and a range of risk assessments. The views of service users are sought through day-to-day encounters in the home. Together, these activities aim to ensure that service users needs are met, that their independence is supported, that risk is minimised, and that care is provided in line with the person’s wishes. EVIDENCE: There is a care plan in place for each service user. The care plans for four service users whose care was being ‘case tracked’ during the inspection visit were examined. Care plans are comprehensive and from mid 2007 include a person centred plan (PCP) and risk assessment. A separate document, the ‘Health Action Plan’, contains key health information for the service user. DS0000060921.V353030.R01.S.doc Version 5.2 Page 11 The PCP includes a photograph, a pen portrait of the person, the person’s social network, and sections headed ‘What I really like’ and ‘What I don’t like’. Care plans include relevant history, key support needs, personal care guidelines and an assessment of independence in which the level of support required across a range of activities is recorded. In one of the care plans this included the support required in personal care, in the bathroom, kitchen, while dealing with clothing and laundry, managing money, travel, and the person’s ability to identify and respond to hazardous situations. The ‘Assessment Package’ included health needs, psychological support and mental health needs, managing emotions, communication skills, daily living skills, self-care skills, relationship and sexual needs, community presence, employment, relaxation, cultural and spiritual (needs), finance, ‘strengths/wants/needs’, and likes and dislikes. Notes are made under each heading. While being comprehensive in scope some of the information is presented in easy read and pictorial form for service users. The care plans examined were considered to achieve a good balance between gathering information on relevant subjects, presenting the information in a way which supported good care planning, and which aimed to involve service users in the process. Staff aimed to involve service users in decision making in day-to-day interactions, by offering choice, monthly house meetings, and advocacy. One advocate was in regular contact with two residents acting in the role of an IMCA (‘Independent Mental Capacity Advocate’ – from the statutory Independent Mental Capacity Advocate service launched across England in April 2007). Risk assessments cover a wide range of subjects. Including those associated with the house cats, the barbeque, steps to part of the building, electrical equipment, moving and handling, food hygiene, wooden flooring and decking, and fire safety. Risk assessments in care plans included risk associated with bathing and showering, refusing medication, financial exploitation, fire risk (smoking cigarettes in particular), eating and drinking, harm to self or others and self neglect. Risk assessments included identification of the risk, the potential consequences, and action required to reduce the risk. In some cases the organisation’s own risk assessments are supplemented by those of the placing statutory authority. NHS CLDT risk assessment cover harm to others (including carers), self-harm, self-neglect and others (such as exploitation). DS0000060921.V353030.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 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents lead a varied lifestyle according to their individual interests, abilities and wishes. This ensures that service users have experience of a range of social, leisure and other activities and are involved with the local community. Service users are provided with a varied and nutritious diet. EVIDENCE: At the time of this inspection none of the service users resident were attending ongoing education at a local college. Some service users were attending sessions on cookery, numeracy and literacy, beauty and socialisation at the Cheam centre. Some attended sensory sessions and interactive events at another venue, Pine Lodge. The registered manager said that the home maintains good relations with its neighbours. The home was not too far from the amenities of Epsom town DS0000060921.V353030.R01.S.doc Version 5.2 Page 13 centre and made use of the shopping facilities, fast food outlets, pubs and other services there. All service users had had some form of holiday this year. Some had been to Disneyland near Paris for five day, others to Butlin’s in Bognor Regis, West Sussex, and to a holiday home near Clacton, Essex. Staff and service users had been on day trips to Brighton and Hove and were planning a trip to London Zoo. One service user said that she was particularly looking forward to a meal in a restaurant in London. For Christmas they were planning to go to see a performance of ‘Snow White’ at the local theatre in Epsom and to a carol service in Dorking. Service users are supported in maintaining links with family and friends. One service user spent most weekends with her family. A family respondent to the CSCI survey carried out in connection with this inspection said that the home always ‘Helps me keep in touch with my daughter…’. The same respondent ticked ‘always’ to survey questions on meeting the needs of the service user, being kept up to date on developments, staff having the right skills and experience and