Care Home: Params The (18)

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What the care home does well All the written and verbal feedback we received from the people who live, work and regularly visit the Params was in the main very positive. Typical comments included - `I like living at the Params... i want to stay`, `i don`t want to move anywhere... this is my home`, `this is a good place to work... i think the people who live here are happy`, and `I`ve always been made to feel welcome every time i visit the Params`. During this two day inspection we observed numerous examples of staff actively encouraging and supporting people who use the servcie to do more things for themselves where they were willing and able to do so. E.g. We saw people who use the service making hot drinks in the kitchen, doing their own laundry, and travelling independently to and from community based activities. We also saw staff interacting with the people who use the servcie in a very kind, respectful, and professional manner at all times. Finally, the atmosphere in the home remained very relaxed and pleasant throughout this two day inspection. The Params felt like a very homely place to live. What has improved since the last inspection? The service has recognised and address all the shortfalls we identified in its last inspection report within the agreed timescales for action: As required last time all the people who use the servcie have been provided with all the information they need to know about the Params in its Guide; Staff have access to more detailed protocols to help them administer `as required` PRN medication in line with best practise guidelines and individually agreed prescriptions; Satisfactory preemployment checks are always obtained in respect of all new recruits; Sufficient numbers of staff have achieved a National Vocational Qualification in care (level 2 or above), and up dated their infection control training; and the results of the homes annual stakeholder satisfaction surveys are now published and made available to all on request. Other improvements made by the service since the last inspection include some environmental ones. e.g. New carpets have been fitted in the lounge, computers bought to enable the people who use the service to get more involved in how their home is run, and a new shower unit installed on the first floor. Staffing levels have also recently been reviewed and increased to reflect the changing needs of the people who use the service. The duty rotas are also a lot more flexible to fit around the lifestyles of the people who use the service. Finally, individual staff supervision sessions and peer group meetings now take place at more regular intervals. All the staff met told us they find these forums useful places to share good practise and develop their knowledge and skills. What the care home could do better: All the positive comments made above notwithstanding their remains a number of areas of practise where further improvement is required in order to enhance the lives of the people who use the service: The service should develop easy read versions of its Guide to enable all the people wholive at the home to know what services and facilities are available to them. This good practise recommendation was made in the services last inspection report, but was not fully implemented. The service needs to establish more detailed risk management strategies to deal with unplanned absences of service users and behaviours that challenge. The views of all the relevant health and social care professionals need to be taken into account when agreeing these challenging behaviour guidelines. This will ensure staff have all the information they need t deal with unplanned absences and behaviours that challenge in the most effective and consistent way possible as agreed by all the relevant professionals involved. When staff give out as required medication they should record the rationale for its use on the back of medication administration record sheets. This will enable anyone authorised to inspect these records to determine whether or not as required medication is being appropriately administered in line with agreed protocols for its use and best practise guidelines. We must be notified without delay about the occurrence of any significant incident, accident or event that adversely affects the health and welfare of the people who use the service. These notifications will enable us to determine whether or not staff have dealt with a signfcient incident or event appropriately and the home is still able to keep the people who use th service safe. The way in which the service records specifc challenging behaviour guidelines and any limitations agreed with service users and their representatives as to their freedom of movement and choice should be reviewed as risk management strategies currently in place lack detail. We recommend the providers should establish a time specifc action plan setting out when and how they intend to replace and/or upgrade the kitchen. This will ensure the people who use the servcie have a well equipped and homely kitchen where staff can support them to make their own meals and drinks. All staff must refresh their moving and handling training. This will ensure the people who use the servcie who have mobility needs are moved and transfered safety in the way they wish. Sufficient numbers of the homes staff team should receive specialist training in working with adults with dementia, mental ill health and autism. This will ensure have the necessary knowledge and skills to meet the needs of all the people they support. The fire risk assessment for the building should be reviewed on an annual basis and up dated accordingly. This will ensure this document accurately reflects all the changes that may have occurred in the previous 12 monhts which will help staff keep the people who use the service safe. Finally, the way in which the service manages fire drills and fire safety instruction for its staff should be reviewed to ensure night staff receive this at least once a quarterand day staff on a bi-annual basis. This will ensure all staff who work at the home have the knowledge and skills to keep the people who use the service safe and will bring the homes procedures in line with the local fire authorities (LFEPA) `best practise` fire safety guidance. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Params The (18) 18 Foxley Lane Purley Surrey CR8 3ED     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: Lee Willis     Date: 2 2 0 7 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 38 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.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 38 Information about the care home Name of care home: Address: Params The (18) 18 Foxley Lane Purley Surrey CR8 3ED 02086607747 02087638615 sivakparam@hotmail.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) : Mrs Isabel Parameswaran,Mr Siva Kandaswami Parameswaran care home 13 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 13 The maximum number of service users who can be accommodated is: 13 The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Date of last inspection Brief description of the care home The Params is a privately run residential care home that provides accommodation and personal support for up to 13 generally older adults with moderate learning disabilities. The service continues to be co-owned by Mr and Mrs Parameswaran. Mrs Parameswaran remains the services registered manager and continues to be in overall charge of the home along with her husband, although they both share the responsibility of the day to day running of the Params with two suitably qualified and competent deputy managers. This detached Victorian property is perched on a hill in a residential suburb of Purley and is approached by climbing a steep set of winding steps. The home is within ten Care Homes for Adults (18-65 years) Page 4 of 38 Brief description of the care home minutes walk of the centre of town, which is well served by a wide variety of local shops, cafes, restaurants, take-always, pubs, and banks. The home is also on a main line bus route and less than fifteen minutes walk away from a local train station with good links to central Croydon and London. The home comprises of thirteen single occupancy bedrooms, a large entrance hall, main lounge, separate dinning room, conservatory, kitchen, laundry room, office, and top floor games room. The sloping gardens at both the front and rear of the property are well maintained. Service users have all been offered copies of the homes Statement Of Purpose, Residents Guide, and Occupancy Agreements. These documents specify information about services and facilities provided and fees charged, which currently stand between two and a half to four and a half thousand pounds a month per placemnt. Care Homes for Adults (18-65 years) Page 5 of 38 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: From all the available evidence gathered as part of this key inspection we still rate the Params as a two star good performing service with the people who live there experiencing good quality outcomes. The service has significantly more strengths than areas of weakness, and no issues were identified in respect of the way it is managed. We spent five hours at the home spread over two days. During these site visits we met well over half the people who use the service, the co-owners/managers, a deputy manager responsible for tis day to day running, and four support workers. We also looked at records and working documents, including care and health action plans for four people who use the service. The remainder of these visits was spent touring the premises. Care Homes for Adults (18-65 years) Page 6 of 38 We received fifteen of our have your say comment cards about the home - ten of which came from the people who use the service (some with help from a relative or their keyworker, four from staff who work there, and one from a health care professional who regularly visits the Params. As part of the inspection process the services co-owner/manager also completed and returned our Annual Quality Assurance Assessment (AQAA), which tells us how they make sure of good outcomes for the people who live at the home, and any future developments they are planning. What the care home does well: What has improved since the last inspection? What they could do better: All the positive comments made above notwithstanding their remains a number of areas of practise where further improvement is required in order to enhance the lives of the people who use the service: The service should develop easy read versions of its Guide to enable all the people who Care Homes for Adults (18-65 years) Page 8 of 38 live at the home to know what services and facilities are available to them. This good practise recommendation was made in the services last inspection report, but was not fully implemented. The service needs to establish more detailed risk management strategies to deal with unplanned absences of service users and behaviours that challenge. The views of all the relevant health and social care professionals need to be taken into account when agreeing these challenging behaviour guidelines. This will ensure staff have all the information they need t deal with unplanned absences and behaviours that challenge in the most effective and consistent way possible as agreed by all the relevant professionals involved. When staff give out as required medication they should record the rationale for its use on the back of medication administration record sheets. This will enable anyone authorised to inspect these records to determine whether or not as required medication is being appropriately administered in line with agreed protocols for its use and best practise guidelines. We must be notified without delay about the occurrence of any significant incident, accident or event that adversely affects the health and welfare of the people who use the service. These notifications will enable us to determine whether or not staff have dealt with a signfcient incident or event appropriately and the home is still able to keep the people who use th service safe. The way in which the service records specifc challenging behaviour guidelines and