Care Home: Person Centred Care Homes

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What the care home does well Person centred care home lives up to its name. People who live there are treated as individuals. Their needs are comprehensively assessed and care programmes are tailored to their individual needs and are regularly reviewed to take account of changes. The key-worker system at the home ensures that an individualised service is maintained. People benefit from a qualified and experienced manager who is ably supported by a well-trained staff team. The environment in which people live is a pleasant one and they have a good range of activities planned into their daily lives. Relatives spoken with as part of the inspection process expressed their happiness with the care and attention given to people at the home. One quote was " my son is very happy at the home". What has improved since the last inspection? The previous inspection listed one requirement relating to fire precautions which had been met by the time of this inspection. The manager has now successfully completed her registered manager`s award which was a condition of registration. CARE HOME ADULTS 18-65 Person Centred Care Homes 1 Bodiam Close and 3 Pevensey Avenue Enfield Middlesex EN1 3HZ Lead Inspector Stephen Boyd Key Unannounced Inspection 19th April 2007 09:30 Person Centred Care Homes DS0000030409.V336662.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 Person Centred Care Homes DS0000030409.V336662.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. Person Centred Care Homes DS0000030409.V336662.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Person Centred Care Homes Address 1 Bodiam Close and 3 Pevensey Avenue Enfield Middlesex EN1 3HZ 020 8366 7557 020 8366 1377 marianewton@hotmail.co.uk 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) Mr Savvas Michael Mrs Maria Newton Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Person Centred Care Homes DS0000030409.V336662.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Physical Disabilities Restriction That the home may not be used by people with physical disabilities. This is in accordance with Regulation 16 of The Care Home Regulations 2001 and the National Minimum Standards for Care Homes for Younger Adults - Standard 25.4. 15th December 2005 Date of last inspection Brief Description of the Service: Person Centred Care Home is a care home registered to provide residential services to six adults with learning disabilities. The home is located in a quiet residential area close to the shopping and transport facilities of Enfield Town Centre. The provider, Mr Savvas Michael, has another home near Enfield Town Centre. The home has two floors. Most bedrooms, staff sleeping room, bathroom and toilet are situated on the first floor. The ground floor comprises of the kitchen, dining area, lounge. Bedroom with en-suite, activities room, office and two laundry rooms. There is a spacious garden both at the front and the rear of the house. The home specialises in providing support for service users who are on the autistic spectrum and who may have complex behavioural needs. The philosophy of the home is to support service users to achieve individual lifestyles, enhance peoples daily experiences and improve social inclusion. Fees charged at the home range from £1200 - £1800 per week. A copy of this Inspection report can be requested directly from the home or via the CSCI website (web address can be found on page 2 of this report.) Person Centred Care Homes DS0000030409.V336662.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place in one day in April 2007. The inspector was pleased to meet two of the people who live at the home, the registered manager, Mrs Maria Newton, two members of staff and a relative of a resident. A tour of the premises was undertaken and various records and policies were viewed. After the inspection a further relative was contacted to obtain their views. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Person Centred Care Homes DS0000030409.V336662.R01.S.doc Version 5.2 Page 6 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 Person Centred Care Homes DS0000030409.V336662.R01.S.doc Version 5.2 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home have had a comprehensive assessment of their needs carried out, covering all the areas listed in the national minimum standards for younger adults. EVIDENCE: Since the previous inspection in 2005, the home has admitted two new people. Both of these people were seen to have had comprehensive assessments completed regarding a full range of care needs. Although these particular people were out during the course of the inspection, one of their relatives spoken with during the inspection indicated she had been consulted as part of the assessment process. Person Centred Care Homes DS0000030409.V336662.R01.S.doc Version 5.2 Page 8 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People at the home have individual care plans based on their assessed needs. People are enabled to make choices and decisions in their day-to-day lives with assistance from staff as needed. Risk assessment is seen as a tool to enable people to lead as independent lives as possible and is comprehensively carried out in respect of the people living in the home. EVIDENCE: Three files of people living at the home were sampled during the inspection. These were found to have well written care plans, with clear aims and how these could be met. The plans covered