commended the home on the ‘Excellent care.’ it provides. The daily routine of the home seems to suit the needs of service users, taking account of external commitments as well as preferred individual routines. Most service users tend to get up early and receive support in their personal care as required from staff. Breakfast is around 8.00 am. Service users then either go out to planned activities, go out to local shops or amenities with staff, or spend the morning at home. Lunch is around noon and again in the afternoon service users either go out or stay in the home. Those staying in the home were noted to watch TV, listen to music, participate in an activity with staff, or read. Dinner is around 5.30 pm and in the evenings people tend to take it easy in the home. Meals are planned with service users. The advice of a dietitian is sought as required – where a service user has special dietary needs. Breakfast is taken around 8.15 am and consists of cereals, toast, fruit juice and hot drinks. Lunch in the home is served at 12.00 noon and is a lighter savoury meal which may include soup. Sandwiches, salads, toasted sandwiches or sausage rolls. A two course meat roast with vegetables and dessert is served on Sundays. Dinner is served around 5.30 pm and is a two course meal. Choices around the time of this inspection included: Salmon Fillets served with New Potatoes and Broccoli followed by Fruit Jelly; Mild Chicken Curry with Rice followed by Yoghurts; Fish, Chips and Peas (generally on Fridays) followed by Fruit; and, Ham, Egg and Chips followed by Mousse. The home aims to weigh each service user monthly. The nutritional status of individuals is informally monitored i.e. monitoring does not involve a formal nutritional assessment tool. DS0000060921.V353030.R01.S.doc Version 5.2 Page 14 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 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff support residents as required. Arrangements for liaising with health and social care services in the community are good. Arrangements for the control and administration of medicines are generally satisfactory. Together, these aim to ensure that service users healthcare needs are met. EVIDENCE: Staff were noted to take account of service users wishes. Throughout the day of the inspection visit service users followed a range of activities, being on their own or with others as they wished. Some individual preferences are noted in care plans. Personal care is provided in bedrooms or bathrooms. Service users are supported by staff in their personal care as required. All service user are registered with a local GP practice. The home has occasional contact with the local community learning disability team – on the DS0000060921.V353030.R01.S.doc Version 5.2 Page 15 day of inspection one of the service users was visited by a community psychiatric nurse (CPN) from the team. Arrangements are in place for service users to see an optician when needed. Arrangements are also in place for referrals to an NHS dentist – service users can either visit the surgery or the dentist can visit the home. A visiting CPN was complimentary about the home and expressed satisfaction with the care provided to service users and the quality of its liaison with the CLDT. A GP respondent to the CSCI survey wrote (in answer to the question ‘What do you feel the service does well?’) ‘Really care for the individuals as individuals. Pay a lot of attention to their medication. Bring individuals out to the surgery (where appropriate) rather than requesting lots of visits – this helps me and is good for the individuals to get out and about’ and ‘The carers are in regular communication with me and I get the impression that they have the individuals best interests at heart’. The administration of medicines is governed by the organisation’s policy which was last reviewed in May 2006. The home has a hand written homely remedies policy although it is noted that this does not include reference to the upper limits of medicines which can be dispensed before contacting the service users GP. Medicines are prescribed by the service users GP and dispensed by Boots Chemists in Epsom. Medicines are recorded on receipt on the MAR chart and in a book when returned to the pharmacy. Arrangements for the storage of medicines are satisfactory given current levels of activity. Staff training is a combination of internal training by the registered manager and a one day training course run by Boots. Staff are not approved to administer medicines until they have successfully completed the administration of medicines on three occasions under the observation of the registered manager or deputy manager. Examination of the medicines administration records (‘MAR’ charts) of the service users case tracked showed satisfactory practice. Individual medicine records include a photograph of the service user, the MAR chart, any homely remedies in line with policy, and relevant correspondence. References available to staff include a 2004 BMA textbook (note. a new edition of which was due to be published in November 2007). The manager will obtain a copy of the most recent guidelines on the subject of the administration of medicines in social care published by the Royal Pharmaceutical Society of Great Britain (published in October 2007). DS0000060921.V353030.R01.S.doc Version 