Care Home: Person Centred Care Homes

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What the care home does well The house is small and homely and has special equipment to help the residents who use wheelchairs to live an ordinary life. There are good assessments and good care plans that help the staff to understand each person`s needs and wishes. There are risk assessments to help keep people safe and to help them be as independent as they can. Because of people`s needs, finding ways of helping them to communicate is important and the staff get to know the ways each resident tells people what they like and don`t like. There is a good relationship between staff and residents and the staff help residents to make as many choices as they can. The staff help residents to see and keep in touch with their friends and families. Residents can do the activities that they like to do, like going to the day centre, going out for lunch, to the cinema and bowling. The home has a special bus for people who use wheelchairs so they can go out on trips. The staff make sure that residents` can see people about their health, like their doctor, dentist, and speech therapist and the staff help residents to go to their hospital appointments. The staff also make sure residents get the food that they like to eat and help with their special diets. The residents seem relaxed and comfortable living in their home and the staff who spoke to the inspector were person centred in their approach. What has improved since the last inspection? Another minibus has been bought so people can get out more. The manager and staff are always looking for more activities that the residents might like and the residents who use wheelchairs can go to. The activities that residents go to are getting better. They are having regular aromatherapy and massage sessions at home and are trying trampoline sessions and a new art session locally. Some staff have had training in food hygiene. What the care home could do better: Although the care plans are good, they could be made easier for people to understand and be involved in by using pictures and large print. The risk assessments for residents could be made better by having more information about what is already being done, and what the staff need to do to make the resident safer. It would be better for 2 residents if they had someone to go to the home every year to look at their money and what they have spent. Although the house is nicely decorated, the carpet and flooring in that hall and on the stairs and landings need to be replaced. The home should get advice from an occupational therapist about the best way to get 1 person`s special bed checked for how safe it is. Because some residents have other disabilities it is a good idea for staff to be given training about sensory impairment. CARE HOME ADULTS 18-65 Person Centred Care Homes 24 Little Park Gardens Enfield Middlesex EN2 6PG Lead Inspector Caroline Mitchell Announced Inspection 25th January 2008 09:00 Person Centred Care Homes DS0000058138.V354566.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 DS0000058138.V354566.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 DS0000058138.V354566.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Person Centred Care Homes Address 24 Little Park Gardens Enfield Middlesex EN2 6PG 020 8363 5398 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) marianewton@hotmail.co.uk Savvas Michael Mrs Maria Newton Care Home 4 Category(ies) of Learning disability (4), Physical disability (4) registration, with number of places Person Centred Care Homes DS0000058138.V354566.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home will have a full time deputy manager who will be available when the manager is not present in the home. The management of the home will be reviewed in six months time from the date of registration. The owner and the manager must be aware that, if by that time, the inspector finds that the care home is less than satisfactory, an application for an independent manager will have to be made. The four service users being provided for from Chase Farm Hospital must be moved in to the new home in stages to ensure that each has the opportunity to adapt to the new environment and to the new staff. The inspector will not set a time limit but expect the manager to make an appropriate decision based on the assessment of the service user. The home must not have more than two wheelchair dependent service users, one of whom can be cared for in the ground floor room and one of the rooms on the first floor. 23rd January 2007 3. 4. Date of last inspection Brief Description of the Service: Little Park Gardens is a care home for 4 younger adults with learning and physical disabilities. Mr Savvas Michael, who also owns another care home in Enfield, owns the home. Mrs Maria Newton manages both homes. The home has been registered with the CSCI since March 2004 and is in a quiet street a few minutes walk from Enfield Town centre and local transport. The semidetached house has 4 bedrooms for residents. The home has aids and equipment to meet the needs of people who use wheelchairs and there is a small lift to the 1st floor. 3 of the bedrooms are located on the 1st floor and 1 on the ground floor. The home also has a lounge, a kitchen with a dining area and a small, paved garden. The washing machine is in a small room on the ground floor. The aim of the home is to support adults with learning disabilities to lead inclusive lifestyles by using a person centred approach. Fees for the home range from £1,100 - £1,500 per week. Residents are expected to pay separately for items such as individual activities such as aromatherapy, and toiletries, hairdressing and clothes. Following Inspecting for Better Lives the provider must make information available about the service, including inspection reports, to residents and other stakeholders. Person Centred Care Homes DS0000058138.V354566.