identified needs arising from the individual assessments and were clearly subject to regular review with the involvement of people living at the home and significant others. People living at the home have a range of communication issues and the home actively seeks to ensure that people can make choices and decisions, for Person Centred Care Homes DS0000030409.V336662.R01.S.doc Version 5.2 Page 9 example about what food to eat and clothes to wear by having pictorial aids readily available around the home. People have their likes and dislikes recorded as part of their care programmes so that staff are knowledgeable regarding choices a person may prefer. People living at the home have risk assessments completed that were seen to be comprehensive and well written. The assessments cover various risks associated with for example, behaviour outside of the home and had clear strategies as to how the risk could be minimised to the person and others. Person Centred Care Homes DS0000030409.V336662.R01.S.doc Version 5.2 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People at the home benefit from a good range of activities suited to their needs many of which are pursued in the local community. Contact with family and friends is seen as an integral part of peoples’ lives. People living at the home are treated with respect and dignity and responsibilities are encouraged. People benefit from a good food provision. EVIDENCE: People living at the home benefit from participating in a range of activities both within and outside of the home. These include: Arts and crafts, shopping, bowling, swimming, attending day centres and college courses, trips to pubs and cinemas and aromatherapy sessions. There are plans to create a new activities/relaxation room in the grounds of the home which will further enhance the varied social life opportunities of the people. The home has it’s own transport to facilitate people participating in activities they like within the local community. Person Centred Care Homes DS0000030409.V336662.R01.S.doc Version 5.2 Page 11 Most people living at the home have regular contact with their family and friends. Some people go to relatives’ homes for visits and other relatives make visits to the home. A relative spoken with during the inspection said they always felt welcome to visit the home and found staff to be very helpful. Some people attend a gateway social club where they can meet up with friends. People observed at the home during the inspection looked well cared for in terms of their appearance. Staff were seen to address people in a respectful manner and ensuring privacy for people was also an area that staff promoted. People where able are encouraged to take responsibility for housekeeping tasks such as setting the table at mealtimes and hovering and these are built into care programmes. Menus seen at the time of the inspection indicated a good level of choice and variety was present in people’s diets. Cultural preferences were clearly catered for within the menus. Main meals tend to be taken in the evenings to fit around people’s daytime activities. Food stocks were seen to be adequate as were shopping arrangements. Person Centred Care Homes DS0000030409.V336662.R01.S.doc Version 5.2 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People receive personal support in an appropriate manner to their individual needs. Health needs are met as part of a holistic approach to care. The home has an appropriate medication system. EVIDENCE: Care programmes showed how people needed and preferred to be cared for in good detail. For example, with respect to help with personal hygiene. None of the current group of people required any assistance with mobility around the home. Daily care programmes indicated preferences with areas such as when to get up, go to bed etc. The health needs of people were well understood by staff and reflected in record keeping including care plans. Details of appointments with a range of health professionals such as g.p’s, dentists and opticians were seen. People have access to regular visits from a community nurse. One person was seeing a speech and language therapist. Person Centred Care Homes DS0000030409.V336662.R01.S.doc Version 5.2 Page 13 The home operates a monitored dosage system of medication administration. All staff responsible for medication administration had received appropriate training. None of the current people living at the home are able to selfadminister medicines. A consultant visits the home to review what medication people are taking. The system of medication administration was seen during the inspection and was safe and secure. To further enhance the system, it is recommended start dates are recorded for items not in blister packs, to allow for easier auditing. Person Centred Care Homes DS0000030409.V336662.R01.S.doc Version 5.2 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home has good systems in place to respond to concerns, complaints and protection issues regarding the people living there. EVIDENCE: The home was found to have an appropriate complaints policy and procedure. Since the previous inspection the home had responded to three complaints in an appropriate manner. The home also has an appropriate policy and procedure in respect of the protection of vulnerable adults. Staff have received training in understanding and responding to adult abuse situations. The home has a copy of the London Borough of Enfield’s Pova policy and procedure in the home. The home has not been subject to any investigation regarding the protection of vulnerable adults or had to make any referrals since the previous inspection. Person Centred Care Homes DS0000030409.V336662.