any limitations agreed with service users and their representatives as to their freedom of movement and choice should be reviewed as risk management strategies currently in place lack detail. We recommend the providers should establish a time specifc action plan setting out when and how they intend to replace and/or upgrade the kitchen. This will ensure the people who use the servcie have a well equipped and homely kitchen where staff can support them to make their own meals and drinks. All staff must refresh their moving and handling training. This will ensure the people who use the servcie who have mobility needs are moved and transfered safety in the way they wish. Sufficient numbers of the homes staff team should receive specialist training in working with adults with dementia, mental ill health and autism. This will ensure have the necessary knowledge and skills to meet the needs of all the people they support. The fire risk assessment for the building should be reviewed on an annual basis and up dated accordingly. This will ensure this document accurately reflects all the changes that may have occurred in the previous 12 monhts which will help staff keep the people who use the service safe. Finally, the way in which the service manages fire drills and fire safety instruction for its staff should be reviewed to ensure night staff receive this at least once a quarter Care Homes for Adults (18-65 years) Page 9 of 38 and day staff on a bi-annual basis. This will ensure all staff who work at the home have the knowledge and skills to keep the people who use the service safe and will bring the homes procedures in line with the local fire authorities (LFEPA) best practise fire safety guidance. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 38 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 11 of 38 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 service makes information about what services and facilities it has to offer to all its stakeholders, although its Guide should be made available in more easy to read versions to enable prospective new service users to make informed decisions about whether or not the service is right for them. The impact any new referral would have on the people already living at the home is always taken into account when assessing the suitability of a prospective new admission. Evidence: As required in the services last two inspection reports the relatively new deputy manager has reviewed the homes Guide and up dated to reflect the views of the people who use the service, support worker qualifications and what arrangements are in place for managing the home on a daily basis. However, despite it being recommended in the services last report, the amended version of the Guide is still not available in a particularly easy to read format, which all the people who use the service Care Homes for Adults (18-65 years) Page 12 of 38 Evidence: can understand. The deputy manager the service continues to be fully occupied and therefore they have not accepted any new referrals since his appointment. Nonetheless the deputy demonstrated a good understanding of what constituted best practise regarding new admissions and was very clear that she would not accept any new referrals without first considering the impact this would have on the people who have resided at the Params for many years. Care Homes for Adults (18-65 years) Page 13 of 38 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes approach to care planning is person centred and focuses on individuals unique strengths and personal preferences. The service also has a can do attitude with regard the people who use the service taking responsible risks in order for them to maintain and develop their independent living skills and to live the life they want. However, guidelines on dealing with behaviours that challenge and unplanned absences need to be improved to enable staff to have more information about how to prevent and/or minimise the risks associated with them in order to keep the service users safe. The service has good arrangements in place to enable the pope who use the service to express their views and participate in the day to day running of their home. Evidence: 75 of the staff who returned our surveys told us they were always given up to date Care Homes for Adults (18-65 years) Page 14 of 38 Evidence: information in care plans about the needs of the people they support, although one person wrote that this was usually the case. Two members of staff also told us that staff hand-overs at the end of each shift were very useful ways of keeping up to date with the service users current needs. A health care professional who returned our survey also told us the home was good a supporting individuals who use the service to live the life they chose and always took into account the diverse ethnicity, age, disability, gender, faith and sexual orientation of the current service user group. The three care plans we looked at in depth were person centred and set out in great detail how these individuals current personal, social, and health care needs were being met through positive interventions, and what their unique strengths and preferences were. Care plans viewed were all illustrated with pictures, symbols and photographs to make them easier to read. Several service users met told us they liked the new look care plans, were fully involved in helping staff to develop them , and were always invited to their care plan review meetings. All three care plans being case tracked had been reviewed in the past six months with all the relevant parties, including the service user, and up date accordingly to reflect any changes in need. We were made aware in the AQAA that a number of the people who use the service have communication difficulties. We viewed the care plan for one of these individuals which contained detailed information about this service users preferred method of communication and how staff should interact with them. Staff met demonstrated a good understanding of this individuals communication needs and the aids they were expected to use to enable to them to communicate more effectively with