5.2 Page 16 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 and 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 a policy and procedure for recording and investigating complaints. It has a framework of policy, reporting arrangements and staff training with regard to safeguarding vulnerable adults. Together, these aim to protect service users from abuse and to ensure that complaints are properly investigated. EVIDENCE: The home has a straightforward complaints procedure. There is a copy of the procedure in the office and on the notice board in the dining room. A copy of the procedure is included in the Service User’s Guide. It is noted that the procedure correctly includes reference to a service user’s right to complain to CSCI. It appears to link this to dissatisfaction with the way a complaint is handled or to its outcome, whereas the standard states that a service user may complain to CSCI at any stage (see standard 22.3). All copies of the procedure need updating to include the Oxford office of CSCI. Given changes in CSCI it might not be advisable to name a particular inspector in the policy which is the home’s practice at present. CSCI administrative staff will pass on the complaint to the appropriate inspector. It is also noted that the procedure includes reference to a complainants right to refer a complaint to the ‘local police’ but that it does not mention their care DS0000060921.V353030.R01.S.doc Version 5.2 Page 17 manager. This might be considered in a revised version of the procedure. The procedure is also available in picture and symbol form. Neither the home nor CSCI have received any complaints about this home since the last inspection. The home has a laminated copy of the organisation’s policy on the protection of vulnerable adults (reviewed in August 2007). This is also on display on a notice board. The home has a copy of the Surrey joint agency statutory authorities policy on the protection of vulnerable adults (reviewed in Fenruary 2005) and of the Department of Health document ‘No Secrets’. The home is not in contact with an advocacy service, although as stated earlier two service users are in touch with an advocate acting as an IMCA (see under ‘Individual Needs and Choices’ above). In the annual quality assurance assessment (AQAA) completed for this inspection the registered manager has expressed an intention to ‘Get the advocates more involved’ (in the home). Staff seen during the course of the inspection visit were familiar with the home’s policy and with internal reporting arrangements. They expressed confidence in managers to investigate any reports of alleged abuse. The subject is included in the home’s induction and NVQ training programmes. Staff practice in managing service users monies is governed by the organisation’s policies and procedures. The home has some involvement in managing money for all service users. Four service users affairs were managed by the Court of Protection. An Abbey National Bank account had been opened for each service user. Small amounts of cash are held in individual containers in secure circumstances in the home. All transactions are recorded and receipts obtained. The details of two service users were checked during this inspection. In both cases the balance of cash held corresponded with records. DS0000060921.V353030.R01.S.doc Version 5.2 Page 18 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 and 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 an accessible, pleasant and well-maintained environment which provides those living there with a comfortable and safe place to live. EVIDENCE: The home is a large detached house, situated in a quiet residential road, about one mile from Epsom town centre. It is about one mile from Epsom station and two miles from Sutton station. Buses from the centre of Epsom serve the area but are reported to be relatively infrequent in the evenings. There is parking and drop of space to the front of the home and plenty of parking in nearby streets. The home has its own seven-seater minibus for use by service users and staff. The statement of purpose includes details of the size of each bedroom, a list of furniture in each bedroom, and photographs of some bedrooms, the kitchen, dining room, lounges and bathrooms – an excellent practice. DS0000060921.V353030.R01.S.doc Version 5.2 Page 19 The ground floor accommodation comprises: the entrance hall, a quiet lounge, a second lounge with TV etc, the kitchen, laundry, dining room, two bedrooms, and WCs. The first floor accommodation comprises: seven bedrooms and one bathroom. The second floor accommodation comprises: one bedroom and a staff sleep-in room (if required). All bedrooms have en-suite facilities. There is a pleasant garden with areas of lawn, decking with seating, flower beds and shrubs which is used in good weather. The ground floor is accessible to a wheelchair user. The home does not currently have a lift. The home did not require any special aids to mobility around the time of this inspection. The registered manager said that the business plan for the next three years includes provision for the installation of some aids. This matter will then be kept under review in light of the changing needs of service users. It is likely that some adjustments to the use of space will be required in some areas of the home in order to