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection was done on an announced basis, so the manager knew we were coming. The inspector was accompanied by Claire Duncan, who is a user involvement manager with the Commission. The inspection took 1 day to complete. We met all 4 of the residents and talked to the manager and some of the staff. We looked at the files that the home keeps about 2 residents, which included their care plans and risk assessments. The inspector saw the files for 2 staff, which showed the way that they were recruited and the training and supervision they have had to help them work with the residents. Other things that we looked at were the complaints book, the medication, health and safety and 1 resident’s money. The Annual Quality Assurance Assessment (AQAA) is an assessment that is done by the home and sent to the Commission to tell us how well outcomes are being met for people living in the home. While doing the inspection the inspector looked at what the home had put in their AQQA. What the service does well: The house is small and homely and has special equipment to help the residents who use wheelchairs to live an ordinary life. There are good assessments and good care plans that help the staff to understand each person’s needs and wishes. There are risk assessments to help keep people safe and to help them be as independent as they can. Because of people’s needs, finding ways of helping them to communicate is important and the staff get to know the ways each resident tells people what they like and don’t like. There is a good relationship between staff and residents and the staff help residents to make as many choices as they can. The staff help residents to see and keep in touch with their friends and families. Residents can do the activities that they like to do, like going to the day centre, going out for lunch, to the cinema and bowling. The home has a special bus for people who use wheelchairs so they can go out on trips. The staff make sure that residents’ can see people about their health, like their doctor, dentist, and speech therapist and the staff help residents to go to their hospital appointments. The staff also make sure residents get the food that they like to eat and help with their special diets. The residents seem relaxed and comfortable living in their home and the staff who spoke to the inspector were person centred in their approach. Person Centred Care Homes DS0000058138.V354566.R01.S.doc Version 5.2 Page 6 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 DS0000058138.V354566.R01.S.doc Version 5.2 Page 7 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 DS0000058138.V354566.R01.S.doc Version 5.2 Page 8 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a service user guide that is specific to the individual home and the resident group they care for. The guide details what the prospective residents can expect and gives a clear account of the specialist services provided, quality of the accommodation, qualifications and experience of staff, how to make a complaint. A format is available for people with learning disabilities. Admissions have not been made to the home until a full needs assessment has been undertaken. The assessments have been conducted professionally and sensitively and involved the person and their family or representative, where appropriate. Where the assessment has been undertaken through care management arrangements the service received a summary of the assessments and copies of the care plans. EVIDENCE: All of the residents have lived in the home since it opened. They moved to the home from a large hospital. We looked at 2 people’s files and these showed that when people moved into the home, it was done in a well-planned way. There were copies of needs assessments on people’s files. The manager told us that when the residents were still living in the hospital the staff from Little Park Gardens spent 1 month working along side the staff in the hospital, so that they could get to know the residents properly before they moved to the home. In the information the home recently gave to the Commission in their AQQA the manager said that the home also held several meetings with Person Centred Care Homes DS0000058138.V354566.R01.S.doc Version 5.2 Page 9 parents/carers during the transition period. The manager showed the inspector the service user guide and the residents’ charter, which include “Widget” symbols to help people with learning disabilities to understand them. Person Centred Care Homes DS0000058138.V354566.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff understand the importance of residents being supported to take control of their own lives. People are encouraged to make their own decisions and choices in a way that is relevant to them. The service knows and records the preferred communication style of each person, and uses proven methods that enable them to lead a full life that promotes independence and choice. Plans are written in plain language, are easy to understand and look at all areas of people’s lives. They include reference to equality and diversity and address any needs identified in a person centred way. Staff have skills and ability to support and encourage residents to be involved in the ongoing development of their plan. A key worker system allows staff to work on a one-to-one basis and contribute to the care plan for the individual. The plans include information about