Care Home: Raola House

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What the care home does well All the feedback received from one person who uses the service and the three staff on duty at the time of this visit was overall very positive about the standard of care provided at the home. Typical verbal and written comments included, "I like living here", "I like watching television and gardening, and have takeaways sometimes", "Having worked in various care settings this home compares very favourably with them", and "my initial induction, and the training and supervision I have received since starting work at Raola House has been excellent". The home demonstrated it had a strong commitment to ensuring the diverse ethnic and cultural mix of the people who use the service and all that entails is respected and promoted. For example, both documentary and anecdotal evidence was produced on request to show that the people who use the service have numerous opportunities to practice their beliefs, celebrate festivals, eat meals, and have hairstyles that reflect their diverse cultural heritage. Furthermore, the home is commended for ensuring the ethnic, gender and age mix of the current staff team is well matched to that of the people currently living at the home. Finally, employing three staff throughout the day ensures the home has plentiful staff available at all times to support the needs, activities and aspirations of the three people who currently reside at Raola House in an individualised and person centred way (i.e. one to one support). What has improved since the last inspection? Now the proprietor is only responsible for the day to day management of Raola House Mrs Obaro now has more time to spend on site dealing directly with the people who use the service, their representatives and staff. The introduction of one to one monthly keyworker sessions to provide the people who use the service with more opportunity to express their views about how their home is run and have a greater say in their lives. The recruitment of an independent consultant to carry out regular spot checks and quality monitoring visits provides evidence of the proprietors commitment to ensuring the views of the people who use the service, their representatives and staff are all listened to, and underpins the homes development. The proprietor is commended for ensuring all the outstanding requirements identified in the homes last inspection report have also been addressed in full in a timely fashion (see below): The Statement of purpose and Guide has been amended to include all the information people who use the service and their representatives need to know about the home. Care plans have been improved to ensure they are more person centred and focus on individual`s unique strengths and wishes. All staff that work at Raola House have recently update their safeguarding vulnerable adults and managing challenging behaviour training. No students work more than 20 hours at week at the home. The staff file for the homes lasted recruit contained all the relevant checks the proprietor is legally obliged to obtain (e.g. CRB and references from previous employers). Records showed that staff are now receiving one formal recorded supervision session with the proprietor at least once every two months. The temperature of hot water emanating from a shower unit has now been fixed to ensure is never exceeds a safe 43 degrees Celsius. Finally, all substances hazardous to health are kept safely locked away. CARE HOME ADULTS 18-65 Raola House 205 Woodcote Road Wallington Surrey SM6 0QQ Lead Inspector Lee Willis Unannounced Inspection 23rd July 2008 10:30 Raola House DS0000065735.V364285.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 Raola House DS0000065735.V364285.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. Raola House DS0000065735.V364285.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Raola House Address 205 Woodcote Road Wallington Surrey SM6 0QQ 020 8835 2258 020 8669 3533 tordarrach@yahoo.com 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) Tordarrach Mrs Ayodele Obaro Care Home 6 Category(ies) of Learning disability (6), Sensory impairment (6) registration, with number of places Raola House DS0000065735.V364285.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd May 2007 Brief Description of the Service: Raola House is registered with the Commission for Social Care Inspection (CSCI) to provide residential care for up to six adults with learning disabilities and or sensory impairment. The service is owned and managed by Mrs Ayodele Obaro Raola is situated on a busy main road on the edge of Wallington and is within a mile radius of the town centre with its wide variety of local shops and other community based services and facilities. The home also has its own vehicle and is situated directly opposite a bus stop with good links to the local town and the surrounding areas. This one storey property comprises of six single occupancy bedrooms all with en-suite facilities. There are sufficient numbers of W/C’s and bathing facilities located throughout. Communal areas are largely located on the ground floor and include a main lounge, large conservatory, kitchen, separate games/visitors room, outhouse laundry, and top floor office. There is ample space in the front garden for parking and the back garden, which has a patio area and large lawn, is extremely well maintained. The philosophy of care and principle objectives of Raola House are based upon the development of community-based initiatives, recognising that people with learning disabilities have the right to a normal pattern of life. The range of weekly fees is between £1,200 and £1,400. Raola House DS0000065735.V364285.