create sufficient space for some bathing facilities, especially where that requires the use of moving and handling equipment. However, while discussed in passing during the course of the inspection visit, this was not an issue on this inspection. Some improvements in the form of new radiators and a new bath have taken place since the last inspection and new carpets were due to be fitted in some areas the week after this inspection visit. Further improvements are planned for the coming year. Bedrooms vary in size and all have en-suite facilities. Those seen during the course of this inspection visit were well decorated and furnished and provided a comfortable place for the service user. All areas of the home were clean, tidy and well maintained. The kitchen was in good order, tidy and clean, and food had been appropriately labelled when opened. An environmental health officer had inspected the kitchen since the last inspection and had found everything to be in order. No requirements were necessary. It was noted that a box of latex gloves had been left out and these can pose a risk to a service user if swallowed. It was also noted that the ground floor windows do not have security locks. Both of these matters should be risk assessed by the registered manager and appropriate action taken where necessary. Overall, the home provides a comfortable, pleasant and generally safe environment for service users. The registered manager was aware of the need to plan for increasing needs of service users in the not too distant future and had incorporated some of this into the home’s business plan for the next three years. DS0000060921.V353030.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels, procedures for the recruitment of new staff, and for staff training, development and support are generally satisfactory. These aim to ensure that there are sufficient numbers of appropriately trained and supervised staff to meet the needs of people receiving support from the service EVIDENCE: The organisation’s policies and procedures aim to ensure that staff have the relevant qualities and skills to support service users. At the time of this inspection over half of the staff had acquired NVQ qualifications at Level 2 and above. The staff establishment provided for four staff in the morning, three in the afternoon and two waking staff at night. These figures exclude the registered manager. The registered manager reports that the home has, since the last inspection, employed male staff to provide particular support to male service users. DS0000060921.V353030.R01.S.doc Version 5.2 Page 21 Staff seen during the course of the inspection were positive in their views of the home and of the manager. They said that the service users were well cared for, that service users and staff participate in a range of activities together, and that the manager was “very thorough”. Enquiries from prospective applicants are referred to the home. Applications from prospective staff are processed by the organisation’s human resources department. Interviews are conducted by the registered manager, deputy manager or a manager from another home. Candidates invited for interview are required to bring confirmation of identity (such as a passport or driving licence) to the interview. All applicants are required to complete an application form, supply two references, complete a health declaration regarding their fitness for the post, and provide an enhanced CRB (Criminal Records Bureau) certificate. The files of three staff recruited since the last inspection were examined in the presence of the registered manager. In all cases an application form and health declaration had been completed, two references received, and an enhanced CRB obtained. A recent photograph was on record in two of three files. In two of three files an enhanced CRB had been received prior to the person staring work. The position with regard to a third person was less clear. An enhanced CRB had been received about two months after the person had taken up employment. A POVA first was on file but did not appear to have been received in the home until about a month after the person had taken up post. References were in order. The organisation has good arrangements in place for staff training and development. New staff follow the Skills for Care common induction standards in addition to an internal programme. Staff aim to complete the induction process within three months. Staff are supported in pursuing NVQ through an external training organisation or a local college. The organisation offers training in ‘mandatory subjects’ (first aid, fire safety, food hygiene, and moving & handling), and in medicines administration (using Boots Chemists and in-house materials), managing aggression, Autism, Epilepsy and the use of rectal Diazepam, PCP awareness, and in the Mental Capacity Act 2005. Some training takes place in the home and some in the organisation’s offices in Wimbledon. It is reported that on occasions staff have encountered problems in travelling to training events when relying on public transport networks. Staff are encouraged to maintain personal development portfolios. All care staff receive supervision at intervals of two months but the registered manager intends to increase this to monthly. The manager and deputy DS0000060921.V353030.R01.S.doc Version 5.2 Page 22 manager carry out supervision. Records are maintained. At the time of this inspection annual staff appraisals were not in place for all staff. DS0000060921.V353030.