Care Home: Our House

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What the care home does well The service is able to demonstrate its commitment to equality and diversity issues and it remains service user focused. As part of RCHL, the service benefits from a robust recruitment process, which ensures that care workers are suitable to work with vulnerable people. There is a well-funded training programme to ensure that staff are competent and well trained. When asked do staff treat you well one person said, "of course they do".Feedback received from relatives and other professionals for last years Annual Service Review included the following comments: "I am impressed by the length that staff go to, to make choices work. They appear to understand and respond appropriately to the needs /requests of their residents." "My experience of working with this house has been very positive. They are a pleasure to work with. The staff have been very conscientious, following guidelines and engaging in discussion about meeting the persons health needs and taking appropriate action." "The residents of `Our House` are generally well looked after and content." "The service provides excellent care and the commitment of staff is absolute. My daughter is always well groomed and happy in her environment". "The residents are cared for as individuals." "They are very good at providing a homely caring atmosphere and encourage and support the residents to be involved and to make choices in their lives." The service asked relatives for anonymous feedback on areas of the AQAA (Annual Quality Assurance Assessment) and comments included: "Residents always look clean and groomed. "They are appropriately dressed and are a credit to care and support given by staff" "The house has an open door policy with an excellent relationship with parents and families. Impromptu invitations to breakfast or dinner are much appreciated by parents and re-enforce the family atmosphere of the house which is so important to them" "Staff are very caring and conscious of the needs of the residents and parents and they do their best to satisfy them" "Social activities are arranged at which photos and videos are taken which give them all much pleasure later. The computer is used in the same way to send photographic birthday cards, thank you letters etc, which are enjoyed by all who receive them" Holidays and mini breaks are arranged and anticipated with great pleasure. These are appreciated and show the dedication of the staff" "The house and garden are always in good order with them all being involved. The garden has been used to involve some of them in useful occupation and helps give them a sense of pride in their own home". "The manager and staff are always ready to listen to parents concerns and help to sort them out however small". Another professional said: "The service provided at Blueberry Close is delivered by a very dedicated staff team who treat the tenants with great respect and make `Our House` feel like a home".Our HouseDS0000025914.V373655.R01.S.docVersion 5.2Page 7 What has improved since the last inspection? Person Centred Plans and communication and financial `passports` have been introduced and these give clear information about peoples` needs and how to support them. These are all user friendly and people living at Blueberry Close have been very involved in doing these. One of the people living at the home now helps staff to carry out the health & safety checks. There have been some improvements to the house. The kitchen has had new flooring and the hallways have had new carpets. There is a new flat screen television and also new garden furniture. What the care home could do better: The service continues to grow and develop and staff support people to be as independent as possible. Staff are committed to this and continue to look at different ways of improving and developing the service further. This service is a part of a bigger organisation. The organisation takes on board advice given and keeps up to date with good practice and other changes. The organisation has a commitment to provide a good quality service. The `expert by experience` did not have any negative comments or feedback about the service. There are not any requirements from this visit. CARE HOME ADULTS 18-65 Our House 5 Blueberry Close Woodford Green Essex IG8 0EP Lead Inspector Jackie Date Unannounced Inspection 15th January 2009 09:40 Our House DS0000025914.V373655.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 Our House DS0000025914.V373655.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. Our House DS0000025914.V373655.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Our House Address 5 Blueberry Close Woodford Green Essex IG8 0EP 020 8559 7585 020 8599 7585 blueberry.close@rchl.org.uk www.rchl.org.uk Redbridge Community Housing Limited [RCHL] 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) No registered manager. Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Our House DS0000025914.V373655.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 5 6th March 2007 Date of last inspection Brief Description of the Service: 5 Blueberry Close, also known as Our House, is a home for five people with learning disabilities. It is one of a number of homes run by RCHL, Redbridge Community Housing Ltd. The house is in Woodford in the London Borough of Redbridge. The home was built in 1998 and was designed with the support of the parents of the tenants. It is a bungalow and accessible for wheelchair users. The home has five large bedrooms, two with ensuite showers and toilets. There is a large lounge, a kitchen/dining area, a bathroom, a shower room and a laundry room. There is also a small conservatory. In addition to this there is a staff sleeping in room and an office. All of the tenants have lived together since the home opened. They do a lot of things in the home, the day centre, and the college. They have strong links with the local Catholic Fellowship and join them for a lot of social activities. The basic charge per week for each person is £1,056.36. The manager provided this information in the AQAA (Annual Quality Assurance Assessment). Information about the service provided is contained in the service users guide. Our House DS0000025914.V373655.