people’s goals and aspirations, how they communicate, their skills and abilities, how they make choices in their life and information about their health. It is kept up to date and focuses on how individuals will develop their skills, and considers their future aspirations. Reviews focus on asking what has worked for the person, where there has been progress, achievements, concerns and identifies action points. Person Centred Care Homes DS0000058138.V354566.R01.S.doc Version 5.2 Page 11 EVIDENCE: We looked at 2 people’s care plans and these showed that there is a person centred approach and people’s changing needs are clearly detailed. The quality of the care plans is good. They set out people’s needs, preferences and goals very clearly. However, they could be further improved by being presented in a way that is more accessible and meaningful for the residents. This could be done by using pictures of the residents, and a larger print. Recommendation is made about this. The other care records that we looked at showed clear evidence of ongoing assessments, regular reviews of care plans and of the overall placements of the residents. Due to limitations in resident’s ability to communicate verbally, the home has ensured that staff get to know the unique ways in which each person communicates their wishes and choices. The ways in which people communicate are clearly described in people’s plans. The manager told us that residents’ family or representatives are also consulted to provide the staff team with as much information as possible to help them understand residents’ needs and preferences. Staff support residents to make decisions. The inspector spoke to 2 staff who were able to demonstrate that they knew the residents well and were familiar with the way in which they make choices and indicate what they like and don’t like. There is a key worker system in place. Throughout the day we observed staff offering support and guidance in a respectful way. In the information the home recently gave to the Commission in their AQQA the manager said that due to the severe learning disabilities and communication difficulties the residents have it is difficult for them to make decisions. However, due to close observation and monitoring the staff are able to make judgments on their behalf. The staff meetings ensure that it is not just 1 person’s view taken. Where residents have family the staff try to involve them in any decision made on behalf of the resident. At the inspection the inspector was able to confirm this. The inspector also noticed that the staff were very person centred in their approach. The risk management system supports to be as independent as possible within their capabilities. People’s files contained risk assessments that had been regularly reviewed. The risk assessments were generally of an adequate standard and gave guidance about each of the risks that are relevant to each person. 1 person sometimes has a behaviour that can be harmful to them and this was not included in their risk assessment. This was addressed at the time of the inspection, as the manager amended the risk assessment when this was pointed out. The risk assessments could be improved further if they were expanded to include more information regarding what arrangements that are Person Centred Care Homes DS0000058138.V354566.R01.S.doc Version 5.2 Page 12 in place to minimise the risks, and included more information about specific strategies and interventions by staff. A recommendation is made about this. Person Centred Care Homes DS0000058138.V354566.R01.S.doc Version 5.2 Page 13 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, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a strong commitment to enabling residents to develop or maintain their skills, including social, emotional, communication, and independent living skills. People who live in the home have the opportunity to develop and maintain important personal and family relationships. The staff practices promote individual rights and choice, but also consider the protection of individuals in supporting them to make informed choices. The service respects people’s human rights with fairness, equality, dignity, respect and autonomy underpinning the care and support being provided. Staff understand and are sensitive to the particular religious and cultural needs of people and their families. The staff team help residents with communication, both within the service and in the community, to enable residents to participate in daily living activities. Residents are involved in meaningful daytime activities according to their individual interests, needs and capabilities. Where appropriate, educational opportunities are encouraged, supported and promoted. Residents can access and enjoy the opportunities available in their local community, such as the local pub, and local leisure facilities. Where appropriate, residents are involved in the domestic routines of the home. The menu is varied and the meals are balanced and nutritious. The menu includes a variety of dishes that encourage Person Centred Care Homes DS0000058138.V354566.R01.S.doc Version 5.2 Page 14 people to try new and sometimes unfamiliar food. Care staff are sensitive to the needs of those residents who find it difficult to eat and give assistance with feeding. They are aware of the importance of feeding at the pace of the resident, making them feel comfortable and unhurried. EVIDENCE: On the day of the inspection, all of the residents left for their day activities, some to visit a new art group for the first time and others to the day centre that they attend regularly. The manager and staff said that all residents get out into their local