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of this service is 2 stars. This means the people who use this service experience good quality outcomes. This marks a significant improvement on its one star rating given at its previous Key inspection in May 2007. From all the available evidence we gathered during the inspection process it was clear the service now has significantly more strengths than areas of weakness. All the major shortfalls that emerged in the past twelve months have now been recognised by the proprietor and appropriate action taken to address them. We spent six hours at the home. During the visit we met all three of the people who currently live there, the owner/manager, and three support workers, including a relatively new member of staff. We also looked at records, documents, and photographs, including the care plans for two people who were chosen to have their cases tracked. The remainder of this site visit was spent touring the premises. We received five ‘have your say’ comment cards about the home, which had all been completed by members of staff. Finally, as part of the inspection process we received the homes Annual Quality Assurance Assessment (self assessment form - AQAA) which tells us what the proprietor thinks her service does well and what they could possibly do better in future. What the service does well: All the feedback received from one person who uses the service and the three staff on duty at the time of this visit was overall very positive about the standard of care provided at the home. Typical verbal and written comments included, “I like living here”, “I like watching television and gardening, and have takeaways sometimes”, “Having worked in various care settings this home compares very favourably with them”, and ”my initial induction, and the training and supervision I have received since starting work at Raola House has been excellent”. The home demonstrated it had a strong commitment to ensuring the diverse ethnic and cultural mix of the people who use the service and all that entails is respected and promoted. For example, both documentary and anecdotal evidence was produced on request to show that the people who use the service have numerous opportunities to practice their beliefs, celebrate festivals, eat meals, and have hairstyles that reflect their diverse cultural heritage. Furthermore, the home is commended for ensuring the ethnic, gender and age Raola House DS0000065735.V364285.R01.S.doc Version 5.2 Page 6 mix of the current staff team is well matched to that of the people currently living at the home. Finally, employing three staff throughout the day ensures the home has plentiful staff available at all times to support the needs, activities and aspirations of the three people who currently reside at Raola House in an individualised and person centred way (i.e. one to one support). What has improved since the last inspection? What they could do better: Raola House DS0000065735.V364285.R01.S.doc Version 5.2 Page 7 All the positive comments made above notwithstanding their remains a number of areas of practice where further improvement is required in order to enhance the lives of the people who use the service and keep them safe: All the people who use the service and their representatives must be provided with more up to date contracts that make it more explicit what facilities and services they will be charged ‘extra’ for (i.e. not covered by the basic cost of each placement). This will enable the people who use the and/or their representatives to determine whether or not they are getting value for money. The home needs to purchase a thermometer as a matter of urgency to monitoring the temperature of hot water emanating from all the homes baths and shower units. This must be done at regular intervals and records kept to ensure water temperatures remains below a safe 43 degrees Celsius. There must be at least one member of staff trained in first aid on duty at all times to ensure the people who use the service receive will appropriate treatment in the event of an accident occurring. We also recommended the proprietor considers implementing the good practice measures highlighted below: The homes statement of purpose and guide should be dated and include more detailed information about the full range of needs the service intends to meet (i.e. sensory impairment). A better selection of more ‘age’ appropriate social and recreational should be available in the home for the people who use the service to access as and when they choose. The way in which the service records the outcome of all the appointments people who use the service attend with various health care professionals should be reviewed as the current approach is rather ad hoc and variable. This will make monitoring the health of the people who use the service far easier. People who use the service and their representatives should have access to easy to read versions of the homes complaints procedures. This will ensure everyone who has a stake in the service will know exactly who and how to make a complaint if they are feeling dissatisfied with the service. Finally, more of the homes staff team should receive specialist training in understanding and working with people who have been assessed as having autism, PICA, and continence issues. This will ensure the people who use the service receive the person centred support that meets their needs. Please contact the provider for advice of actions taken in response to this Raola House DS0000065735.V364285.R01.S.doc Version 5.2 Page 8 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. Raola House DS0000065735.V364285.R01.S.doc Version 5.2 Page 9 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 Raola House DS0000065735.V364285.R01.S.doc Version 5.2 Page 10 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 & 5 People who use the service experience good quality outcomes in this area. We have made this judgement using arrange of evidence, including a visit to this service. Overall, people