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 3 star. This means the people who use this service experience excellent quality outcomes. This inspection was unannounced and started at 9:40 am. It took place over seven hours. This was a key inspection and all of the key inspection standards were tested. Staff were asked about the care that people using the service receive, and were also observed carrying out their duties. People using the service were asked to give their views on the service and their experience of living in the home. All of the shared areas and four bedrooms were seen. Staff, care and other records were checked. We were joined for part of the inspection by an ‘Expert by Experience’ who was accompanied by a support worker. The ‘Expert by Experience’ had a look around the home and spent time talking to staff and the people living there. She then provided feedback about the service. Comments from her report have been included in this report. Feedback questionnaires were sent to people who use the service, staff and other professionals. Feedback was received from people who live at the home, two staff, two other professionals and one relative. In addition feedback from relatives was available at the home as part of their quality assurance. People using this service are seen as ‘tenants’ of Blueberry Close and therefore this is the term that is used in this report when referring to them. Services are now required to complete an AQAA (Annual Quality Assurance Assessment) and the completed form was received in August 2008. Information provided in this document also formed part of the overall inspection The inspector would like to thank the people living at Blueberry Close, the staff and the ‘Expert by Experience’ for their input during the inspection. What the service does well: The service is able to demonstrate its commitment to equality and diversity issues and it remains service user focused. As part of RCHL, the service benefits from a robust recruitment process, which ensures that care workers are suitable to work with vulnerable people. There is a well-funded training programme to ensure that staff are competent and well trained. When asked do staff treat you well one person said, “of course they do”. Our House DS0000025914.V373655.R01.S.doc Version 5.2 Page 6 Feedback received from relatives and other professionals for last years Annual Service Review included the following comments: “I am impressed by the length that staff go to, to make choices work. They appear to understand and respond appropriately to the needs /requests of their residents.” “My experience of working with this house has been very positive. They are a pleasure to work with. The staff have been very conscientious, following guidelines and engaging in discussion about meeting the persons health needs and taking appropriate action.” “The residents of ‘Our House’ are generally well looked after and content.” “The service provides excellent care and the commitment of staff is absolute. My daughter is always well groomed and happy in her environment”. “The residents are cared for as individuals.” “They are very good at providing a homely caring atmosphere and encourage and support the residents to be involved and to make choices in their lives.” The service asked relatives for anonymous feedback on areas of the AQAA (Annual Quality Assurance Assessment) and comments included: Residents always look clean and groomed. They are appropriately dressed and are a credit to care and support given by staff The house has an open door policy with an excellent relationship with parents and families. Impromptu invitations to breakfast or dinner are much appreciated by parents and re-enforce the family atmosphere of the house which is so important to them” Staff are very caring and conscious of the needs of the residents and parents and they do their best to satisfy them Social activities are arranged at which photos and videos are taken which give them all much pleasure later. The computer is used in the same way to send photographic birthday cards, thank you letters etc, which are enjoyed by all who receive them Holidays and mini breaks are arranged and anticipated with great pleasure. These are appreciated and show the dedication of the staff The house and garden are always in good order with them all being involved. The garden has been used to involve some of them in useful occupation and helps give them a sense of pride in their own home. The manager and staff are always ready to listen to parents concerns and help to sort them out however small. Another professional said: “The service provided at Blueberry Close is delivered by a very dedicated staff team who treat the tenants with great respect and make ‘Our House’ feel like a home”. Our House DS0000025914.V373655.R01.S.doc Version 5.2 Page 7 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. Our House DS0000025914.V373655.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 Our House DS0000025914.V373655.