Care Home: Nas House

What the care home does well The home continues to effectively ensure that the people who use this service are supported appropriately in all aspects of their day-to-day living. The service provides the necessary support that will enable people to be a part of the wider community and to have aspirations, expectations and goals. This includes encouraging and supporting service users to maintain family relationships / friendships and develop social and life skills. The ethos of the home continues to be geared toward working with service users in a way that acknowledges and respects their rights as human beings. Most of the people who live at Nas House have done so for a considerable number of years and are clearly still satisfied with not only the support that they receive but also obviously view this as their own home. The service also benefits from having a largely long term staff team who know the people who use this service very well indeed. What has improved since the last inspection? The minutes of service users CPA reviews are now being received more speedily, staff appraisals are taking place and supervision notes reflect more of what is discussed. Aspects of quality assurance have improved although further improvement is advised as to has the review of policy and procedure. Refurbishing the bathrooms has also taken place as was previously recommended. What the care home could do better: Further work should be done in connection with annual quality assurance for the service and with ensuring that policy and procedure reflects the most up to date current best practise. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Nas House 370 Bensham Lane Thornton Heath Croydon Surrey CR7 7EQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: James Pitts     Date: 1 9 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 25 Information about the care home Name of care home: Address: Nas House 370 Bensham Lane Thornton Heath Croydon Surrey CR7 7EQ 02086843165 F/P02086843165 famungur@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Ahmed Fawzi Mungar care home 14 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Additional conditions: 14 The maximum number of service users who can be accommodated is: 14 The registered person may provide the following category/ies 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: Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home Nas House is located centrally within the local community of Thornton Heath, close to shops, local library and good public transport - with busses just at the top of the road (a main bus interchange point a couple of stops away) and Thornton Heath Railway station is also close by. Set in an ordinary street, the home is indistinguishable as a care home and looks similar to the other houses in the area. Operating since 1985, the home provides for fourteen people with past or present mental ill health, principally in single rooms, but with six people sharing three double bedrooms. The communal spaces and large rear garden provide various pleasant and comfortable spaces for the occupants, ensuring that people don?t get `on top of one another?. Toilets are Care Homes for Adults (18-65 years) Page 4 of 25 Brief description of the care home provided on each floor and bathrooms on the three upper storeys. A small quiet room is provided on the second floor, a TV lounge on the ground, and a large Lounge / Diner is at lower ground level leading out into the grassed and terraced rear garden. Care Homes for Adults (18-65 years) Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place on a Monday early afternoon. There were approximately half of the service users at home during the visit. The comments that were made by service users either in person and in questionnaires that they sent to us did not indicate that there were any concerns about their care, as is usually the case. A relative was also present and praised the service highly for the work that they do. In addition to the site visit we also examined other information that has been provided to the Commission since the previous key standards inspection in 2007. Care Homes for Adults (18-65 years) Page 6 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service can continue to feel confident that the home will only offer a service to people that the staff are able to care for. Evidence: No one is offered a service unless the staff get all of the proper information that helps to decide if the person can be properly cared for here. One new person moved into the service in the last year. The home received all of the relevant information in order to assess whether this person could be offered a service and a proper review of the placement has subsequently taken place and a contract of service is also in place. It remains very clear that the staff that work at the home are still able to meet the needs of all of the people who live here at the moment, even those who are over 65 years of age. Care Homes for Adults (18-65 years) Page 9 of 25 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service can continue to feel confident that staff know what they need. They can also be assured that the staff will make sure that each person who lives at the home is allowed to live the sort of life that they choose, with acceptable risks being taken into consideration. Evidence: All of the service users continue to have a service user plan, and three of these were examined in detail, as well as the care plan of the most recently admitted person to use the service. These care plans continue to be based on those that are written for people who suffer from mental health problems (Known as the Care Programme Approach). Since the previous inspection it is noted that now in all of the cases that were examined that the service has the minutes of each persons most recent CPA review. Each person who uses the service sees their Psychiatrist regularly and many also see their CPN (Community Psychiatric Nurse). Because