them. All the service users we met told us they had a keyworker. All knew who their keyworker was, and said they got on well with them. A support worker met demonstrated s good understanding of what their keyworker role and responsibilities were. Documentary evidence in the form of minutes were produced on request that showed us service users meetings are being held on a monthly basis. During this visit we met the two service users who always Chair and write up the minutes of these peer group meetings who told us they were always well attended by the vast majority of the people who currently use the service. Other service users we met told us they liked going to these meetings because it gave them a chance to help plan the food menus and choose what activities they did. The deputy manager told us he is committed to actively encouraging and support the Care Homes for Adults (18-65 years) Page 15 of 38 Evidence: people who use the service to do as much for themselves as individuals are willing and capable of doing so. During the course of this inspection two people who use the service were observed helping themselves to drinks in the kitchen, another was seen vacuuming, and another doing their laundry. The deputy also told us another individual now has their own personal computer which they now use to write their own correspondence and plan their travel arrangements. All three care plans viewed referred to the household chores they had each agreed to participate in each week in order to maintain and develop their independent living skills. The plans also contained comprehensive sets of assessments and management strategies that detailed the action staff should take to minimise any identified risks associated with every aspect of the services users lives. Documentary evidence was produced on request which detailed the occurrence of several significant incidents, including a number of unplanned absences, involving the same service user in the past 12 months. It was evident from the comments made by the services management team, and other staff that this individuals needs have significantly altered in this time. It was therefore positively noted that the service had been very proactive in seeking advice and input from all the relevant community based health and social care professionals to enable the hoe to continue meeting this individuals increasingly challenging behaviours. However, although guidelines are in place to help staff deal with the increased risk of unplanned absences and behaviours that challenge the service in respect of this individual they need to be made more specific, especially with regards the management strategies all the relevant professionals involved have agreed should be implemented to keep this person safe. Care Homes for Adults (18-65 years) Page 16 of 38 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 excellent 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 the service have excellent opportunities to participate in a wide variety of stimulating and meaningful leisure, educational and vocational activities of their choosing, which reflects their social interests. Dietary needs and preferences are well catered ensuring the people who use the service are provided with daily variation, choice, and far more nutritionally wellbalanced meals that meets people specific food preferences. Evidence: 80 of the people who use the service who returned our surveys told us they could always make decisions about what they did during the day, evenings and weekends. The rest wrote this was usually or only sometimes the case. Typical comments made Care Homes for Adults (18-65 years) Page 17 of 38 Evidence: by the people who use the service regarding activities included its my life - i do what i want, i go to the bank, church, shopping , and visit my family, i am fully independent and my schedule is very busy. On arrival we noted that most of the people who use the service were out engaging in various pre-planned community based activities. Furthermore, a lot of the staff who feedback to us about the home often referred to the service being good at ensuring the people who used it had lots of opportunities to get involved in interesting social activities, household tasks, attend college course, and in some cases work. During this visit we observed on two separate occasions people who use the service preparing themselves hot drinks in the kitchen, someone else bring their dirty laundry down from their bedroom to be cleaned, and several others engaging in an art session in the dinning room. Care plans examined in depth each contained weekly activity schedules, which appeared to reflect these individuals unique social interests, educational and vocational aspirations, and all the household chores they had each agreed to do participate in on a regular basis. Staff entries made in service users daily diary notes provided us with additional evidence that showed us the people who use the service life interesting social, educational and vocational lives. The deputy manager told us that based on an assessment of peoples willingness and capacity to have their own bedroom and front door keys 40 have taken up this opportunity. During a tour of the kitchen we noted it was well stocked with a wide variety of nutritional well balanced food stuffs. All the written and verbal feedback we received from half a dozen or so people who use the service about the standard of the food they were provided was very positive. Typical comments included - the food is good here... you can choose what you have, food is always on time, and i help staff plan the menus. We observed a member of staff preparing meatballs for lunch on the first day of this inspection, which one of the meal choices reflected on the planned menu for that day. We also overheard an individual who uses the ask to have fish instead of meatballs for their lunch, which the member of staff preparing lunch that day catered for. Staff appropriately maintain up to date records of all the food and drink the people who use the service consume each day. This record showed us the meals provided reflect the food preferences and tastes