Care Home: Real Life Options 90 Capel Gardens

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What the care home does well The home is retaining staff very well and staff is very familiar with residents needs, behaviours, likes and dislikes. The team is working very well together allowing residents to live in an environment without any added tension. Staff are very well trained and supported to gain qualifications in care; this provides a skilled workforce to people using the service. Assessments are done very detailed ensuring that the home is meeting the needs of prospective residents. Care plans are person centred and a range of communication styles are used, this allows people using the service to take part in the review process and make choices about their live. What has improved since the last inspection? The home has met all requirements made during the last key inspection, which has improved the overall quality outcome for people using the service. The medication procedure has improved, liquid medication is now signed once opened by staff; this ensures people using the service are not administered medicines which are out of date. All staff has received Safeguarding adults training and demonstrates good knowledge of reporting and recording abuse allegations, which allows residents to report any allegations safely. The damp patch in the hallway has been repaired and the manager told us that three service users rooms have been redecorated, to improve living conditions for people using the service. Control of Substances Hazardous to Health material is now locked away safely. The registered manager has left, before achieving qualifications in care and management. The home send us an annual development plan following the last key inspection. CARE HOME ADULTS 18-65 Real Life Options 90 Capel Gardens 90 Capel Gardens Pinner Middlesex HA5 5RD Lead Inspector Andreas Schwarz Key Unannounced Inspection 4th July 2008 09:00 Real Life Options 90 Capel Gardens DS0000017523.V365961.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 Real Life Options 90 Capel Gardens DS0000017523.V365961.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. Real Life Options 90 Capel Gardens DS0000017523.V365961.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Real Life Options 90 Capel Gardens Address 90 Capel Gardens Pinner Middlesex HA5 5RD 020 8868 7149 F/P 020 8868 7149 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) www.reallifeoptions.org Real Life Options Mr Pankaj Bhalla Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Real Life Options 90 Capel Gardens DS0000017523.V365961.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 6 5th July 2007 Date of last inspection Brief Description of the Service: 90 Capel Gardens is a registered care home providing personal care and accommodation for 6 men aged 18-65 who have learning disabilities. The home had no vacancies during this inspection. The home is a detached two storey building in a quiet cul-de-sac in a residential area. It is close to shops and transport links in Pinner and North Harrow. There is a bus stop at the bottom of the street and the home has its own people carrier to transport service users to community facilities. Each person living in the home has his own bedroom. There is a bathroom on each floor and an additional toilet. There are separate lounge and dining areas and a well-maintained garden. Fees and charges can be obtained from the registered manager on request. Real Life Options 90 Capel Gardens DS0000017523.V365961.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The outcomes for people using the service are good; this is a two star service. This unannounced key inspection took place in July 2008 and lasted the whole day. The new acting manager was available throughout this inspection. The previous manager visited during the morning of this key inspection. We spoke to five members of staff during their team meeting and observed them interacting and supporting people using the service. We have received three service users surveys and one staff survey. The home returned a completed Annual Quality Assurance Assessment within the given time scale. We assessed three care plan, three staff files, policies, procedures and other documents enabling us to make a quality judgement. The home has kept the Commission for Social Care Inspection informed of any significant events occurring during the inspection year. We would like to thank everybody involved and supporting the Commission for Social Care Inspection during this key inspection. What the service does well: The home is retaining staff very well and staff is very familiar with residents needs, behaviours, likes and dislikes. The team is working very well together allowing residents to live in an environment without any added tension. Staff are very well trained and supported to gain qualifications in care; this provides a skilled workforce to people using the service. Assessments are done very detailed ensuring that the home is meeting the needs of prospective residents. Care plans are person centred and a range of communication styles are used, this allows people using the service to take part in the review process and make choices about their live. Real Life Options 90 Capel Gardens DS0000017523.V365961.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. Real Life Options 90 Capel Gardens DS0000017523.V365961.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 Real Life Options 90 Capel Gardens DS0000017523.V365961.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): We looked at National Minimum Standards 1 and 2 during this key inspection. People using the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. Significant time and effort is spent planning to make admission to the home. Prospective residents and their families are treated as individuals and with dignity and respect for the life-changing decisions they need to make. The home has developed a comprehensive statement of purpose and service user’s guide, which is very specific to the resident group and considers the different styles of accommodation, support, treatment, philosophies and specialist services required to meet the needs of people who use the service. EVIDENCE: This is what you told us in your Annual Quality Assurance Assessment: A detailed organisational policy on referrals and admissions is in place, they are available in a user-friendly format. We assess with the Person Centred Planning process whether the home is meeting peoples needs. All residents have a licence agreement, statement of purpose and service users guide, which is provided to them on admission. This is what we found during this inspection: Real Life Options 90 Capel Gardens DS0000017523.V365961.R01.S.doc Version 5.2 Page 9 The home has a very detailed statement of purpose and service users guide in place. Both documents use pictures and symbols