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5. People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. The Statement of Purpose and Service Users guide provide people with the information that they would need to make an informed choice about whether they wish to live in the home. If a vacancy arose the required information would be gathered on a prospective tenant and they and their relatives could spend time in the home to find out what it would be like to live there and to enable the person to make a choice about living in the home. Tenants and their representatives have a written and costed contract/statement of terms and conditions and will therefore be clear about what they are entitled to. EVIDENCE: There is a Statement of Purpose and Service User Guide. These are updated when needed. The Service User Guide is available in a user-friendly format with lots of photographs to help people to understand it. Our House DS0000025914.V373655.R01.S.doc Version 5.2 Page 10 Our House was purpose built in 1998 for the five people that live there and there have not been any new admissions since then. However, the organisation has an admissions procedure that includes gathering of information and assessments. The policy also includes several visits to the home including over night stays to ensure that the potential tenant would be happy that the service met their needs and that they would fit in well with the other tenants. Each person has a contract/statement of terms and conditions and these include information about individual financial arrangements. The contracts were available at the home. This means that there is clear information available about the service that will be provided to each individual. Our House DS0000025914.V373655.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 & 10. People using the service experience excellent quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. People living at Blueberry Close are involved in developing and reviewing their personal plans and these provide staff with the information they need to meet individual needs. The risk assessments are appropriate and reviewed and up to date. People are supported to take risks according to their needs and they have the opportunity to try things and to develop their skills as safely as possible. People are encouraged and supported to be involved in decisions about what they do and what happens in the home. This includes staff recruitment and the development of the business plan. Their opinions are valued and listened to. Our House DS0000025914.V373655.R01.S.doc Version 5.2 Page 12 EVIDENCE: Each person has a comprehensive and individualised Person Centred Plan, which identifies all of their needs, likes/dislikes and hopes for the future. The plans of three people were checked. The personal planning books are in a user-friendly format and have lots of photographs and symbols to help people to understand what is in them. People who have communication difficulties have their own individualised ‘Communication Passport’. These detail how people express themselves and what keywords mean. For example, “I can express myself by pointing or saying yes”. Everyone also has a ‘financial passport’ that details their financial situation and what help and support is needed to help them to be more indepenant. The tenants also sign these. Tenants said that their plans were discussed with them and they have signed their plans. All tenants have been involved in compiling their individual Care Plans and Risk Assessments, which are reviewed with the person on a regular basis. Tenants are actively involved in preparing their six monthly reviews, which are attended by family members, and any professionals involved with their care. A report is written for the review meeting and those seen on file contained very comprehensive information, supported by photographs, and gave a clear picture of the individual and what they had been doing. Therefore information is available to enable staff to provide appropriate support to people and to meet their needs. The tenants are treated as individuals and are encouraged and supported to treat ‘Our House’ as their home. They are supported and encouraged to make decisions that affect their lives. Tenants meetings are held on a monthly basis and minutes of these show that they are supported and encouraged to make decisions about all aspects of their home. Tenants also meet every Monday and choose their meals for the week using a pictorial menu and they also take turns to help with the weekly shopping. The tenants are very involved in everything that happens in the home. One tenant was recently on the interview panel for project workers at the service. This tenant has also started to do the weekly health and safety checks with staff and has his own userfriendly file to help him with this. Tenants are consulted about all aspects of life in the home and make decisions about their lives. RCHL held five service user participation days in the last year. These were: ‘The Service User Survey Day’, ‘The Annual Report Day’, ‘The Business Plan Day’, ‘A Speak Up Day’ and ‘A Day on what is Important in Services’. They also held a service user consultation day facilitated by independent drama and advocacy consultants. Some of the tenants attended these events. The ‘expert by experience’ said, “residents are involved in the running of the home, decorating their rooms with colours and furniture of their choice. Residents have choices of when to go to Our House DS0000025914.V373655.R01.S.doc Version 5.2 Page 13 bed”. A relative said, “I am impressed by the length that staff go to, to make choices work”. Daily notes are kept for each person and contain details of how they have been and what they have done. These notes are coded in line with points on the care plan to assist staff to retrieve information for reviews. Risk assessments are the in place. These identify risks for the tenants and indicate ways in which the risks can be reduced to enable their needs to be met as safely as possible whilst supporting them to be as independent as possible. Risk assessments cover all the necessary areas and are relevant to individual needs. For example one