of the people who use the service, as identified in care plans. For instance, the record revealed that roast dinners were always served on a Sunday and a curried dish prepared every now and again, which is what a couple of people who use the service told us they liked to eat every week. The deputy manager told us menus are changed on a regular basis and as recommended in the last report Care Homes for Adults (18-65 years) Page 18 of 38 Evidence: all the people who use the service are actively encouraged and supported by staff to plan the weekly menus. Care Homes for Adults (18-65 years) Page 19 of 38 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. Suitably robust arrangements are in place to ensure the people who use the service receive personal support in the way they prefer and require. The service also has excellent arrangements in place for seeking the advice and support of community based health care professionals as and when required. This ensures all the physical and emotional health care needs of the people who use the service are continually recognised and met. Policies and procedures for handling medication are in the main sufficiently robust to keep the people who use the service safe, although there is room to improve the way staff authorised to handle medication on behalf of the service users record the rationale for administering as required PRN medication. Evidence: All the service users we met during the course of this two day inspection were suitably dressed for the time of year in well kept clothing that reflected these individuals ages and genders. Care Homes for Adults (18-65 years) Page 20 of 38 Evidence: The one health care professional who returned our survey told us this care service always seeks advice and acts upon it to meet and improve individuals health care needs, and always respects individuals privacy and dignity. Health care action plans examined in depth contained up to date information about each service users health care needs, the support they required to remain healthy and the outcomes of all the appointments they had attended with various health care professionals. It was clear from entries made in these action plans that the service is continually seeking input and advice from all the relevant community based health care professionals to meet the physical and emotional health Care needs of the service users. Professionals contacted in the past six monhts included a community psychiatric nurse and a challenging behaviour management specialist, dietitian, speech therapist, a Deprivation of Liberties assessor, and GP. A health care action plan examined in depth showed us that one individual is supported by staff to attend a local memory clinic once a quarter where their dementia is monitored and checked by the relevant professionals. The deputy manager produced a moving and handling assessment on request which set out in detail how staff should support one individual to be transfered and moved in they way they preferred and required. Documentary evidence was also produced that showed us sufficient numbers of staff had been suitably trained in the correct use of this individuals external stair climber. No recording errors were noted on any of the medication administration records (MAR) sheets currently in use at the home. These records accurately reflected current stocks of medication held in the home on behalf of the people who use the service. The deputy manager told us all the staff who are authorised to handle medication in the home on behalf of the people whom live their have received up to date training in the safe handling of medication in a residential care setting. The deputy also told us staff carry out a weekly audit of the hokes medication handling practises, which he produced a record of on request. As required in the services last report clear instructions for staff to follow regarding the use of as required PRN medication was made available on request. Staff spoken with about medication handling practises in the home demonstrated a good understanding of when and how to administer as required medication. However, although staff who had administered as required medication in the past six months had signed the appropriate medication records when this type of medication was given they had sometimes failed to record the rationale for its use on the back of MAR sheets. Care Homes for Adults (18-65 years) Page 21 of 38 Evidence: The health care professional who returned our survey told us that in line with best practise the service supports individuals to administer their own medication or manages it correctly where this is not possible. Care Homes for Adults (18-65 years) Page 22 of 38 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 homes arrangements for dealing with concerns and/or complaints made by stakeholders are sufficiently robust and understood by staff to ensure people who use the service feel listened too and safe. Furthermore, the services arrangements for ensuring the people who use the service are protected and kept safe are in the main sufficiently robust. However, the way in which the service records specific managing challenging behavioural guidelines and any limitations agreed with services users and their representatives as to their freedom of movement and choice need to be improved. How the service intends to review , monitor and ensure staff have the right knowledge and skills to implement these agreed risk management strategies also needs to be made clearer. Finally, the way in which the home keeps us informed about the occurrence of significant incidents and/or events involving the people who use the service must be improved. We need to be notified without delay about any incident which adversely affects the health and or welfare of the service users in order to determine whether or not it was appropriately managed. Evidence: 100 of the service users who returned our surveys told us they knew who to speak to if they were unhappy and how to make a complaint if they needed. A lot of the Care Homes for Adults (18-65 years) Page 23 of 38 Evidence: written feedback we received referred to the homes