enabling people who are unable to read accessing it. The statement of purpose details what care is provided by the home and how the home is planning to meet prospective people using the service needs. The new manager told us that she is currently in the process of updating the service users guide, to bring in line with current changes within the field of health and social care. The home has admitted two new residents since the last key inspection and has no longer any vacancies. The previous manager has undertaken assessments. He visited the prospective residents at their home and did a full needs assessment. The needs assessment looked at areas such as general information, social communication, which includes relationships and Triad of Impairments, physical wellbeing, emotional wellbeing, material wellbeing, challenging behaviour (this section was very detailed in both assessments viewed), risk assessments and service requirement, which includes looking at diversity issues. Staff from the previous has been involved in the assessment process. Prospective residents had trial visits to the home, which have been recorded. Due to level of disabilities the service users were not able to communicate their views verbally, but the holistic approach within the assessments process allowed the home to make a clear decision if they are able to meet the complex needs. We observed the two new admissions during this visit and noted that they were very relaxed and at home in Capel Gardens. Real Life Options 90 Capel Gardens DS0000017523.V365961.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): We assessed National Minimum Standards 6, 7 and 9 during this inspection People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The key principle of the home is that people using the service are in control of their lives and they direct the service. Staff is fully committed in supporting individuals to lead purposeful and fulfilling lives as independently as possible. People using the service make their own informed decisions and have the right to take risks in their daily lives. EVIDENCE: This is what you told us in your Annual Quality Assurance Assessment: You have good documentation of peoples likes and dislikes. Your care plans become more person centred, by using pictures and symbols. You tried to involve people much more in care planning processes. Key workers have very Real Life Options 90 Capel Gardens DS0000017523.V365961.R01.S.doc Version 5.2 Page 11 good relationships with their key clients. You have positive and detailed risk assessments in place. This is what we found during this inspection: During this key inspection we looked at three care plans, two of the plans were of residents recently being admitted to the home. Care plans are person centred and called “This is my life”. They are split in four parts. Part one is called “all about me”, which addresses medication, allergies, and health issues. Part two is called “Looking after myself”, which addresses personal care and hygiene. Part three is looking at likes and dislikes and part four is looking at activities. Care plans are using pictures and symbols making them available for a wider audience. Care plans have been reviewed; we spoke to one key worker who informed us that she used visual prompts such as happy, sad, angry, upset to enable the person participating in the process. Each care plan has clear goals. These goals are assessed monthly during key working meetings, which are clearly recorded. People’s progress is recorded in daily records, which are of very high standard and outcome based. The home is using a proforma for daily records, which is based on National Minimum Standards outcome groups. During discussions with staff we were told that individual key workers have excellent relationships with residents, this was evidenced by the reduction of challenging behaviour, pictures viewed of outings and interactions observed during this key inspection. We checked financial records, which are all of good standard. Previous financial irregularities have been addressed and people using the service have been reimbursed as required by the Commission for Social Care Inspection. The manager informed us that she tried to access advocacy, but was not able to do so, due to the lack of funding and availability in the local borough. People likes, dislikes and choices are recorded in their care plans. Residents living in Capel Gardens require support to access their benefits and finances, records are of good standard and people are protected by good guidance and policies. We viewed detailed risk assessments in all of the three files assessed during this inspection. All risks are individually scored and depending on the level of severity a risk management plan is put into place. Risk assessments are reviewed during care plan reviews or as and when required. Real Life Options 90 Capel Gardens DS0000017523.V365961.R01.S.doc Version 5.2 Page 12 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): We assessed National Minimum Standards 12, 13, 15, 16 and 17 during this key inspection. People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service has a strong commitment enabling residents to develop or maintain their skills, including social, emotional, communication, and independent living skills. People who use the service have the opportunity to develop and maintain important personal and family relationships. The staff team help with communication skills, both within the service and in the community, to enable residents to fully participate in daily living activities. Residents are involved in meaningful daytime activities of their own choice and according to their individual interests, diverse needs and capabilities. The menu is varied with a number of choices including a healthy option. It includes a variety of dishes that encourage individuals to try new and sometimes unfamiliar food. The meals are balanced and nutritious and cater for the varying cultural and dietary needs of individuals. Real Life Options 90 Capel Gardens DS0000017523.V365961.R01.S.doc Version 5.2 Page 13 EVIDENCE: This is what you told us in your Annual Quality Assurance Assessment: The home is encouraging good relationships with family members. Two residents attend regular church services. All residents have a skills development plan. Residents visit west end theatres, cinemas, pubs and café’s and have library and gym member ships. One of the people living at the home is attending Drama and Movement therapy regularly. This is what we found during this inspection: Five residents use a day service in Stanmore, which is provided by Real Life Option. The home is providing tailor-made activities to one service user, i.e. food preparation class, and weekly drama and movement classes. The person will attend these activities on a weekly basis. In the daycentre residents have structured activities such