community and enjoy visiting the pub, restaurants and local shops. The way she spoke about activities showed that she is always looking for new opportunities that the residents might enjoy. In the information recently given to the Commission in their AQQA the manager said that accessing the community by public transport has been difficult for the residents who are wheelchair users and that this can limit activities. The home has provided transport and had it made wheelchair accessible. “We have access to transport on request”. At the time of the inspection the manager also told us that a second vehicle that is also wheelchair accessible has been purchased recently. We looked at 2 residents’ files and each included information about residents’ individual culture and their needs and opportunities. They contained information on the individual activities that each person takes part in. There is a weekly plan of activities for each resident with details of what they are scheduled to do that week. In 2 weeks, for the 2 people whose files we saw, these included visits to the cinema, bowling, a trampoline session, arts and crafts, hairdresser, massage, visiting cafes, meals out, cooking, and attending a specialist day centre. These plans were also displayed on the notice board in the kitchen. In the information recently given to the Commission in their AQQA the manager said that although residents are unable to carry out housekeeping task, they are present where possible when these are taking place, for example when cleaning their bedrooms once a week. Residents’ files contained information on their next of kin and information on what contact they have with their family. There was plenty of evidence that staff support them to maintain involvement with family and friends. The manager explained that some residents have a lot of support from their families, whilst as they get older, other people’s families are not able to play such an active part in their lives. However, it was evident that all 4 residents have at least 1 person who takes an interest in their welfare, such as a friend or a family member. We met all 4 of the residents when they returned from their daytime activities. Because they do not communicate verbally for the most part, it was a Person Centred Care Homes DS0000058138.V354566.R01.S.doc Version 5.2 Page 15 challenge for us to understand their opinions about living in the home. However, they seemed happy, relaxed and comfortable with the staff and responded to them in a positive way. Throughout the inspection the staff were directly and indirectly observed talking with people in a sensitive and supportive way. The menu was displayed on a notice board in the kitchen. The manager explained that it changes each week over a 4-week period to make sure that there is enough variety. There was lots of evidence that health care specialists were involved on an ongoing basis, as some people have special diets, and staff had received specialist training to meet other specialist health care needs around swallowing. We also noticed that there was plenty of fresh fruit and vegetables available in the home. 1 staff member told the inspector about the ways the team makes sure that the resident from an Afro-Caribbean background has opportunities to try different dishes from the Caribbean. We noticed that the national minimum standards for mealtimes were displayed on the notice board in the kitchen, next to the menu and the manager explained that she encourages the staff team to focus on and become familiar with the different standards on a regular basis. As residents came home from their daytime activities we noticed staff were helping them to have their drinks in a sensitive way. Person Centred Care Homes DS0000058138.V354566.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People receive personal and healthcare support using a person centred approach with support provided based upon the rights of dignity, equality, fairness, autonomy and respect. Personal healthcare needs including specialist health, nursing and dietary requirements are clearly recorded in each person’s plan. They give a comprehensive overview of people’s health needs and act as an indicator of change in health requirements. Personal support is responsive to the varied and individual needs and preferences. Staff respect privacy and dignity and are sensitive to changing needs. Residents have access to healthcare and remedial services. Residents have the aids and equipment they need and these are well maintained to support them and staff in daily living. The home has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. Care staff manage medication on the residents’ behalf. Medication records are fully completed, contain required entries, and are signed by appropriate staff. Staff have completed and passed an appropriate medication course. EVIDENCE: The 2 people’s plans that we looked at included information about their individual personal care needs, and how the staff should carry out their Person Centred Care Homes DS0000058138.V354566.R01.S.doc Version 5.2 Page 17 personal care. People’s cultural needs are included in their plans. People have been provided with the appropriate aids and adaptations to make sure that their needs are met properly and safely. In the information recently given to the Commission in their AQQA the manager said that where residents cannot express themselves, this is done through staff observation. People’s plans identify any preferred routines, and the likes and dislikes of those residents who cannot easily communicate. All residents have their own personal care toiletries, which reflect their personality. At the inspection the inspector