complaints book and telling staff. typical comments included , i write in the complaints book,i talk to my relative or Isabella (homes co-owner/manager), and i will speak to my keyworker first then the manager, who will help me. The health care professional who returned our survey wrote the service always responds appropriately if you or the person using the service raises concerns about their care. 100 of staff who returned our surveys told us they knew what to do if a service user, relative, advocate or friend has concerns about the home. Staff also maintain a detailed record of all the concerns and complaints made by stakeholders and any action taken to resolve them. The deputy manager told us that as stated in the services AQAA all four of the complaints made about the home operation in the past year were successfully and promptly resolved to the complainants satisfaction within 28 days. The deputy manager was able to produce appropriately maintained records of all the significant incidents and accidents involving the service users that according to the homes AQAA had occurred in the past year. These record revealed the nature of these accidents and incidents and showed us that staff involved at the time had dealt with them in a very prompt and professional manner. However, we were not notified about the occurrence of these significant events. Registered care services have a duty of care to keep us informed without delay about the occurrence of any significant incident, accident or event which adversely affects the health and welfare of service users. A number of the significant incidents that had occurred since the service was last inspected involved the same individual. It was evident from the comments made by the deputy manager and other staff met that this individuals increasingly challenging behaviour is being appropriately managed through the use of non physical intervention techniques to limit this individuals freedom to make decisions and freedom of movement when it is deemed in their best interests to do so. This individuals care plan did contain some specific guidance to help staff deal with behaviours that are increasingly challenging the service, but they lack detail. Behavioural risk management assessments must be developed with the service user, their representatives and all the relevant professionals which clearly set out any agreed limitations and other actions that staff should take in order to keep this person safe. How the service intends to continually monitor, review, and ensure staff have all the knowledge and skills to implement these behavioural management guidelines must also be made clear. The one safeguarding referral made to the local authority about this service since its last inspection was not upheld following a thorough investigation by the council. The service cooperated fully with the process in line with the local authorities safeguarding Care Homes for Adults (18-65 years) Page 24 of 38 Evidence: protocols and took on board the case conference recommendations that staff be reminded of their responsibilities to always follow agreed guidelines as stated in individuals service users care plans. The deputy manager and other staff met were all very clear that they should always pass ion any information they may have if they have witnessed, suspect or have been notified that anyone who uses the service is being abused. Staff met demonstrated a good understanding of what constitute abuse in a residential care setting and it was positively noted that also as agreed at the last safeguarding meeting the service was involved with 100 of staff have refreshed their safeguarding training through the Local Authorities E-Learning programme. Care Homes for Adults (18-65 years) Page 25 of 38 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 interior decoration of the home, including its fixtures, and fittings, are relatively well maintained ensuring the people who use the service live in a homely and comfortable environment. The homes arrangements for controlling infection are sufficiently robust to ensure the people who use the service also live in a very clean and safe environment. Evidence: Since the last inspection there service has laid a new carpet in the lounge, installed in new dish washer in the kitchen, and fitted a new shower unit on the first floor. All the bedrooms viewed were extremely personalised and decorated in all manner of pictures, posters, and photographs that seemed to reflect the individual tastes and styles of the people who occupied ed these bedrooms. Some of the cupboards, worktops and equipment in the kitchen look quite old and rather worn. We recommend the providers establish a time specifc action plan setting how when they intend to upgrade this area of the home. During a tour of the premises it was noted that all the communal areas were spotlessly clean. 100 of the people who use the service told us their home was always kept Care Homes for Adults (18-65 years) Page 26 of 38 Evidence: fresh and no offensive odours were noted during our tour of the building. The homes AQAA states that it has an infection control policy and that as required in its last report the vast majority of the staff team have now received infection control training. Care Homes for Adults (18-65 years) Page 27 of 38 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The servcie has increased its staffing levels and made them more flexible to meet the needs and wishes of all the people who live at the Params. Consequently, the people who use the service are kept safe and in the main receive the support they require as there are enough suitably experienced and competent staff on duty at all times. However, the homes arrangements for ensuring staff continue to up date their existing knowledge and skills at regular intervals and receive all the right specialist training to meet the needs of the pople who use the servcie must be improved. Nonetheless, the homes arrangements for ensuring all the staff that work there get the right supervision and support they require to perform their duties of care effectively and meet the needs of the pople who use the service