those who live here do continue to see these people so regularly this helps to make sure that if anyone starts Care Homes for Adults (18-65 years) Page 10 of 25 Evidence: to become unwell then they can get the help that they need very quickly. The care plans that the home writes are updated but do not change very often as each of the service users is very settled in the way in which they choose to live their life. Some placing authorities have told the home that they do not hold a review about each person that is placed here each year. As the service continues to carry out their own review and then tell the placing authorities of the outcome then this should not be a significant problem. The people who use this service all continue to get involved in things like choosing what food to and eat arranging their social and leisure activities. Most of the people who live here remain very independent and do not often need staff to help them to go out or to do the things that they want to do. It would be advisable for the home to make sure that any matters raised at the monthly meeting of service users are taken forward to the next meeting to ensure that progress is made and reported back to those who use the service. The home writes a risk assessment for each of the service users. A risk assessment tells the staff how to make sure that each of the service users is kept safe from anything that might harm them. The previously noted improvements to the updating and review of the risk assessments has continued and these are changed if they need to be. The risk assessments do not often require much change. The staff are still very good at making sure that nobody is told anything about any of the people who use this service unless the person is allowed to know. The staff continue to be very good at making sure that they tell the right people about things that are happening to the people who live here. But they only tell those people that are allowed to know. The home has a confidentiality policy, as mentioned in the reports of previous inspection visits, that tells staff about how to make sure that they keep to this. Care Homes for Adults (18-65 years) Page 11 of 25 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service can continue to feel confident that the staff of the home will provide active support for each person to participate in the community both in terms of the activities of daily life and leisure interests. The opportunity for person to develop and maintain personal and family relations is also offered and is actively encouraged and supported by the staff team. Evidence: Most of the people who use this service attend drop in centres of decide to engage in their own activities. Sometimes a lot of support and encouragement is needed from staff, although this usually achieves success. Everyone is able to use physically use public transport although for one person they do require assistance from staff. Family contact is actively supported and encouraged by the staff and many people do Care Homes for Adults (18-65 years) Page 12 of 25 Evidence: have at least some contact with their family. Visits to or from family members are supported and a number visit their relatives for weekends or even longer. One relative was visiting on the day of this inspection visit and commended the staff on the way in which they have supported their loved one who lives here. There are not many rules at this home. The one major important one is that no one is allowed to smoke in their bedroom. This is for safety reasons in case some one might fall asleep and drop their cigarette resulting possibly in a fire. Each person has their own front door and bedroom key. People are also allowed to use the entire house except other peoples bedroom or the office. Everyone controls their own personal finances and have help from their family if this is needed. These arrangements are clearly written down and staff have no say about what each person chooses to spend their money on. Menu options and the choices that each person makes are written down each day. If someone decides to have a different meal than the one on the menu then these choices are also recorded. Care Homes for Adults (18-65 years) Page 13 of 25 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service can continue to feel confident that they will get the right support to take care of their personal and health care needs. Anyone who needs to take medicine regularly to help them stay well will get the proper support from staff to make sure that this happens. Evidence: None of the people who use this service need technical aids or equipment to help them to be as independent as possible. Each person has a care plan that tells the staff in great detail the way that each wants to be cared for and supported, and about what each person likes or does not like. No one needs help to bathe or to dress. The staff do sometimes need to encourage some people to do this although this is not usually a problem. All of the people who live at the home usually go to see a local GP if they are not feeling well. They can see any local GP that they want to. The staff write down anything that happens if anyone becomes unwell. If anyone has an illness or something else is wrong with them then the staff do know what this is and how to help Care Homes for Adults (18-65 years) Page 14 of 25 Evidence: them to get the treatment that they need. Some of the people who use this service need to take medicine every day and the staff are very good at making sure that this happens so that they can stay well. The staff are also good at making sure that no one can get hold of any medicine that they should not have and so they keep medicines locked away. The staff also make sure that medicines are handled properly to help to keep everyone safe. All of the people who use this service that do need to take medicine have to have help from the staff to do this. The home includes in the individual medication profile the reason why they need to be