person has an electric scooter. Tenants’ records and other information are stored in a lockable cabinet in the office and staff are aware of issues of confidentiality. A care professional said, “I have always found Blueberry Close to have an extremely strict confidentiality policy Our House DS0000025914.V373655.R01.S.doc Version 5.2 Page 14 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): 11, 12, 13, 14, 15, 16 & 17. People using the service experience excellent quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. People are encouraged to be as independent as possible, to take part in activities and to be part of the local community. They have a very busy social life. People are supported to keep in contact with their relatives and visitors are made welcome at the home. People are given meals that they have chosen, like, and that meet their needs and preferences. EVIDENCE: Tenants are supported and encouraged to lead an active life within the community, attending colleges, Day Centres. swimming, church, cinemas, local pubs and restaurants. They are members of the Catholic Fellowship, Our House DS0000025914.V373655.R01.S.doc Version 5.2 Page 15 Redbridge Dippers and Redbridge Mencap and regularly participate in outings and trips. Tenants are involved in planning their annual holiday and go to places of their choice. Last year three people went to Wales and the others went to Norfolk. In addition some people go on holiday with the Catholic Fellowship and last year two people went to New York and another to Lourdes. In the past year people have had an overnight stay in a hotel in Brighton and on two occasions three people went to see live shows and stayed in hotels. Two people go to church regularly. The expert by experience said, “the home has a large airy lounge where the residents socialise, play board games, watch TV or work on the computer. Friends and family do visit the residents. They are also involved in the homes’ activities. Residents go on holidays. One resident told us she likes going to Paris and she would be going again in the summer. People get involved in a lot and seem to enjoy this”. Relatives said, “holidays and mini breaks are arranged and anticipated with great pleasure. These are appreciated and show the dedication of the staff. “Social activities are arranged at which photos and videos are taken which give them all much pleasure later. The computer is used in the same way to send photographic birthday cards, thank you letters etc, which are enjoyed by all who receive them”. Tenants participate in household tasks on a rota basis. This includes the cooking as well as domestic chores. Personal plans contain lots of different ways in which they are supported to develop their skills and to be as independent as possible. For example, personal care, finances and medication. One persons personal plan states, “you should ask me to assist with making a drink, no matter how small my input is”. The tenants have a cat called Jet that they take care of. Relatives said, the house and garden are always in good order with them all being involved. The garden has been used to involve some people in useful occupation and helps give them a sense of pride in their own home”. Tenants are encouraged to maintain close contact with their families and friends. The families and friends are invited to all social events at ‘Our House’ and people often invite family members to join them for dinner. The tenants’ families were involved in the setting up, planning and building of the home and they are still very much involved. They visit regularly and people also go home for visits and short stays. There is an open door policy and family and friends often drop in. Three monthly family meetings are held and these are very well attended. Relatives said, “the house has an open door policy with an excellent relationship with parents and families. Impromptu invitations to breakfast or dinner are much appreciated by parents and re-enforce the family atmosphere of the house which is so important to them”. Our House DS0000025914.V373655.R01.S.doc Version 5.2 Page 16 Three of the tenants voted in the local elections. Information was gathered and read to them, they were then supported to go to the polling station. They will be supported to vote at any future elections if they wish. The weekly menu is varied and chosen by the tenants. Although they usually eat together they are free to eat alone and at a time of their choice. Snacks are available at any time. They are encouraged to eat healthily and fruit and yoghurts are available. One person usually has a vegetarian diet and a different meal is cooked for her when necessary. The expert by experience said, “residents have choices of meals. A menu is in place and they can have alternatives on the day if they so wish. While we were at the home a member of staff offered sandwiches to the residents, but they chose what fillings they wanted. One resident who is able to, went to make a sandwich for herself”. One person’s personal plan says that she does not like hot or spicy food. People said that they enjoyed the food. Our House DS0000025914.V373655.