has significantly improved since the last inspection. Evidence: 90 of the service users who returned our surveys told us staff always treated them well and listened and acted upon what they said, while one person said that this was only sometimes the case. Typical comments made by service users about staff were in the main very positive. i love all the staff here, all the staff are kind and helpful, and Care Homes for Adults (18-65 years) Page 28 of 38 Evidence: staff are good. All the staff we observed during this two day inspection interacted with the pople who use the service in a very kind, respectful and professional manner. During the first day of this inspection we noted four staff, including the manager, were all working an early shift, which was reflected in that mornings duty roster. The deputy manager told us that at least three staff always worked during the day, a fourth now worked in the afternoon to meet one services users increasingly challenging behaviour, and a fifth was sometimes employed to ensure service users social needs and wishes were met. At night the servcie continues to employ one waking and one sleep-in member of staff. Most of the staff who returned our surveys told us there were always enough staff on duty to meet the needs of all the people who use the service. The deputy was able to produce up to date Criminal Bureau Records (CRB) and Protection Of Vulnerable Adults (POVA) First checks on request in respect of the homes two most recently recruited members of staff. The deputy told us that as stated in the AQAA satisfactory pre-employment checks are carried out on all new staff before they are allowed to commence working at the Params. 100 of staff who completed our surveys also told us their employer had carried out Criminal Record Bureau and reference checks on them before they started working there. Where applicable the hoe had also obtained Home office approved work permits for those staff who were foreign Nationals. Deputy told us the home currently has no vacancies and continues to experience low rates of staff turnover. The health care professional who returned our survey told us the staff have the right skills and experience to support the individuals social and health care needs, and 75 of staff wrote the training they were given was relevant to their role, help them understand and meet the service users needs and keep them up to date with new ways of working. Furthermore, most staff who completed our surveys told us their induction covered everything they needed to know about their job very well. As recommended in the services last report the deputy manager was able to produce documentary evidence on request that showed us 90 per cent of the homes permanent staff team had new achieved a National Vocational Qualification in care Level 2 or above. According to the recent assessment carried out the deputy manager in respect of his staff teams training needs and strengths the vast majority of received up to date training in fire safety, first aid, food hygiene, safeguarding, safe handling of medication, infection control, person centred care planning, staff supervision, dignified continence promotion and using the stair climber. However, a lot of the staff team have not refreshed their moving and handling training for over three years and we also recommended sufficient numbers of staff attend specialist courses in understanding dementia, mental ill health and autism. 75 of staff who completed our surveys told us their manager regularly meets with them to give them support and to discuss how they are working. The deputy manager Care Homes for Adults (18-65 years) Page 29 of 38 Evidence: told us he shares the responsibility of supervising staff with his co-deputy. Staff records sampled at random for the past six monhts revealed staff were receiving at least one formal supervision session with one of the homes deputy managers every two months. A member of staff who returned out survey wrote - we have monthly staff meetings. Minutes of the last six staff meetings revealed that they are routinely held on a monthly basis and are well attended by all staff. Staff met told us these peer group meetings are useful forums for discussing servcie users changing needs and good practise ideas. We commend the servcie for its much improved staff supervision and peer group support arrangements. Care Homes for Adults (18-65 years) Page 30 of 38 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 home is well run by suitably experienced and qualified managers who are in day to day control of the Params. Sufficiently robust quality assurance and monitoring systems are in place that allows the views of the people who use the service to influence homes operation and development. The people who live and work at the home are kept safe because it has sufficiently robust health and safety arrangements in place, although it could improve some of its fire safety plans by up dating its fire risk assessment of the building and ensuring fire drills are carried out at more regular intervals. Evidence: The relatively new deputy manager told us he shares the responsibility of the day to day running of the home with a co deputy, and the overall management of the service Care Homes for Adults (18-65 years) Page 31 of 38 Evidence: with the registered owner/manager, Mrs Isabella Params, and her co owner husband, Mr Params. The deputy manager we met told us these unique managerial arrangements work well because there is always someone on hand to offer him advice and support. The deputy manager told us as required in the homes last report he is about to complete his National Vocational Qualification in management and care level 4 and that his co-deputy has already achieved this award. The deputy told us he regular has one to one supervisions with the homes owner and/or manager. As required in the last inspection report the home has improved its arrangements for ascertain the views of the people who use the service and their relatives about the standard of care provided at the Params. The deputy manager was able to produce an annual report which was published in 2008 that showed