who use the service and their representatives have access to most of the information they require to make an informed decision about what facilities and services the homes can offer them. The homes current arrangements for charging people who use the service and their representatives for any additional facilities and services not covered in the basic cost of their placement is not very clear and will need to be improved to make the process more open and transparent. This will enable people who use the service to determine whether or not they are getting value for money. EVIDENCE: As required in the homes last inspection the proprietor was able to produce a recently revised Statement of Purpose and Guide for the service which included the vast majority of information people who use the service and their representatives would need to know about the home. We recommend these documents be amended further to include a date and more detailed information about how the service intends to meet the needs of people who are sensory impaired. Raola House DS0000065735.V364285.R01.S.doc Version 5.2 Page 11 The proprietor confirmed her service was still had three vacancies and that she had not accepted any new referrals, including any respite ones, since May 2007. The proprietor demonstrated a good understanding of the importance of carrying out a thorough assessment of prospective new service users during the initial stage of an admission to minimise the risk of a placement breaking down. Mrs Obaro stressed the importance of encouraging a prospective new service user and their representatives to visit the home before a decision was taken about moving in on a ‘trial’ basis and assessing how compatible the individual might be with the others already residing at Raola House. Costed contracts that had been reviewed in May 2008 and up dated accordingly to reflect any changes in provision were produced on request in respect of the people whose care was being case tracked. Both these contracts had been signed and dated by the individual’s representatives and the homes proprietor. The documents were very clear how much people would be charged for basic items such as accommodation and food, but it was not always clear what services and facilities were covered by their placement fees and what were not (e.g. so called extras like toiletries for which there is an additional fee). Raola House DS0000065735.V364285.R01.S.doc Version 5.2 Page 12 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 & 9 People who use the service experience excellent quality outcomes in this area. We have made this judgement using arrange of evidence, including a visit to this service. Improvements made to the way the home develops care plans ensures these documents are more person centred thus reflecting what is important to the individual, what their capabilities are, and what support they need to achieve their personal goals. The homes arrangements for assessing, managing and reviewing risk are sufficiently robust to ensure the people who use the service are kept safe, while their rights to develop their independent living skills are not restricted unnecessarily. EVIDENCE: We looked at the care plans for the two people we had selected to track. As required in the homes previous report improvements had been made to the way the service developed peoples care plans. The two viewed were person centred and set out in detail what support these individuals required to ensure Raola House DS0000065735.V364285.R01.S.doc Version 5.2 Page 13 their personal, social, and health care needs were to meet, and what their strengths, wishes, and aspirations wishes were. Both plans had been reviewed in the past six months involving all the relevant people, including the person for who it was intended, and up dated accordingly to reflect any changes in provision. Staff met told us the home continues to operate a keyworker system. One member of staff informally interviewed at length was very clear about their keyworker responsibilities and told us they “made sure that other staff always knew about the current needs and wishes of the person they keyworked.” Records were produced on request to show that keyworkers arrange quarterly one-to-one sessions with the people they keyworked. The home is commended for ensuring the so far as reasonably practicable the people who use the service are actively encouraged and supported by their keyworkers to influence key decisions about their homes operation despite having high communication needs. We agree with the proprietor’s comments that the majority of the people who currently use the service would be unable to participate in residents meetings. Both care plans looked at in detail contained a comprehensive set of management strategies to minimise any identified risks and hazards. These assessments are kept under constant review and cover every aspect of people lives, including use of the kitchen, knifes, bathing and accessing the wider community - for example. It was evident from the information included in these assessments that the proprietor is committed to ensuring the people who use the service are able to take ‘responsible’ risks in order to help people develop their independent living skills. Where limitations are imposed, a record justifying the measure could always be produced on request. E.g. the rational for the fitting of a keypad device to the front door to prevent the people who use the service going out unaccompanied by staff. Raola House DS0000065735.V364285.