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This is a well managed home where a positive approach to monitoring the quality of the service is providing good care outcomes for service users. Arrangements for health and safety are generally thorough and aim to maintain a safe environment service users, staff and visitors. EVIDENCE: The registered manager is a well qualified and experienced registered nurse who had managed the home for three and half years. The manager holds an MBA (Masters in Business Administration) and the RMA (Registered Managers Award). In the past year the registered manager has attended update training DS0000060921.V353030.R01.S.doc Version 5.2 Page 24 in safeguarding vulnerable adults. The registered manager is supported by an experienced deputy manager. The organisation has a department which co-ordinates and oversees quality assurance across its services. Staff from the department visit each home on four occasions a year. This home had been visited by an internal quality assurance inspector on the day before this inspection and it seemed evident from the summary left by the inspector that such checks are thorough. A stakeholder survey had been carried out in 2007 but the results were not yet available in the home. The quarterly checks by inspectors are followed up by reports and action plans. A care manager respondent to the CSCI survey wrote ‘I visit a few homes in the area and the care given at 9 Longdown Road is exceptional. It has a home from home feel, it is kept clean and free from odours. Everything they do is well thought out to benefit the clients’. The registered manager said that the home had just submitted its business plan for the next three years. This had been sent to the head office of the company. A copy was not available at the time of this inspection. Arrangements for health and safety appear satisfactory.The quality assurance department has a sub-group which oversees health and safety matters across the organisation. A fire risk assessment was carried out in March 2007. A fire drill, which included an evacuation of the premises, was carried out in November 2007. Fire training for staff is available throughout the year. Contracts are in place for the maintenance of fire safety and fire fighting equipment. The fire alarms and fire fighting equipment was checked in September 2007. Emergency lighting is checked by contractors twice a year. Cooking in the home is done on gas equipment and this was checked in March 2007. The central heating is run on oil. Portable electrical equipment (‘PAT’) was tested in July 2007. The home’s fixed wiring was checked in 2004 and is thought to be checked five yearly. The stored water was checked for Legionella through laboratory analysis in June 2007. Systems are in place for recording and monitoring accidents in the home. The home had had an inspection by an environmental health officer earlier in 2007 and no requirements were made. The insurance certificate on display in the hallway was out of date but the registered manager said that a new one had been obtained but had not yet been put on display. As noted under standard 24 above boxes of latex gloves were left out in an area used by service users. The ground floor windows do not appear to have secure locks. Each of these matters should be risk assessed and action taken as necessary. Staff training, including training in matters of health and safety, is managed through the organisation’s head office. The induction and basic training programme includes health and safety. DS0000060921.V353030.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 X 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 2 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 X 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 4 X 3 X X 3 X DS0000060921.V353030.R01.S.doc Version 5.2 Page 26 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA34 Regulation 19 Schedule 2 Requirement The registered manager must ensure that the home maintains evidence of full conformance to the Regulations governing the employment of staff. Timescale for action 31/01/08 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 YA13 Good Practice Recommendations It is recommended that the organisation consider the provision of a computer at the home to assist with compilation of documents and communication with the organisation. It is recommended that the registered manager review the homely remedies policy, taking advice from a pharmacist as required, and include guidance to staff on the upper limits of such medicines to be administered before seeking medical advice. It is recommended that the registered manager conduct a DS0000060921.V353030.R01.S.doc Version 5.2 Page 27 2 YA20 3 YA42 4 YA42 risk assessment of boxes of latex gloves left out in areas used by service users, taking action as necessary. It is recommended that the registered manager carry out a risk assessment of ground floor windows, taking action as necessary DS0000060921.V353030.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 DS0000060921.V353030.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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