Care Home: Mrs Anita Gungaram

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What the care home does well The service provides support under an "extended family" model, so that residents have developed good working relationships with the people that care for them. People`s needs are assessed, so that their care can be properly planned. Residents have detailed care plans, to make sure they get the support they need in ways that suit them. Plans and risk assessments are reviewed regularly so that they are kept up to date. People get a good standard of basic personal care. Staff that know them well look after them, and treat them with warmth and respect. They get the support they need to keep appointments with doctors and other health professionals, to help them stay healthy and well. They are able to pursue valued activities and to keep in touch with people who are important to them. They have access to a good diet and enjoy their food. Staff support them to do as much for themselves as they can, to promote their personal independence. We have not received any complaints in respect of this service. The house is generally well maintained, decorated and furnished throughout. This means that residents can enjoy the benefit of living in a place that is clean, safe, comfortable and homely.Staff are properly qualified, so that they have the skills and knowledge they need to do a good job. Important checks are carried out on staff before they start work at the home. This is to make sure they are fit for the job. The home is generally well run. Important checks are carried out regularly on essential equipment, to make sure that people living and working in the home can stay safe. What has improved since the last inspection? A previous requirement that the Manager complete formal qualification for the post (Registered Manager`s Award [RMA]) has now been met. The home has continued to meet the residents` needs in an extended family setting. The staff team remains consistent, providing residents with familiarity, stability and continuity of care. What the care home could do better: Develop people`s care plans to include goals with outcomes that can be clearly measured. Review and evaluate these regularly, so that people get the support they need to achieve the things that are important to them. Improve the standard of recording to show clear links between people`s activities and their agreed goals. This will help plan activities more effectively, and make sure people get the support they need to achieve their goals. Update safeguarding policy and procedures to include details of local agency contacts. This is so that advice can be gained or referrals made promptly, if required. Develop Health Action Plans for each resident, to positively promote individuals` healthy lifestyles. Keep records of medical or health related appointments separate form general recording. This is so that important information can be found quickly and easily. Develop a staff training plan, to ensure that the training and development needs of all the team can be monitored more effectively. Put in place a proper system for monitoring and quality assurance of the service. Collate information, analyse and report to interested parties, so that it can be seen how the residents` views and wishes have been taken into account. CARE HOME ADULTS 18-65 Mrs Anita Gungaram Tenby Lodge 180 Hobs Moat Road Solihull Birmingham West Midlands B92 8JZ Lead Inspector Gerard Hammond Key Unannounced Inspection 19th February & 4th March 2009 09:30 Mrs Anita Gungaram DS0000004542.V374248.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 Mrs Anita Gungaram DS0000004542.V374248.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. Mrs Anita Gungaram DS0000004542.V374248.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mrs Anita Gungaram Address 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) Tenby Lodge 180 Hobs Moat Road Solihull Birmingham West Midlands B92 8JZ 0121 247 1501 0121 241 8680 tenbylodge@hotmail.com Mrs Anita Gungaram Mr Veer Gungaram Mrs Anita Gungaram Mr Veer Gungaram Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Mrs Anita Gungaram DS0000004542.V374248.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th February 2007 Brief Description of the Service: Tenby Lodge is a privately owned small residential home, owned and run by Mr. and Mrs. Gungaram, providing accommodation for up to 3 persons with a learning disability. The home is situated in a semi-detached house in a residential area, just off a main road into Solihull. There are a number of shops nearby and the town centre is a short bus/car ride away, making it readily accessible to amenities such as shops, places of worship and public transport. The home has a lounge, dining room and domestic style kitchen. There are three large upstairs bedrooms for the residents, a smaller staff sleep in room that is also used as an office. There is a bathroom upstairs with a shower over the bath, toilet and wash hand basin. There is an additional toilet downstairs. There are gardens to the rear and front of the property with parking space available for two vehicles at the front. Mrs Anita Gungaram DS0000004542.V374248.