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. People using the service experience excellent quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. People who use the service receive personal care that meets their individual needs and preferences. People are supported to receive their prescribed medication safely and to participate in this as far as they are able. People who use this service are actively supported to receive the medical and health care that they need and to remain as healthy as possible. EVIDENCE: Tenants personal care needs and the support that they need are identified in their personal plans. These also indicate the ways in which people can be supported to be as independent as possible, to make choices and to have privacy and dignity. For example, one person needs to use a bath chair to get into the bath. This person is supported by the staff but is encouraged to work the controls himself. Another person’s support plan states, “ offer me a bath or a shower. At night I like to have a bath. Leave me in the bath for 10 Our House DS0000025914.V373655.R01.S.doc Version 5.2 Page 18 minutes to relax and then support me with personal care”. Support plans also identify skin care needs, e.g. prescribed creams. Tenants choose what time they receive their personal care and which clothes they wish to wear. One personal plan states “put three outfits on my bed and ask me to chose which one to wear”. There is a mixed staff team and people are usually able to have same gender support with personal care. Relatives said, “my daughter is always well groomed”. Residents always look clean and groomed. They are appropriately dressed and are a credit to care and support given by staff. Each person is registered with a local GP practice and receives specialist input as and when required. This includes input from the dietician, physiotherapist and psychologist. They also have a yearly health check prior to their annual review. Tenants are supported to attend appointments. Each persons file contains a record of medical appointments and these show that they have checks from the optician, dentist and when needed the chiropodist. The outcomes of all visits are clearly documented and actioned and show that people’s healthcare needs are closely monitored and that they have regular access to health care professionals. Staff had been concerned about one person and arranged for medical and psychological tests. When nothing conclusive was found they actively pursued the matter and a medical problem has finally been identified and the necessary action taken. Tenants are supported to get the healthcare that they need and to be as healthy as possible. A healthcare professional said, “my experience of working with this house has been very positive. They are a pleasure to work with. The staff have been very conscientious, following guidelines and engaging in discussion about meeting the persons health needs and taking appropriate action.” Another care professional said, “prompt attention if I show any concerns regarding health issues. I am informed of any health issues promptly”. There are policies and procedures for the handling and recording of medication and all staff have received training in the administration of medication. This is updated every two years. Each person’s medication is kept in their rooms in a locked cabinet. The keys to the cabinets are in a locked key cupboard in the office. The tenants are reminded individually that it is time for their medication. They collect the key to their medication cabinet and then staff go with them to their room. The tenant unlocks the cabinet and staff assist them with their medication. The idea of this is to give people an understanding about their medication and to enable them to be as independent as possible even though at present none are able to totally self medicate. During the course of the visit one of the tenants was assisted to apply some cream. He had a laminated sheet of the different creams that he uses and was asked to point to the one that he needed to use. He was then able to select the correct cream and apply it himself. The staff sign the medication administration record. The medication records were all up to date and appropriately kept in line with good practice. There were clear guidelines for any PRN (when required) medication so that staff are clear as to when and how this should be administered. Our House DS0000025914.V373655.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. People living at Blueberry Close are safeguarded by the working practices at the home and by the support of the staff team. EVIDENCE: Each tenant has a copy of the user-friendly complaints procedure in his or her bedroom. It is also displayed in communal areas so family and visitors have access to it. The complaints procedure is always on the agenda at tenants and staff meetings. As the result of a recent service user audit of all of their services RCHL are in the process of producing a complaints video on how to make a complaint with voluntary participation of users of the services. Independent advocates who support people to give their views on services carry out the audit. The expert by experience said, “if residents are not happy about anything they said that they would speak to the staff about this and they would sort things out for them”. There were two recorded complaints last year. Both of these were made by tenants, about the behaviour of other tenants. These were dealt with at the time. There were a number of recorded compliments mainly from the tenant’s relatives and relate to the quality of care and service provided. The expert by experience observed, “the staff are friendly and treat the residents well”. The organisation has produced a detailed adult protection policy that tells staff the actions to take in the event of abuse/suspected abuse being discovered. Our House DS0000025914.V373655.R01.S.doc Version 5.2 Page 20 All staff have attended training on POVA (Protection of Vulnerable Adults), Diversity, Challenging Behaviour and Working Within Boundaries of Good Practice. Staff spoken to were aware of the issues of abuse and aware of their responsibility to the tenants. The complaints made but tenants related to the behaviour of other tenants who at times have exhibited challenging behaviour towards both tenants and staff. These incidents have been appropriately recorded and advice and guidance sought from other professionals. The staff team are using strategies recommended by the psychologist