was able to confirm this. There is evidence that people’s health and wellbeing is monitored and taken seriously and that they are supported to gain access to health care services. The manager said that the home gets very good support from the specialist community health team in the area. There was clear evidence of the input of specialist health care professionals in people’s records and good monitoring records of this. Various health care professionals, such as occupational therapists and speech and language therapists have assessed residents’ health care needs and given advice to staff on how to support the residents with their health care. Staff have also had specialist training in specific areas. Emotional as well as physical health needs are detailed in each resident’s care plan. All residents are registered with a General Practitioner. In the information recently given to the Commission in their AQQA the manager said that a resident’s needs recently changed, the home liaised with the community nurse for advice how to make sure that their needs were met. This involved making a referral to an occupational therapist and requesting an incontinence referral. At the inspection the inspector was able to confirm this. None of the residents administer their own medication. Medication Administration Record (MAR) sheets, were completed correctly. In the information recently given to the Commission in their AQQA the manager said that medication is facilitated through Boots pharmacy, that all medication, where possible, is in blister packs, that records are kept of any medicines received, administered and returned to the pharmacy and that staff administering medication receive appropriate training. At this inspection the inspector was able to see evidence to confirm that this was the case. Person Centred Care Homes DS0000058138.V354566.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a complaints procedure that is clearly written and easy to understand. It is available in a format that helps anyone living at, or involved with, the service to complain or make suggestions for improvement. The complaints procedure is supplied to everyone living at the home and is displayed in a number of areas within the service. The home keeps a record of complaints. The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. Staff working at the service know when incidents need external input and who to refer the incident to. The home understands the procedures for safeguarding adults and will attends meetings or provide information to external agencies when requested. The outcomes from a recent referral were managed well and issues resolved to the satisfaction of all involved. Training of staff in safeguarding is regularly arranged by the home. Staff understand what restraint is and alternatives to its use in any form are looked for. Equipment that may be used to restrain individuals such as bed rails, keypads, recliner chairs and wheelchair belts are only used when necessary. People are involved in the decision making process about any limitations to their choice in this area. Individual assessments are completed which involve people’s representatives and any other professionals such as the care manager or GP. EVIDENCE: The home has a clear complaints policy and the procedure has been produced in format for people with learning disabilities, with “widget” symbols. A complaints book is kept and no complaints have been recorded since the home opened. Person Centred Care Homes DS0000058138.V354566.R01.S.doc Version 5.2 Page 19 There are policies and procedures for reporting and responding to actual or suspected abuse. The manager told us that since the last inspection 1 issue had been dealt with through the safeguarding adults procedure. This was about how a staff member had dealt with the behaviour of a particular resident. The outcome was that although the staff member’s intervention was not best practice, they had acted with the best interests of the resident in mind and with no intention of abuse. The manager has ensured that the person’s care plan now better reflects what interventions are acceptable. Training records confirmed that some staff have completed external training in safeguarding people from abuse. The manager also told us that she has done extra training in this area so that she is competent to train the staff. Person Centred Care Homes DS0000058138.V354566.R01.S.doc Version 5.2 Page 20 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, 26, 27, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that is appropriate to the specific needs of the people who live there. The environment is generally well maintained and provides specialist aids and equipment to meet their needs. The home is a very pleasant, safe place to live the bedrooms and communal rooms meet the NMS or are larger. Bedrooms have en-suite facilities and residents are encouraged to personalise their bedrooms. The environment promotes the privacy, dignity and autonomy of residents. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in private. The bathrooms and toilets are fitted with appropriate aids and adaptations to meet people’s needs, and are in sufficient numbers and of good quality. The home is well lit, clean and tidy and smells fresh. EVIDENCE: The manager showed us around the home. We noticed that it was nicely decorated and homely in appearance and despite the necessary aids and adaptations, feels like a family home. It was also clean and tidy and free from any offensive odours. The kitchen is well equipped and includes the pleasant Person Centred Care Homes DS0000058138.V354566.R01.S.doc Version 5.2 Page 21 dining area. People have their own single bedrooms and there are sufficient toilets and bathrooms to meet their needs. All areas have been designed with space in mind for residents with physical disabilities, with assess to all areas except the top floor, where there is a staff office. A lift has been installed to make sure people who use wheel chairs can get up and down from the 1st floor. The room that was previously a downstairs toilet is being used for the washing machine and dryer. This is near to the front door so there is no need for taking dirty laundry into the kitchen. Each person’s bedroom has been personalised. The bathrooms and toilets are wheelchair accessible, and there are enough hoists, shower chairs and assisted baths. It is recommended that advice be sought from the occupational therapist regarding the maintenance and safety checks for 1 person’s special bed. The manager said that the team is considering taking 1 toilet out of 1 resident’s en-suite room, to provide more room to store their hoist, as the resident doesn’t use the toilet. Because of the wear and tear from the wheelchairs the floor covering be in the hall is beginning to look a bit tired and the manager said that the carpet on the stairs and landings is due to be replaced. A recommendation is made about replacing these. Person Centred Care Homes DS0000058138.V354566.R01.S.doc Version 5.2 Page 22 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, 34, 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Rotas show well thought out and creative ways of making sure that the home is staffed efficiently, with particular attention given to busy times of the day and people’s needs. Accurate job descriptions and specifications clearly define the roles and responsibilities of staff. All staff receive relevant training that is focussed on delivering improved outcomes for residents. There is a good recruitment procedure that clearly defines the process to be followed. This procedure is followed in practice with the home recognising the importance of effective recruitment procedures in the delivery of good quality services and for the protection of residents. There are clear contingency plans for cover for vacancies and sickness and there is little use of any agency or temporary staff. Staff meetings take place regularly. EVIDENCE: We saw the rota and the manager and staff told us that there are always a minimum of 3 staff on duty during the daytime so that there are consistently enough staff available to meet the needs of the people living in the home on an individual basis, and so that they can get out into the community. In the information recently given to the Commission in their AQQA the manager said “We have relatively long term permanent staff and a very low turnover of staff, Person Centred Care Homes DS0000058138.V354566.R01.S.doc Version 5.2 Page 23 which provides consistency and continuity to residents. We also have a number of part time staff which minimises the use of agency staff as it allows us to call on them if short staffed”. At the inspection the inspector was able to confirm this. The manager said that the deputy manager was on maternity leave and a senior member of the staff team was acting-up in the post until she returns. We saw the personnel files of 2 staff and each included a job description outlining their roles and responsibilities. 2 staff spoke to the inspector in private and both had a good understanding of people’s needs and the support that they provide to the residents. The personnel files contained information showing that staff go through proper vetting procedures before being employed by the home. The recruitment information included 2 written references for each applicant and Criminal Records Bureau (CRB) checks. The manager keeps training records that show what training each staff member has had and what training is needed. This gives immediate access to information so that this can be monitored very easily. Staff files also include the certificates given to staff when they have completed each training course and show that staff have been receiving training appropriate to the work that they perform in the home such as lifting and handling, food hygiene and health and safety. The manager said that many of the staff are undertaking their National Vocational Qualification (NVQ) at level 2 and some at level 3. As there are residents in the home who have sensory impairment a recommendation is made for staff to be provided with training regarding working with people with sensory impairment. The 2 staff, who spoke to the inspector said that they had a good induction, receive good support and training and attended regular staff meetings. Person Centred Care Homes DS0000058138.V354566.R01.S.doc Version 5.2 Page 24 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, 41, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has the required qualifications and experience and is competent to run the home. The manager has a clear understanding of the key principles and focus of the service, and works to continuously improve the service. They provide an increased quality of life for residents with a strong focus on equality and diversity issues and promoting human rights, especially in the areas of dignity, respect and fairness. There is also a focus on person centred thinking, with residents shaping service delivery. There is a strong ethos of being open and transparent in all areas of running of the home. The AQAA contains clear, relevant information that is supported by a wide range of evidence. The AQAA lets us know about changes they have made and where they still need to make improvements. It shows clearly how they are going to do this. The data section of the AQAA is