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This is the service’s key inspection for the year 2008-9. We gathered information from a number of sources to help us make the judgements contained in this report. The Manager completed an Annual Quality Assurance Assessment (AQAA) and sent it to us. We made two visits to the home and met with the people who live there. We also spoke with the Managers and staff on duty. We looked at residents’ care plans and personal files, staff records and other documents. These included previous inspection reports, information that the service has sent to us (“notifications”), reports and other documents and records about health and safety. Thanks are due to the residents, Managers and staff for their co-operation, support and hospitality throughout the inspection process. What the service does well: The service provides support under an “extended family” model, so that residents have developed good working relationships with the people that care for them. People’s needs are assessed, so that their care can be properly planned. Residents have detailed care plans, to make sure they get the support they need in ways that suit them. Plans and risk assessments are reviewed regularly so that they are kept up to date. People get a good standard of basic personal care. Staff that know them well look after them, and treat them with warmth and respect. They get the support they need to keep appointments with doctors and other health professionals, to help them stay healthy and well. They are able to pursue valued activities and to keep in touch with people who are important to them. They have access to a good diet and enjoy their food. Staff support them to do as much for themselves as they can, to promote their personal independence. We have not received any complaints in respect of this service. The house is generally well maintained, decorated and furnished throughout. This means that residents can enjoy the benefit of living in a place that is clean, safe, comfortable and homely. Mrs Anita Gungaram DS0000004542.V374248.R01.S.doc Version 5.2 Page 6 Staff are properly qualified, so that they have the skills and knowledge they need to do a good job. Important checks are carried out on staff before they start work at the home. This is to make sure they are fit for the job. The home is generally well run. Important checks are carried out regularly on essential equipment, to make sure that people living and working in the home can stay safe. What has improved since the last inspection? What they could do better: Develop people’s care plans to include goals with outcomes that can be clearly measured. Review and evaluate these regularly, so that people get the support they need to achieve the things that are important to them. Improve the standard of recording to show clear links between people’s activities and their agreed goals. This will help plan activities more effectively, and make sure people get the support they need to achieve their goals. Update safeguarding policy and procedures to include details of local agency contacts. This is so that advice can be gained or referrals made promptly, if required. Develop Health Action Plans for each resident, to positively promote individuals’ healthy lifestyles. Keep records of medical or health related appointments separate form general recording. This is so that important information can be found quickly and easily. Develop a staff training plan, to ensure that the training and development needs of all the team can be monitored more effectively. Put in place a proper system for monitoring and quality assurance of the service. Collate information, analyse and report to interested parties, so that it can be seen how the residents’ views and wishes have been taken into account. Mrs Anita Gungaram DS0000004542.V374248.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. Mrs Anita Gungaram DS0000004542.V374248.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 Mrs Anita Gungaram DS0000004542.V374248.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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s needs have been assessed, so that their care and support can be properly planned. EVIDENCE: There are three male residents living in this home. There have been no admissions to the home since the last inspection, and there are currently no vacancies. The residents have lived together for over eleven years, and been cared for by the Manager and her husband for all that time. We looked at the residents personal files: all of them contained a current assessment of their support needs, as required. Conversations with the staff team showed that they have a good knowledge of the people in their care. Mrs Anita Gungaram DS0000004542.V374248.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have detailed care plans, to ensure that they get the support they need and to stay safe. They are helped to make decisions, so that they can make choices about things that are important to them. EVIDENCE: We looked at peoples records to see how their care and support is planned. All of the residents have a detailed care plan. These follow the same format, so information is generally easy to find. Plans give clear guidance about how each individual needs to be supported with his personal care, details of medication and healthcare. They show the things that people can do independently, and what they need help with. Records show that plans have been kept under review, as required. Care plans include individuals risk assessments, so that people get the support they need to stay safe. Mrs Anita Gungaram DS0000004542.V374248.R01.S.doc Version 5.2 Page 11 We talked to residents and they told us that they like to help out around the house. Things they do include keeping their rooms clean and tidy, helping with dusting, vacuum cleaning and polishing, washing up and laundry. They told us that they make choices about the activities they do, the places they go to, and the things they like to eat and drink. The things people are able to do is restricted to a greater or lesser extent by their individual levels of learning disability. We discussed care planning and management with the homes owners. Planning could be improved by setting some specific goals with outcomes that can be clearly measured. Plans do already include some goals, but it is not clear how these are being monitored or evaluated. For example, one mans care plan showed a goal to develop self-help skills within the home setting. It was suggested that the goal should show clearly how this is to be achieved. This could be done by identifying specific tasks, saying how often these should happen, who will be involved, and when things will be done by. Goals should be set with