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 & 17 People who use the service experience good quality outcomes in this area. We have made this judgement using arrange of evidence, including a visit to this service. People who use the service are involved in meaningful daytime activities of their own choice and according to their individual interests and capability, although more ‘age’ appropriate social resources could be made available in the home to further enhance their lives. Meals are varied, well balanced, and highly nutritional ensuring the varying cultural and dietary needs of the people who use the service are well catered for. Raola House DS0000065735.V364285.R01.S.doc Version 5.2 Page 15 EVIDENCE: It was positively noted on arrival that two out of three of the people who currently living at the home were out attending various classes at a local day centre. One person spoken with at length told us they “were allowed to watch television when they wanted and that they went out shopping with staff a lot, which they liked”. As recommended in the homes last report the proprietor has introduced new activity records that set out in greater detail what social and recreational activities the people who use the service participate in each day. The new record showed that one individual had engaged in a wide variety of meaningful activities in the local community in recent months, including a picnic in the park, various walks, trips to the pub, shopping, and bus rides. The activity record also showed that in accordance with this individual’s cultural heritage and spiritual needs, which are clearly identifiable from their care plan, staff actively encourage and support them to regularly attend services at an appropriate place of worship. This individual also went out with staff one evening to celebrate his country of births patron Saint. During a tour of the premises a variety of different games and art and leisure resources were noted to be stored in both the conservatory and visitors room. However, not all these resources seemed to be particularly ‘age’ appropriate for the people who currently reside at the home, although staff told us it was well used. The proprietor told us she is planning to extent the building to include a new sensory room. We agree with the proprietor that this would significantly enhance the lives of the vast majority of the people who use the service. Progress made to achieve this aim will be assessed at the homes next inspection. One person who uses the service told us they often went food shopping with staff. This and other household chores people who use the service had agreed to be responsible for on a regular basis were specified in the two care plans being case tracked and on a notice board in the games room. It was clear from comments made by the proprietor and entries made in the homes visitors book that the relatives of the people who use the service are actively encouraged to visit their loves ones whenever they wished. One person who uses the service told us “the food is nice”. The meals offered on the four weekly rotating menus looked relatively varied and nutritionally well balanced. Staff maintain a detailed record of the meals actually consumed by the people who use the service that revealed one individuals preference of having takeaway chicken and chips every now and then was being met. This record also showed that Caribbean style cuisine is often served in the home to meet the specific cultural tastes of a number of people who use the service. Raola House DS0000065735.V364285.R01.S.doc Version 5.2 Page 16 We were also told by staff that Caribbean style groceries are regularly dropped of by the relatives of one person who uses the service to ensure they have the right ingredients to make their loved ones favourites dishes. Records showed meals containing plantain and yams are regularly served in the home. One member of staff whose cultural heritage is similar to that of one of the service users told us they were able to make Caribbean style food. The proprietor told us staff also use cards depicting various items of food to enable the non-verbal service users choice what they eat at mealtimes. The proprietor told us advice about healthy eating is sought from a dietician employed by the providers who is actively involved in helping the service users and staff plan the homes weekly menus. During a tour of the kitchen a wide varied of fresh fruit, salad, and vegetables were noted. All items of food stored in the homes fridge, including those taken out of their originally packaging, were correctly labelled and dated in accordance with basic food hygiene standards. Raola House DS0000065735.V364285.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 & 21 People who use the service experience good quality outcomes in this area. We have made this judgement using arrange of evidence, including a visit to this service. Suitably arrangements are in place to ensure the people who use the service receive personal support in the way they prefer and require, and that there unique physical and emotional health care needs are continually recognised and met. Policies and procedures for handling medication are adequate thus ensuring the people who use the service are kept safe. The home has ascertained the views of all the relevant people to ensure they have all the information they need to handle the death of someone who uses the service with respect and as the individual/family would wish. Raola House DS0000065735.V364285.R01.S.doc Version 5.2 Page 18 EVIDENCE: All three people who currently live at the home were suitably dressed in wellmaintained clothes that were age, gender, and seasonally appropriate. Peoples clothing also seemed to reflect their unique personalities and diverse cultural heritage. The proprietor told us a specialist hairdresser regularly visited the home to ensure the culturally specific hairstyle needs and preferences of one person who uses the service were always met. Relatively new health care action plans were produced on request for the two care plans being case tracked. The records indicated that these people had attended various appointments with a number of different health care professionals in the past