supported to take their medicines. Care Homes for Adults (18-65 years) Page 15 of 25 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service can continue to feel confident that the staff team at the home know what to do if there are complaints or concerns about abuse. The home has clear guidance for staff about the procedures to be followed in either of these circumstances. Evidence: The people who use this service are given clear information about how to complain and what happens when they make a complaint. No complaints have been made by any of the service users or by anyone else who either visits or works at the home for around seven years. No complaints have been made to the Commission. The staff team are good at making sure that all of the people who use this service are protected from abuse (this means that the staff at the home do everything that they can to stop any of the service users from being hurt by someone else). The staff know what they then have to do to keep people safe. None of the service users who chatted during this visit said that they are being hurt by anyone else. There have been no serious reportable incidents at this home for at least the last seven years. It could not be ascertained during this inspection the most recent dates on which staff had received updated training on local protection of vulnerable adults procedures. The manager of the service has agreed to send this information shortly. Care Homes for Adults (18-65 years) Page 16 of 25 Care Homes for Adults (18-65 years) Page 17 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service can continue to feel confident that they are living in a well maintained and clean home. Evidence: The home is comfortable and the staff do the right things to make sure that the house is a safe place in which to live. Mr Mungar writes in a maintenance book what decoration and replacements have taken place and when new items are purchased for the house. The house is also kept clean and is free of any unpleasant odours. It was previously advised that the home look at refurbishing the bathrooms as these were beginning to look worn and it need of it. This has now subsequently happened. Care Homes for Adults (18-65 years) Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people that use this service can continue to feel confident that there will be enough staff on duty each day to meet their needs and that these staff are safe and usually properly trained in how to support them. Evidence: Almost all of the staff have already obtained their NVQ qualification. The home has enough staff working each day to make sure that they can properly support the service users. There have been no new staff come to work at the home since the previous key standards inspection in January 2007. It should be noted that the home does historically recruit staff in the correct way taking into account the safety and needs of those who use the service. Mr Mungar has a list of in house training sessions that he conducts with staff, and these include more externally run courses. Mr Mungur has re established an annual appraisals for staff. This now leads to an annual training and development plan as previously required. Staff supervision (this is a time that each member of staff spends talking about how Care Homes for Adults (18-65 years) Page 19 of 25 Evidence: they are getting along in their work) is done by the manager. Staff are supposed to meet with their manager at least 6 times a year. Mr Mungar, as the manager of the home, has continued to make sure that this happens. The topics discussed at supervision are now noted in more detail as was required at the previous key standards inspection. Care Homes for Adults (18-65 years) Page 20 of 25 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service can feel confident that they are living in a safe home that is usually managed effectively. Evidence: Mr Mungar achieved the certificate in management studies and was awarded the NVQ level 4 qualification in September 2006. As Mr Mungur is the registered provider and manager there is no necessity for hime to visit and report on the performance of the service as required under regulation 26. Although service users and relatives are issued with satisfaction surveys there is still no properly established annual quality assurrance process. A business plan is in place up to 2010 this would appear to be a copy of a previous business plan with some dates changed as 2005 is still mentioned within it. It is advisable that the business plan be augmented by an annual quality assurrance process. Care Homes for Adults (18-65 years) Page 21 of 25 Evidence: Policy and procedure documentation have in most part been reviewed since the previous key standards inspection although it is advisable that these be examined to ensure that they are up to date with current best practise and any subsequent changes to legislation. The service remains a safe place in terms of health, safety and fire precautions. The necessary annual checks are carried out and weekly tests of the fire alarm, along with quarterly fire drills, also take place. The London Fire Brigade most recently carried out a routine inspection visit in January 2006 and reported that no concerns were evident. Care Homes for Adults (18-65 years) Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 8 It would be advisable for the home to make sure that any matters raised at the monthly meeting of service users are taken forward to the next meeting to ensure that progress is made and reported back to those who use the service. It is advisable that the business plan be augmented by an annual quality assurrance process. It is advisable that the policy and procedure documentation be examined to ensure that they are up to date with current best practise and any subsequent changes to legislation. 2 3 39 41 Care Homes for Adults (18-65 years) Page 24 of 25 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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