the clear involvement and agreement of the people involved. It was also suggested that the development of person-centred approaches could make a positive contribution to this process. This could help to identify clearly the things that are most important to each individual. Doing this would provide clear direction for setting goals, so that people get the support they need to achieve what they want. Goals should be evaluated on a regular basis. This is to ensure that things that were agreed are happening when they should. Also, to make judgements about what is working, and what might need to be changed. It was noted that one mans care plan was shown as being reviewed. The record just said needs and risks remain the same. It is suggested that care plan reviews should include an evaluation of the goals set previously. It can then be decided if they have been met, if work to achieve them needs to be continued or changed, and if new goals should be developed. Doing this regularly will provide direction, help to keep care plans live, and make sure that people get the help they need to achieve their ambitions. Mrs Anita Gungaram DS0000004542.V374248.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13,14, 15,16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People get the support they need to go to places they like, do things they enjoy, and keep in touch with the people who are important to them. EVIDENCE: We spoke with all of the residents and looked at their personal records; to find out what opportunities they have to do the things they like. Two of the residents attend a local day centre during the week for structured activities. The other person has more complex support needs. He previously attended day centre, but this environment did not suit him. The Manager said that he goes out each day with a member of staff. He showed us his scorecard from the bowling alley where he had been earlier in the afternoon. He also said that he goes swimming and likes to go out to the shops. One of the other residents is now of retiring age. After his day out at the centre he likes to relax at home. He enjoys painting and drawing, and watching television. The other resident is Mrs Anita Gungaram DS0000004542.V374248.R01.S.doc Version 5.2 Page 13 more active and independent. He goes to a local Gateway club each week. At the weekends he enjoys going into town to go shopping, have lunch out and buy his lottery ticket. On Sundays he attends a local church. People are supported to keep in touch with their friends and families. One resident visits his parents each Tuesday, and speaks to them on the telephone at weekends. Another residents parents live abroad: he went on holiday with his sister last year to visit them. The other resident went to France for a holiday with members of his family during the year. All of the residents also enjoyed a holiday to Spain. It was noted that records about peoples activities are quite limited. It was recommended that these be completed in more detail in future, so that it is possible to assess properly the full range of activity opportunities that people enjoy. Activities should be purposeful. It is recommended that peoples activities should be clearly linked to their agreed goals. This will help to ensure that they get the support they need to achieve the things that are important to them. We looked at the record of the meals that people have actually eaten. This provided evidence of a varied and balanced diet. The Manager said that the residents helped to plan the menu each week. All of the residents said that they liked the food they got, and could have what they wanted. Mrs Anita Gungaram DS0000004542.V374248.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 &20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are well looked after and get the support they need to stay healthy and well. EVIDENCE: We saw that residents were well dressed in good quality clothing that was age and gender appropriate, and suited to the time of year. It was clear that they had been properly supported with their personal care. We were also able to observe directly the interactions between all of the members of the staff team and the residents. Support was given with respect, warmth and friendliness: people are clearly comfortable in each others company. All of the residents told us that they like the staff, and get on well with them. The owners run the home as an extended family. The small staff team has worked together for several years, providing consistency and continuity of care. Peoples care plans provide detailed information about what people can do independently, and what they need help with. Staff are knowledgeable about their regular routines and individual preferences. This is particularly Mrs Anita Gungaram DS0000004542.V374248.R01.S.doc Version 5.2 Page 15 important for people with complex care needs, to make sure they get supported in ways that suit them best. We looked at records to see how residents health care is managed. Personal files contained evidence of regular appointments with the GP, dentist and chiropodist. The Manager said that all three residents enjoy good general health. They have an annual medical check-up with the GP, and are referred for advice or treatment as necessary. The Manager is a trained general nurse, and her husband a trained nurse for people with learning disabilities. It was recommended at the time of the last inspection that Health Action Plans be developed for each of the residents. This is in keeping with the aspirations of the Government White Paper about people with learning disabilities, Valuing People. Health action planning seeks to develop a more proactive (as opposed to reactive) approach to the management of peoples health care. That is, health care is managed in such a way as to actively promote good health (preventive strategies) rather than merely reacting as problems arise. The Health Action Plan should form an integral part of each individuals