year, including dentists and chiropodists. However, staff were not always able to locate information about the outcome of all the appointments people who use the service had attended with other health care professionals, despite reassurances from the proprietor that they had taken place. We recommend any information that relates to health care needs of the people who use the service be maintained in a bound single source document (i.e. in the aforementioned health care action plans) for ease of referencing and monitoring purposes. The proprietor told us that no one had been admitted to hospital or involved in any accidents since the home was last inspected. Staff met told us they were record any accidents that occurred in the home in the accident book, which the proprietor was able to produce on request. No recording errors were noted on any medication administration record (MAR) sheets in use within the home in the previous two months. As recommended in the homes last report any allergies the people who use the service may have are now recorded on these sheets. These records also reflected current stocks of medication held in the home on behalf of the people who use the service. The proprietor told us she carries out a thorough audit of the homes medication on a weekly basis. All medicines are securely stored in a locked metal cabinet attached to a wall in the games room. It was positively noted on one MAR sheet that the individuals GP was routinely involved in reviewing their medication regime. The proprietor told us that none of the people who use the service have the capacity to take greater control of their medication. This was the outcome of risk assessments carried out by the home, which are contained in everyone’s care plan. The home does handle Controlled Drugs (CD), which are securely stored in a locked box within the homes medication cabinet. Staff also maintain a separate Controlled Drugs register to record the receipt, administration and disposal of Raola House DS0000065735.V364285.R01.S.doc Version 5.2 Page 19 this type of mediation, which two staff always sign and date each time a CD is handled. This register accurately reflects current stocks of Controlled Drugs kept in the home on behalf of the people who use the service. Training certificates were produced on request for two members of staff on duty at the time of this inspection that they had received up to date training in the safe handling of medication in a residential care setting. One member of staff spoken with demonstrated a good basic knowledge of how medicines are used and the principles behind the homes medication policies and procedures. An independent pharmacist representing a Primary Health Care Trust recently visited the service in December 2007 and identified no major shortfalls regarding the homes medication handling practices. Peoples wishes regarding dying, and the arrangements they want after death have been openly and sensitively discussed with the individual (where practicable) and their families. These are clearly recorded in peoples care plans and known to the staff delivering the care. Raola House DS0000065735.V364285.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People who use the service experience good quality outcomes in this area. We have made this judgement using arrange of evidence, including a visit to this service. The homes arrangements for dealing with concerns and complaints ensure the people who use the service and their representative’s feel their views are listened too and taken seriously. However, an easy to read version of the complaints procedures should be produced to enable everyone who has a stake in the home to make a compliant if they wish. People who use the service are protected and kept safe by the safeguarding and managing challenging behaviour guidelines the home has in place. EVIDENCE: The homes complaints log revealed that there had been no informal concerns or formal complaints made about the homes operation since it was last inspected. One person who uses the service told us “staff usually listened to what they had to say and they could talk to them if they were unhappy”. A copy of the homes complaints procedure is conspicuously displayed on a notice board in the entrance hall. The procedure is not available in a particularly easy read format and we recommend it should be illustrated with far more pictures, symbols and photographs to enable everyone who has a stake in the service to access its contents. Raola House DS0000065735.V364285.R01.S.doc Version 5.2 Page 21 The proprietor demonstrated a good understanding of what the term safeguarding meant. As required in the homes previous inspection report the proprietor was able to produce documentary evidence on request to show that sufficient numbers of her current staff team had recently attended a suitable safeguarding vulnerable adults and managing challenging behaviour training courses. All three members of staff on duty at the time of this visit were spoken with as a group and were able to demonstrate a good understanding of what constituted abuse, and who they should report it too if they suspected or witnessed it. Staff told us they had not used any form of physical intervention techniques to deal with any incidents of challenging behaviour since the home was last inspected. One care plan contained specific guidance for dealing with challenging behaviour, which had recently been reviewed and up dated. All the staff met, including a relatively new member, told us they had read the new guidelines and demonstrated a good understanding of them. They correctly told us physical intervention techniques should only ever be used as a ‘last resort’ when all other measures to deescalate a potentially significant incident had failed. In 2007 a member of staff who worked at the home physically abused a person who lives there. The disclosure