and staff spoken to were concerned about the issues and the effect on other tenants. They were aware of the need for good teamwork and consistent work practice to address this. From minutes of meetings and discussions with the tenants it was evident that they are encouraged to raise any concerns or things that they do not like. They also have contact with relatives and other agencies and can and do share concerns with them. One of the tenants who had complained about another tenant’s behaviour said that they were happy at Blueberry, it was good and there were no problems. The expert by experience said that, “residents feel safe”. Overall, people live in an environment where their safety and well being is monitored and promoted. Each tenant now has a ‘financial passport’. This details their finances, what help they need and what support is required to assist people to be more independent in this area. The tenants have signed the financial passports. A member of staff said, “the financial passports are easy to follow and give good information on how to support people”. Four of the tenants have got bank accounts and they go to the bank with staff to withdraw their cash. The fifth person’ finances are managed by RCHL in a professionals account. Each tenants has a cash tin and these are kept in the safe. Where possible tenants keep the key to their tin. They are usually present when cash is taken from their tin. Records are kept of financial transactions and weekly checks are made. Cash is also checked as part of the monthly monitoring visits made by RCHL. The cash held for three of the tenants was checked at the time of the inspection and were found to be correct. Appropriate receipts were on file. The organisation carries out annual financial audits and a copy of the most recent audit was seen. The audit was comprehensive and had made appropriate good practice recommendations. The manager had started to make some of the required changes and said that the remainder would be made after staff had discussed this at their next team meeting. Therefore systems are in place to ensure that tenants are protected from financial abuse and that their finances are appropriately managed and monitored. Our House DS0000025914.V373655.R01.S.doc Version 5.2 Page 21 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, 29 & 30. People using the service experience excellent quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. People live in a clean and comfortable home that is suitable for their needs. EVIDENCE: Our House was purpose built in 1998 and is a very short distance from local shops, transport and other facilities. It was designed with the support of the parents of the tenants and can be easily adapted should their needs change in the future. It is a bungalow and accessible for wheelchair users. The home has five large bedrooms, two with ensuite showers and toilets. There is a large lounge, a kitchen/dining area, an assisted bathroom, a shower room that is accessible to wheelchair users and a laundry room. Bathing and showering facilities are suitable for the needs of the tenants. The safe enclosed garden is frequently used by the tenants for barbeques, parties and relaxation. The garden is well maintained by the tenants with support from the staff. There are photographs of tenants and their families all around the home. Tenants have been fully involved in all aspects in the choice of décor of their bedrooms Our House DS0000025914.V373655.R01.S.doc Version 5.2 Page 22 and the communal areas. Relatives said, “the house and garden are always in good order with them all being involved. The garden has been used to involve some of them in useful occupation and helps give them a sense of pride in their own home”. In the last year there has been new flooring in the kitchen, a new large flat screen TV, new garden furniture and all communal areas except the lounge have been re –carpeted. It is planned that in the next year a new kitchen will be fitted and that bedrooms will be re-carpeted. The bedrooms rooms are all well decorated and furnished. They have been individually personalised with family photographs, ornaments, music centres and televisions. The expert by experience said, “the home has a large airy lounge where the residents socialise, play board games, watch TV or work on the computer. The garden is accessible and the residents enjoy parties and barbecues in the summer. Residents are involved in the running of the home, decorating their rooms with colours and furniture of their choice”. At the time of the inspection the home was clean and free from offensive odours. The house is very comfortable and homely and suitable for the needs of the people living there. Maintenance issues are identified during health and safety checks. Approved contractors carry out all of the maintenance and each job is given a priority rating. Therefore the building is well maintained and safe. People living at Blueberry Close have their own front door keys and everyone is clear that it is their home and they take pride in it and feel comfortable inviting their friends and relatives to visit and to join them for celebrations. Our House DS0000025914.V373655.