care plan. As with the general care plan, it is recommended that health action plans contain clear goals with measurable outcomes. Examples of these might be ensuring people eat the recommended five a day portions of fruit and vegetables, maintain an agreed healthy weight, and regularly do something active that they enjoy. As stated previously, goals can only be of any value if they are monitored, reviewed and evaluated regularly. It should be acknowledged that some of the things mentioned above are already happening. It is suggested that including these things in a formal health action plan could help to provide more structure to the process. This could mean that health care management becomes more systematic and better organised. This was discussed with the management team. It is further suggested that liaison with the local Community Nurse (Learning Disabilities) Team might be helpful in this regard. It was also recommended that records of medical / health appointments are maintained separately from general daily notes. None of the residents independently manages his medication. This is stored securely in the upstairs office. We looked at the Medication Administration Record (MAR): this had been completed appropriately. A previous recommendation to maintain copies of prescriptions with the record has been met. Protocols were in place for PRN (as required) medication. The medication store was clean, tidy and secure. Mrs Anita Gungaram DS0000004542.V374248.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 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can be confident that their concerns are taken seriously and acted upon. They get the support they need to be protected and stay safe. EVIDENCE: We have not received any complaints in respect of this service. Information provided by the Manager in the Annual Quality Assurance Assessment (AQAA) shows that the home has not received any complaints either. When we spoke to the residents, they all told us that they are happy living at Tenby Lodge. The home has a complaints policy and procedure. It has to be acknowledged that the complex care needs and levels of learning disability of the three residents mean that formal processes have limited significance for them individually. They depend on staff to be sensitive to changes in behaviour, general demeanour or body language as indicators that they might be unhappy. Conversations with members of the staff team showed that they are knowledgeable about individuals ways of communicating and usual patterns of behaviour. One of the residents was able to say that he would speak to the Manager or other members of the team, if he were upset or unhappy. No safeguarding referrals have been received in connection with the home. Staff were able to demonstrate their understanding of the different forms that abuse can take. They were able to describe potential indicators that might Mrs Anita Gungaram DS0000004542.V374248.R01.S.doc Version 5.2 Page 17 make them suspect that abuse had taken place. They were clear about their responsibilities to report any actual incident or concern about abuse, and the paramount importance of ensuring individuals safety at all times. It is recommended that the safeguarding procedure be updated to include current contacts and significant agencies (e.g. Local Authority Safeguarding Team, Police Vulnerable Persons Officer etc.). Mrs Anita Gungaram DS0000004542.V374248.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, 25, 26, 27, 28, & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents enjoy the benefit of living in a house that is comfortable, clean and homely. EVIDENCE: We looked around the home in the company of the Manager. Each resident has his own single bedroom. All of their rooms are good sized: they are all individually styled and reflect the personalities and interests of each occupant. We saw personal possessions and effects, family photographs, pictures and ornaments, televisions and music players in evidence. The main bathroom is upstairs: this includes an over the bath shower and a toilet. There is another toilet downstairs. The small fourth bedroom doubles as an office and staff sleep-in room. Mrs Anita Gungaram DS0000004542.V374248.R01.S.doc Version 5.2 Page 19 Downstairs there is a comfortably furnished lounge, the kitchen, and a separate dining room. There is an enclosed private garden at the rear of the property for residents to enjoy when the weather permits. We saw that the house was clean and tidy, with good standards of hygiene maintained throughout. Standards of decoration and maintenance are satisfactory. Mrs Anita Gungaram DS0000004542.V374248.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 & 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A small, familiar staff team supports the residents, so their care is reliably consistent. The care team is appropriately qualified, but planning to meet future training and development needs could be improved. This will ensure that people keep the knowledge and skills they need to do their jobs well fully up to date. EVIDENCE: The small staff team of three (Manager, Assistant and Support Worker) remains the same as at the time of the last inspection. The team covers all shifts and sleep-in duties. The managers live close by and always available on call. As reported above, the small size and familiarity of the team with the residents promotes consistency and continuity of care. We were able to meet with all of the team during the course of the fieldwork visits. We looked at the Support Workers staff file. As shown in the last inspection report, this contained a completed application, written references and evidence of a check with the Criminal Records Bureau (CRB). Her file also Mrs Anita Gungaram DS0000004542.V374248.R01.S.doc Version 5.2 Page 21 contained evidence of regular supervision and an annual appraisal. She has completed Learning Disability Awards Framework (LDAF) training, and is qualified to NVQ level 2. She confirmed that she has regular supervision meetings with her Manager, and said that she feels well supported. It is difficult to assess fully the training needs of the staff team in the absence of a proper training and development plan. This should show (for all of the team, including managers) training completed and qualifications gained (with dates). It should show when refreshers are due and indicate when training is scheduled. Each persons record should contain certificates of all training / qualification (or copies) so that these can be verified. It should be acknowledged that some training certificates were available when we looked at the records. It is recommended that the training plan be presented in spreadsheet or chart format. Doing this should provide the Manager with a clear overview and a useful tool for planning future training. It is important that all members of staff keep their personal training and development up to date. This will ensure that they have all the knowledge and skills they need to do their jobs well. Mrs Anita Gungaram DS0000004542.V374248.R01.S.doc Version 5.2 Page 22 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): 37,38 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is generally well run for the benefit of its residents. Quality assurance and monitoring should be developed. This will help to ensure that the needs and wishes of the residents guide the future development of the service. People living and working in the house are supported to stay safe and well. EVIDENCE: The Manager is appropriately qualified to run this service. She is a trained general nurse, and also holds the Registered Managers Award (RMA). Her husband is the Assistant Manager: he is a trained nurse for people with learning disabilities. The managers are also the homes owners. As shown in previous inspection reports, the home is run as an extended family. The Mrs Anita Gungaram DS0000004542.V374248.R01.S.doc Version 5.2 Page 23 whole staff team presents positively and enjoys a good rapport with each other. The Support Worker says that the managers are approachable, and that she is entirely comfortable raising any matters of concern directly with them. The same good rapport exists between the staff and the residents, for whom there is clear affection and respect. We looked at the ways in which service quality is monitored and assured. We saw minutes of regular meetings with the resident group. The last report shows that these occur each week: topics discussed include weekly menus, activities, outings and holidays. It is suggested that there is room for some further development. Quality assurance and monitoring should be guided by the intended outcome for this standard (National Minimum Standards - Care homes for Adults 18-65 Standard 39). This says, Service Users are confident their views underpin all self-monitoring, review and development by the home. It has to be acknowledged that seeking the views of people with complex and communication support needs presents particular challenges. It is suggested that the use of person-centred approaches could make a significant contribution in this regard. Setting goals with measurable outcomes, and evaluating them regularly, could also provide further clear evidence of residents wishes being taken into account. It is also suggested that formally seeking the views of families, involved professionals or other interested parties, could provide additional relevant material. Information gained from this process should be collated and analysed, and a report produced of the findings. It was noted that the written response to the Annual Quality Assurance Assessment (AQAA) was fairly minimal. This was discussed with the Manager. It was suggested that entries should be more detailed, and related specifically to the intended outcomes of each National Minimum Standard. As well as looking around the house, we looked at health and safety records. Weekly checks of smoke detectors are carried out, and a full record maintained. Fire evacuation drills and six-monthly checks of electrical equipment have also been done. Safety certificates for gas and electrical appliances were also seen. People are appropriately supervised in the house to make sure they stay safe and well. Mrs Anita Gungaram DS0000004542.V374248.R01.S.doc Version 5.2 Page 24 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 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 2 X X 3 3 Mrs Anita Gungaram DS0000004542.V374248.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations Develop care plans using person-centred approaches, and goals with outcomes that can be clearly measured. This will ensure that people get the support they need to achieve the things that are most important to them. Establish clear links between individuals’ activity opportunities and their agreed personal goals. Ensure that records of activities contain sufficient detail. Doing these things well will help to ensure that people get the support they need to do the things they want. Develop Health Action Plans for each resident, to more actively promote healthy lifestyles and help people stay fit and well. Update the safeguarding policy and procedure to include current local agency contacts. This is to ensure that advice can be sought or referrals made quickly and easily. DS0000004542.V374248.R01.S.doc Version 5.2 Page 26 2. YA12 3. 4. YA19 YA23 Mrs Anita Gungaram 5. 6. YA35 YA39 Develop the staff training and development plan, to ensure that training is kept up to date for all staff. Develop the home’s systems for quality assurance and monitoring, so that it is clear how people’s views have been taken into account, and guide future planning. Mrs Anita Gungaram DS0000004542.V374248.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Mrs Anita Gungaram DS0000004542.V374248.R01.S.doc Version 5.2 Page 28 - 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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