the results of all the stakeholder satisfaction surveys they had carried out in the previous 12 monhts. The written feedback the home had received from service users and relatives was in the main very positive about the standard of servcie provided. The deputy manager was able to produce a fire risk assessment for the building on request. We recommend the assessment is reviewed to reflect all the changes that may have occurred since the document was last up dated over a year and a half ago. Fire records revealed that staff continue to carry out weekly tests of the homes fire alarm system and that all staff, including night staff, participate in fire drills at regular intervals. Records revealed that although fire drills are being carried out approximately once every six monhts the home sometimes goes over this recommended good practise time frame. e recommend the home review the way it organises fire drills and instructs its staff team about fire safety matters to ensure this happens at least once every six months. We suggest this is done on a quarterly basis to minimise the risk of any new, temporary and/or night staff missing out on a six monthly fire drill practise. Up to date Certificate of worthiness were made available on request to show that suitably qualified professionals had checked the homes gas installations, electrical circuits, water heating systems (legionella), fire extinguishers and alarms, portable electrical appliances, and stair climber in line current legislation and the manufacturers guidelines. During a tour of the kitchen it was noted that all items of food kept there were correctly stored in line with basic food hygiene, including items taken out of their original packaging, which were correctly labelled and dated. The temperature of hot water emanating from a bath on the first floor nearest the quite area was found to be a safe 41 degrees Celsius when we tested it at 1.30pm. Care Homes for Adults (18-65 years) Page 32 of 38 Care Homes for Adults (18-65 years) Page 33 of 38 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 34 of 38 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 1 9 13 The service needs to 01/10/2009 establish more detailed risk management strategies to deal with unplanned absences of service users and behaviours that challenge. The views of all the relevant health and social care professionals need to be taken into account when agreeing these challenging behaviour guidelines. This will ensure staff have all the information they need t deal with unplanned absences and behaviours that challenge in the most effective and consistent way possible as agreed by all the relevant professionals involved. We must be notified without delay about the occurrence of any significant incident, accident or event that adversely affects the health 01/10/2009 2 23 37 Care Homes for Adults (18-65 years) Page 35 of 38 and welafe of the pople who use the service. These notifications will enable us to determine whether or not staff have dealt with a signfcient incidetn or evetn appropriately and the home is still able to keep the people who use the servcie safe. 3 35 13 All staff must refresh their 01/11/2009 moving and handling training. This will ensure the people who use the servcie who have mobility needs are moved and transfered safety in the way they wish. 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 1 The service should develop easy read versions of its Guide to enable all the people who live at the home to know what services and facilities are available to them. This good practise recommendation was made in the services last inspection report, but was not fully implemented. When staff give out as required medication they should record the rationale for its use on the back of medication administration record sheets. This will enable anyone authorised to inspect these records to determine whether or not as required medication is being appropriately administered in line with agreed protocols for its use and best practise guidelines. The way in which the servcie records specifc challenging behaviour guidelines and any limitations agreed with service users and their representatives as to their freedom of movement and choice should be reviewed as risk 2 20 3 23 Care Homes for Adults (18-65 years) Page 36 of 38 management strategies currently in place lack detail. This improvement will ensure staff have all the knowledge and skills they need to effectively deal with incidents that challenge the service in a way that respects the rights of the people who use the service. 4 24 We recommend the providers should establish a time specifc action plan setting out when and how they intend to replace and/or upgrade all the shabby looking cupboards, worktops and equipment (i.e. the fridge/freezer) in the kitchen. This will ensure the people who use the servcie have a well equipped and homely kitchen where staff can support them to make their own meals and drinks. Sufficient numbers of the homes staff team should receive specialist training in working with adults with dementia, mental ill health and autism. This will ensure have the necessary knowledge and skills to meet the needs of all the people they support. The fire risk assessment for the building should be reviewed on an annual basis and up dated accordingly. This will ensure this document accurately reflects all the changes that may have occurred in the previous 12 monhts which will help staff keep the people who use the service safe. The way in which the service manages fire drills and fire safety instruction for its staff should be reviewed to ensure night staff receive this at least once a quarter and day staff on a bi-annual basis. This will ensure all staff who work at the home have the knowledge and skills to keep the people who use the service safe and will bring the homes procedures in line with the local fire authorities (LFEPA) best practise fire safety guidance. 5 35 6 42 7 42 Care Homes for Adults (18-65 years) Page 37 of 38 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.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. 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