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 & 36. People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. People are supported and protected by the recruitment practices of the service. Staffing levels are sufficient, and staff receive the necessary training, in order to meet peoples’ needs. People are supported by a staff team who know them well and who are committed to provide a very good quality service that meets individual needs. EVIDENCE: From the rota and from discussions with staff it was evident that people are supported by a regular staff team that know them well. There are some vacancies due to recent promotions and resignations but these are covered by regular relief staff. There are usually two staff on duty from 7 a.m. to 9 p.m. and then one staff is on duty until 11 p.m. From 11 p.m. to 7 a.m. one member of staff sleeps in. The manager is supernumerary for most of the week but does work at least Our House DS0000025914.V373655.R01.S.doc Version 5.2 Page 24 one shift per week and also sleeps in. Feedback from staff was that there were sufficient staff on duty to meet peoples needs. They also said that there was a good supportive staff team and it was a good place to work. The organisation has a robust recruitment and selection procedure that includes, application forms and interviews. Two references are obtained and POVA (Protection of Vulnerable Adults) and CRB (Criminal Records Bureau) checks are undertaken. People who use the service are involved in interviews. There is only a small staff team and the files of the newest member of staff and one other randomly selected member of staff were inspected. They contained all of the necessary information, including proof of identity. Therefore people are protected by the organisations recruitment procedure. All staff have job descriptions, contracts and staff handbooks and were clear about their roles, responsibilities and duties. They attend an organisational induction programme and also have access to a range of training courses. In 2007 RCHL received a National Training Award in recognition of how their training and development programme has supported organisational success and individual staff development. Records are kept of staff training and show that staff receive the training needed to meet the needs of the people using the service. This includes LDAF (Learning Disabilities Award Framework) or LDQ (Learning Disabilities Qualification. The staff team have all obtained or are working towards NVQ level 3. In addition staff have had training in the Mental Capacity Act, Food hygiene, Autism, Makaton, Fire Safety, Infection Control, Adult Protection and Moving and Handling. Staff said, “training is good. You can raise the topic in supervision and then the training is requested”. Therefore staff receive the training that they need to provide a good service to the people living there. Staff spoken to confirmed are receiving supervision regularly and also that staff meetings are being held regularly. Staff therefore have an opportunity individually and together to discuss issues, concerns and the development of the service. Our House DS0000025914.V373655.R01.S.doc Version 5.2 Page 25 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. People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. People living at Blueberry Close benefit from a service that is very well managed and where their opinions are sought, valued and acted upon. They live in a safe home. EVIDENCE: There has been a new manager in place since April 2008. This was initially an acting up post, as the registered manager was seconded to another service, but has since been confirmed as a permanent appointment. The manager has started the process of registration with the Commission. He has worked at the home for seven years, three of these in a senior capacity. He has NVQ level 3 and is due to start the Registered Managers Award. Our House DS0000025914.V373655.R01.S.doc Version 5.2 Page 26 Feedback from staff was that they are well supported by the manager and that he is approachable and easy to relate to. They also said that the people living at the home, staff and relatives are involved in discussions about the development of the service and that their opinions and ideas are listened to. The home is well managed. The quality of the service provided is monitored by the manager and by the organisation. The service manager carries out monthly monitoring visits to check the quality of the service provided. These indicate the action to be taken if deficiencies are identified. Copies of these reports were available in the home. In addition to this the organisation carries out a quality audit each year and also a financial audit. All of the necessary health and safety checks are carried out and records are kept of these checks. One of the people using the service helps to carry out the checks and has his own health & safety folder. One person told the expert by experience that staff do fire drills. A safe environment is provided. RCHL have held five service user participation days in the last year. These were: ‘The Service User Survey Day’, ‘The Annual Report Day’, ‘The Business Plan Day’, ‘A Speak Up Day’ and ‘A Day on what is Important in Services’. In October 2008 RCHL held a service user consultation day facilitated by independent drama and advocacy consultants. In addition to people giving RCHL their views there was also an opportunity to try activities and have lunch. Therefore people using any of the RCHL services have the opportunity to feedback on services and to help shape future services. A newsletter is published every three months and this contains information about what is happening in the organisation. It also gives information about planned events. The summer edition included a cultural calendar, which gave dates of different festivals and religious occasions. Our House DS0000025914.V373655.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 3 26 4 27 3 28 4 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 4 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 4 3 3 LIFESTYLES Standard No Score 11 4 12 3 13 4 14 4 15 4 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 4 X 3 3 4 X X 3 3 Our House DS0000025914.V373655.R01.S.doc Version 5.2 Page 28 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Our House DS0000025914.V373655.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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