was investigated under Sutton Social Services safeguarding adult’s protocols, and subsequently upheld. The member of staff in question resigned shortly afterwards while still suspended from their duties. The proprietor was able to produce documentary evidence on request to show that as agreed at the subsequent case conference convened by Suttons safeguarding team (learning disabilities) the aforementioned mentioned member of staff has now been referred to the protection of vulnerable adults for possible inclusion on their register. The proprietor told us no allegations of abuse have been made within the home since 2007. One significant event has occurred in the home since it was last inspected. An intruder stole a number of staff’s belongings. Night staff on duty at the time appropriately dealt with the incident and as required in the homes previous inspection report we were notified in writing about the event in a timely fashion. The proprietor and all other staff met during this visit were able to demonstrate a good understanding of what constituted a significant incident or event, and to whom it should be reported. The proprietor was adamant that she would always report any incident that adversely affects the welfare of the people who use the service and that she has reminded her staff about their duty of care to keep the Commission informed about such occurrences. The balances recorded on financial sheets kept in respect of the people who use the service matched the amounts being held by the home on their behalves. There are also receipts for all purchases made by staff on behalf of the people who use the service, and their money is individually stored in Raola House DS0000065735.V364285.R01.S.doc Version 5.2 Page 22 lockable tins kept in the safe. The proprietor told us a qualified accountant is employed to carry out an annual audit of the homes finances. Raola House DS0000065735.V364285.R01.S.doc Version 5.2 Page 23 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, 28 & 30 People who use the service experience good quality outcomes in this area. We have made this judgement using arrange of evidence, including a visit to this service. Overall, the interior layout and decoration of the home, including its relatively well-maintained fixtures and fittings, ensures the people who use the service live in a relatively comfortable and non-institutional environment. Arrangements for monitoring the temperature of hot water used in baths and showers to ensure they remain at a constantly safe level are inadequate. This failure is placing the people who use the service at serious risk of harm and must be rectified as a matter of urgency. The home is also very clean and arrangements for controlling infection and sufficiently robust to ensure the people who use the service live in a hygienically clean. Raola House DS0000065735.V364285.R01.S.doc Version 5.2 Page 24 EVIDENCE: The homes living environment is relatively spacious, comfortable and very homely looking. During a tour of the premises it was noted the place was kept spotless clean by staff, which were witnessed sweeping the floor on several occasions after meals. The domestic style layout of the home also ensures the people who use the service can enjoy small group living which is non-institutional. For example, the people who use the service have a choice to sit and relax in various communal areas, the privacy of their own bedrooms or the quieter games room. However, there seems to be a lack of soft furnishings in the lounge. We recommend these communal areas would look more homely and welcoming if they were supplied with some more cushions and/or throws etc… One bedroom was viewed with the current occupants permission. The individuals told us they had “enough space in their bedroom to keep all their belongings and was happy with it”. The room was very personalised with lots of photographs and pictures hung on the walls. The homes extensive grounds at the rear of the property are extremely well maintained. Lots of well established plants, shrubs, and trees were noted, along with some patio furniture for people who use the service and their guests to enjoy this outdoor space. One person who uses the service seemed to spend lot of their time relaxing in the garden, while another person told us they liked gardening with staff. As required in the homes previous inspection report action has been taken to ensure shower units are fixed to ensure the temperature of hot water emanating from them never exceeds a safe 43 degrees Celsius. The proprietor told us all the homes baths have been fitted with fail-safe thermostatic mixer valves that prevented hot water temperatures exceeding 43 degrees Celsius. However, contrary to health and safety regulation the home does not posses a thermometer to test the valves at regular intervals. This health and safety check should be carried out at least once a week and a record kept of hot water temperatures found. The homes laundry room is accessed by going outside the house, but is suitably positioned so staff do not have to take foul or soiled laundry through any areas where food is prepared stored or eaten. The washing machine has a sluicing facility and a wash hand basin is predominately sited in the laundry room. Staff were observed wearing latex gloves at various times throughout the inspection and adequate supplies of these gloves were noted in bathrooms. A member of staff demonstrate a good understanding of the homes procedures Raola House DS0000065735.V364285.R01.S.doc Version 5.2 Page 25 for disposing of clinical waste. The proprietor told us the home has a contract for an external company to empty its outside clinical waste bins at least once a week. Raola House DS0000065735.V364285.R01.S.doc Version 5.2 Page 26 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, 33, 34, 35 & 36 People who use the service experience