accurately and fully completed. The manager promotes equal opportunities, has good people skills and understands the importance of person centred care and effective outcomes for people who use the service. The home works to a clear health and safety policy. Staff are aware of the policy and are trained to put theory into practice. Safeguarding is given high priority and the home provides a range of policies and guidance to underpin Person Centred Care Homes DS0000058138.V354566.R01.S.doc Version 5.2 Page 25 good practice. The home is closely monitoring its own practice regarding relevant health and safety requirements and legislation. Health and safety records are of a good standard and are routinely completed. It is not possible for people to manage their own money due to their learning and physical disability and the manager takes responsibility for this on a day-to-day basis. EVIDENCE: The manager is registered with the Commission and has been managing the home since it opened. She also manages another home nearby, which is owned by the registered provider. A deputy manager helps with the day-today running of the home. The manager has more than 15 years experience in care work. It was evident that she has a good understanding of her role and responsibilities in relation to the residents and the staff team and comes across as very committed. In the information recently given to the Commission in their AQQA the manager said that the residents are mainly non-verbal. However, the home uses observation and close monitoring to ensure that views and needs are met. The home liaise we day centres to get feedback about residents. A community nurse visits regularly to give input. Parents’ input is also taken into account to ensure that all views are considered. There are regular staff meetings where staff and key workers give views on behalf of residents so that they are promoted into what the home does. Once a year the home carries out a quality assurance exercise where feedback questionnaires are sent out to families, social workers, day centres, GPs, Community health team, in order to receive their view of the service. At the inspection the inspector was able to confirm that there was evidence that the staff put a lot of work into understanding residents’ views and considering what is in their best interests. The manager has responsibility as appointee for residents. She keeps records of for the day-to-day spending of all 4 residents and the inspector saw the records for recent spending for 1 person. Resident’s financial arrangements are clearly set out in their care plans and the manager carries out this task in a planned and well-organised way, keeping receipts of all spending on resident’s behalf and the arrangement works well, allowing residents access to money for the things that they like and need. The manager said that each person has their own building society account. In discussion with the manager it became evident that 2 residents have representatives who have responsibility to check that their money is being managed in their best interests and 2 people do not. A recommendation is made about this. The manger has demonstrated that she is proactive in her approach, has identified areas in the service where there is room for improvement and is Person Centred Care Homes DS0000058138.V354566.R01.S.doc Version 5.2 Page 26 taking steps to address these. 1 of the areas that she has identified is health and safety awareness in the home. A consultant has been engaged and has created a plan for the home. The manager explained that the management team is scheduled to meet with the consultant this month, to discuss the plan. The records showed that the necessary health and safety checks are carried out regularly. Equipment is checked, fire drills and tests have been done regularly, all safety certificates are in place and the registered person has ensured that the (PAT) Portable Appliances tests have been done. Person Centred Care Homes DS0000058138.V354566.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 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 2 25 X 26 3 27 3 28 X 29 2 30 3 STAFFING Standard No Score 31 3 32 X 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 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 2 3 X Person Centred Care Homes DS0000058138.V354566.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. 1. Refer to Standard YA6 Good Practice Recommendations It is recommended that the format that the care plans are presented in be reviewed to make them more accessible for the residents. It is recommended that the risk assessments that are in place for residents be expanded to include more information regarding what arrangements are in place to minimise the risks, and to include more information about specific strategies and interventions by staff. It is recommended that new floor covering be provided in the hall and on the stairs and landings. It is recommended that advice be sought from the occupational therapist regarding the arrangements for maintenance and safety checks for 1 person’s special bed. 2. YA9 3. 4. YA24 YA29 Person Centred Care Homes DS0000058138.V354566.R01.S.doc Version 5.2 Page 29 5. 6. YA35 YA41 It is recommended that staff be provided with training regarding working with people with sensory impairment. It is recommended that the records kept of 2 of the residents’ financial transactions be independently audited on an annual basis. Person Centred Care Homes DS0000058138.V354566.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Person Centred Care Homes DS0000058138.V354566.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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