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a homely environment which is comfortable and clean. EVIDENCE: The home was found to be in a good state of repair during the inspection. Bedrooms and communal areas were found to be well decorated and furnished to a good standard. People were seen to have personalised bedrooms including evidence of pictures, photographs and ornaments. The home was found to be clean and tidy. There were no obvious safety hazards encountered during the inspection. A relative spoken to during the visit indicated the home always appeared pleasant when they visit which was often unannounced. Appropriate laundry facilities for the size of the home were available. Person Centred Care Homes DS0000030409.V336662.R01.S.doc Version 5.2 Page 16 A recommendation to enhance the homeliness of the environment is to remove any unnecessary staff notices and instructions from the home, for example the staff rota being displayed in the lounge. Person Centred Care Homes DS0000030409.V336662.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People living in the home benefit from a good, well qualified and trained staff team. People are protected by the homes’ recruitment system EVIDENCE: The inspector spoke with two members of staff during the inspection in addition to the manager. Staff presented as knowledgeable about individual people and their needs. Staff have undergone a range of training since the last inspection to ensure they can meet needs and keep updated. Training has included courses in autism, challenging behaviour, protection of vulnerable adults, medication and infection control. The home has a total of fifteen care staff and ten of these have achieved national vocational qualifications at level two or above, meaning that the home exceeds the requirement to have at least fifty percent of staff trained to level two or above. The home has appropriate numbers of staff on duty to meet the needs of people. There at least three staff on each morning shift and four or five on afternoon shifts. The manager is supernumery to these numbers. Person Centred Care Homes DS0000030409.V336662.R01.S.doc Version 5.2 Page 18 Recruitment practices were seen to be in place that protect the people living at the home. Staff complete application forms, attend interviews and if successful have written references taken up on them. They undergo criminal records bureau checks and provide photographic identity and medical declarations before commencing employment. Staff files also indicated that written contracts and job descriptions are available to staff as well as a suitable induction process. Person Centred Care Homes DS0000030409.V336662.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run in the interests of the people living there. Quality assurance processes are in place to ensure views of all parties are taken into account. The health, safety and welfare of people at the home needs to be better protected by means of general risk assessments. EVIDENCE: The registered manager, Mrs Newton has been the manager at the home for some years and is experienced in caring for people with a learning disability. She has completed the registered managers award since the previous inspection. Staff spoke well of her capabilities, saying she was very efficient, approachable and supportive. Person Centred Care Homes DS0000030409.V336662.R01.S.doc Version 5.2 Page 20 Recent surveys were seen completed by relatives and others that showed the home was viewed in a positive light. Surveys are conducted regularly and the home act on any areas identified for improvement. Various safety certificates were viewed during the inspection relating to fire, gas and electrical installations and equipment. Regular checks are carried out on fire equipment. Drills, alarm tests and emergency lighting checks take place at appropriate frequency. The home needs to ensure that a water safety check is carried out. Also, general risk assessments for the building need to be undertaken. The manager said a firm had been commissioned to undertake this work shortly. COSSH assessments also need to be developed. No obvious safety hazards were apparent during the inspection and staff had undergone first aid training. Person Centred Care Homes DS0000030409.V336662.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 2 X Person Centred Care Homes DS0000030409.V336662.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA42 Regulation 12(1) (a) Requirement The registered person must ensure that risk assessments for areas of the premises that may present risks to people are completed. COSHH assessments must also be carried out for the home. A water safety certificate should be progressed Timescale for action 15/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2. Refer to Standard YA20 YA24 Good Practice Recommendations To enable easier audit trails for medication to be carried out, it is recommended that start dates of bottles and boxes of medication are recorded To improve the homely appearance of the premises, it is recommended that a few instruction notices for staff are removed from areas used by people. Person Centred Care Homes DS0000030409.V336662.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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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