good quality outcomes in this area. We have made this judgement using arrange of evidence, including a visit to this service. People who use the service can be sure that they are safe because there are more than enough competent and in the main suitably trained staff on duty at all times. They also have confidence in the staff because checks have been done to make sure that they are suitable to care for them and they receive regular support from the proprietor. EVIDENCE: All three of the support workers on duty at the time of this site visit were observed interacting with all three of the people who currently use the service in a very caring and respectful manner. Typical comments made by one person who uses the service included, “the staff are nice”, and “staff take me out”. Raola House DS0000065735.V364285.R01.S.doc Version 5.2 Page 27 Three members of staff were on duty on arrival, which matched that morning’s staff duty roster. The proprietor that despite only have three people currently living at the home daytime staffing levels have remained unchanged ensuring the people who use the service can have one to one support. This ratio exceeds national Minimum standards for the number and needs of the people who currently use the service. The proprietor is commended for ensuring staffing levels are more than sufficient to meet the personal, social, and health care needs and wishes of the service users. Four members of staff who returned comment cards wrote there are ‘always’ enough staff on duty and one wrote there was ‘usually’. Furthermore, the ethnic, age, and gender mix of the current staff team is also very reflective of that of the service user group. The proprietor told us she was always mindful of the culturally diverse mix of the service users when she employed new staff. As previously mentioned in this report it was positively noted that at least one member of staff had the knowledge and skills to prepare a variety of Caribbean style food. The proprietor told us that none of the current staff team were enrolled on any external courses. As required in the homes previous inspection report the proprietor confirmed she would not allow students to work more than 20 hours a week at the home during term time. One new member of staff has been employed since the home was inspected. Documents obtained by the home in respect of this individual which were made available on request included: a completed application form; two written references, including one from their last job working with vulnerable adults; up to date criminal records bureau and Protection of vulnerable adults checks; and proof of their identity. The new member of staff told us their induction had been very thorough thus far and had covered safe working practices, their role and responsibilities, and the needs of the people who use the service. All staff that returned comment cards wrote there employer had carried out proper checks on them before they had started work at the home. These same members of staff also wrote they were ‘always’ given up to date information about the needs of the people they support and felt they had been given training that was relevant to their role. The proprietor has now carried out a thorough training needs and development assessment of her staff team, which on the whole revealed the vast majority of the long standing permanent members of staff are suitably trained. E.g. all staff have received mandatory training in fire safety, manual handling, food hygiene, safeguarding adults, managing challenging behaviours, and medication. Furthermore, documentary evidence was produced on request to show that 100 of the homes staff team have achieved a National Vocational Qualification - level 2 or above in care, which the proprietor is commended for. Raola House DS0000065735.V364285.R01.S.doc Version 5.2 Page 28 However, as a result of the recent training audit the proprietor told us she was aware there were gaps in staff’s knowledge of basic first aid, which she is in the process of addressing. We also recommend staff receive additional training in a number of specialist areas including understanding autism, PICA, and continence promotion. We examined the personal file of two members of staff who were on duty at the time of this inspection, which revealed they had each received three formal supervisions with the proprietor in the past six months. Both these staff had also received an appraisal of their overall performance in this time. These records revealed these supervision sessions covered a variety of relevant topics including, staff training needs, and safeguarding and managing challenging behaviour issues. A relatively new member of staff told us they felt they ‘got a lot of support from the proprietor’. The minutes of the homes two most recent staff meetings were produced on request, which showed they were being held approximately once a quarter. Both these meetings had been well attended and each covered a variety of topics that were relevant to the running of the home, including the changing needs of the people who live there. Raola House DS0000065735.V364285.R01.S.doc Version 5.2 Page 29 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 & 42 People who use the service experience good quality outcomes in this area. We have made this judgement using arrange of evidence, including a visit to this service. The proprietor now has more time to be involved in the day-to-day running of the home now she is responsible for managing just Raola House, which has benefited the people who use the service. The homes quality assurance and self-monitoring systems are excellent ensuring all the people who have a major stake in how the service is run have their views taken into account and can help it develop. The welfare of people who use the service and staff are promoted and protected because the homes health and fire safety arrangements are sufficiently robust to keep them safe. Raola House DS0000065735.V364285.R01.S.doc Version 5.2 Page 30 EVIDENCE: The proprietor told us she is no longer responsible for managing the day-today operation of two other care establishments she’s owns in the area. Consequently, Mrs Obaro has more time to focus on managing Raola, which we agree can only benefit the people who live and work there. The proprietor has a lot of experience managing care homes and was able to demonstrate she has the knowledge and skills to run Raola effectively. Since the homes last inspection the proprietor now employs an independent consultant to provide her with independent advice and to carry out regular inspections of the home as part of an effective quality assurance system. The subsequent reports produced by the independent consultant are very thorough and cover every aspect of life in the home. The proprietor is commended for seeking the views of an external social care professional as a means of improving the standard of care provided by the home. In addition to these reports the home has produced an annual report, which is based on the views of the people who use the service, their relatives and their professional representatives. The proprietor was able to produce a fire risk assessment for the building on request, which had been up dated in September 2007. New safety notices were now conspicuously displayed in the conservatory as a result of the outcome of the recently up dated fire safety assessment. Fire records revealed the homes fire alarm system is tested on a weekly basis and fire drills carried out on a quarterly basis in line with recommended good fire safety guidelines. During a tour of the premises it was noted that all products hazardous to health were being kept securely locked away as required in the homes previous inspection report. Up to date Certificate of worthiness were made available on request to show that suitably qualified engineers had checked the homes gas installations, water heating systems (legionella), fire extinguishers and alarms, and portable electrical appliances in the past twelve months. Raola House DS0000065735.V364285.R01.S.doc Version 5.2 Page 31 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 2 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 3 27 2 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 4 34 3 35 2 36 3 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 2 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 X 4 X X 3 X Raola House DS0000065735.V364285.R01.S.doc Version 5.2 Page 32 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. 1. Standard YA1 Regulation 5(1)(bc) Requirement All the people who use the service and their representatives must have up to date contracts that make it clear what facilities and services are considered ‘extras’ (i.e. not covered by the basic cost of each placement) for which they will be charged. This will ensure the people who use the and/or their representatives have all the information they need to know about the home in order to determine whether or not they are getting value for money. The temperature of hot water emanating from all the homes baths and shower units must be tested at regular intervals, and outcomes recorded, including any action taken to remedy faults identified. There must be at least one first aid trained person in the home at all times to ensure the people who use the service receive appropriate treatment in the even of an accident occurring. DS0000065735.V364285.R01.S.doc Timescale for action 01/09/08 2. YA27 13(4) 01/08/08 3. YA35 13(4)(c) 23/09/08 Raola House Version 5.2 Page 33 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 YA1 Good Practice Recommendations The homes statement of purpose and guide should be amended further to include a date and more detailed information about the full range of needs the service intends to meet (i.e. sensory impairment). This will ensure prospective new service users and their representatives will have access to all the information they need to know about the home in order to decide whether or not it is the right place for them. A wider variety of ‘age’ appropriate social and recreational resources should be obtained to enable the people who use the service more opportunities to engage in more meaningful and stimulating activities. The way in which the service records the outcome of all the appointments people who use the service attend with various health care professionals should be reviewed as the current approach is variable. If staff appropriately maintain a single source record of all health care check ups and appoints people who use the service attend this make monitoring their health easier. People who use the service and their representatives should have access to easy to read versions of the homes complaints procedures. This will ensure everyone who has a stake in the service will know how to raise their concerns and how long they can expect to wait for a response if they are dissatisfied with the home. Communal areas such as the main lounge and conservatory should be supplied with more soft furnishings. This will ensure the people who use the service live in a more homely and comfortable environment. More of the homes staff team should receive specialist training in understanding and working with people who DS0000065735.V364285.R01.S.doc Version 5.2 Page 34 2. YA14 3. YA19 4. YA22 5. YA28 6. YA35 Raola House have been assessed as having autism, PICA, and continence issues. This will ensure the people who use the service receive the person centred support that meets their needs. Raola House DS0000065735.V364285.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Raola House DS0000065735.V364285.R01.S.doc Version 5.2 Page 36 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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