as painting, cooking, etc. Staff told us that residents take part in household activities such as clearing and setting the table, taking out the rubbish. We observed one resident taking out the rubbish during this inspection. The home is located in Pinner and fits in with the rest of the buildings in the Close. The manager told us that the home has good links with the local community. Two residents go to the local church every weekend. Daily records documented residents going to the local library, cinemas and café’s. The home has a minibus, which is used to take residents to activities and outings. We received three service users surveys, which have been completed by the key worker due to residents’ limited ability. Surveys told us that residents go on drives and walk in parks. Families and significant others are involved in care planning process. One resident is visiting regularly his brother and staff helps him to do this. One key worker told us that the home has supported a resident to make contact with his sister, who is now visiting regularly. Staff told us that they have received sexuality training. We have viewed guidance in how to deal with residents’ inappropriate behaviour. All residents have a key to their room; the keypad on the front door has been removed. This allows residents to leave the building without informing staff. The manager told us that she is planning to fit a bell to the front door, which would alert staff when the door is opened. We observed staff interacting with Real Life Options 90 Capel Gardens DS0000017523.V365961.R01.S.doc Version 5.2 Page 14 residents professionally and sensitive to their needs. One service users survey told us that the resident would go to his room if he wants to be on their own. Residents returned from the day centre towards the later part of this inspection and we observed them moving around freely and accessing all parts of the home. Staff informed us that the menu is planned together with the residents, by using pictures, which allows people to point at the dishes they like. The home is providing a range of different meals, which is cooked by staff. People using the service help staff to prepare ingredients for cooking meals. The fridge and freezer was fully stocked and fruit and vegetables were available on the day of this unannounced key inspection. The menu is varied and reflects people’s cultural background. Real Life Options 90 Capel Gardens DS0000017523.V365961.R01.S.doc Version 5.2 Page 15 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): We looked at National Minimum Standards 18, 19 and 20 during this inspection. People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Personal healthcare needs including specialist health, nursing and dietary requirements are clearly recorded in each health action plan. Personal support is responsive to the varied and individual needs and preferences. Staff have access to training in health care matters. Staff respect privacy and dignity and are sensitive to changing needs. The home has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. Medication records are fully completed, contain required entries, and are signed by appropriate staff. EVIDENCE: This is what you told us in your Annual Quality Assurance Assessment: Real Life Options 90 Capel Gardens DS0000017523.V365961.R01.S.doc Version 5.2 Page 16 The home has good contact and relationships with Harrow Learning Disability Team Clinics, such as Epilepsy clinic, Psychiatry clinic and the community nurse team. You have a detailed medication policy in place. Care plans provide good information in supporting people around their personal care needs such as toileting, shaving, dressing, etc. Due to budget cuts in the local Primary Care Trust access to challenging behaviour teams, speech and language support has suffered. This is what we found during this inspection: We looked at three care plans; all care plans had detailed guidelines for staff supporting people around their personal care. The guidelines are updated and reviewed within the care planning review process. People using the service were dressed appropriately and clean. Toilet and bathroom facilities can be closed from the inside ensuring peoples privacy. Letters and documents in personal files show that people using the service receive input from Harrow Learning Disability team. Though the relevant teams have cancelled some of the support previously received. All residents have a designated key worker; we spoke to one key worker who showed great enthusiasm in supporting her key client towards being more independent. Residents living at Capel Gardens are fully mobile. Residents are registered with a local General Practitioner. The acting manager showed as a new form to record outcomes and actions from visits to Health care professionals. All residents have a health action plan, which is using pictures and symbols. Staff told us that this encourages residents to take part in reviewing the health action plans. People with epilepsy have clear guidelines and epilepsy risk assessments in place. Staff has received epilepsy training. The community nursing team previously trained staff in rectal diazepam administration. This has been stopped due to budget cuts. The home is no longer administering rectal diazepam and guidelines have been updated and changed. The manager told us that the home has been commended by the epilepsy clinic on the monitoring of epileptic seizure. We viewed the document, which is of excellent standard using colours, pictures and diagrams. Health care records show that residents have regular optician, dentist and chiropodist input. The General Practitioner is reviewing medication every six months. The home is using the NOMAD system, which is packed and dispensed by a local pharmacist. Medication is stored safely in a lockable cabinet and the shift leader holds the key. Medication Administration Sheets have no gaps and allergies are recorded. We noted that one of the Medication Administration Sheets had a label giving information about the name, dose and route of the medication. The Royal Pharmaceutical Society recommends handwriting or printing Medication Administration Sheet and not to use labels. All staff have received medication training and demonstrated good knowledge of side effects some of the medication administered can have. The home has clear medication Real Life Options 90 Capel Gardens DS0000017523.V365961.R01.S.doc Version 5.2 Page 17 guidance for staff in place. None of the residents living at Capel Gardens are able to self administer medication. Real Life Options 90 Capel Gardens DS0000017523.V365961.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): We looked at National Minimum Standards 22 and 23 during this key inspection. People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has an open culture that allows residents to express their views and concerns in a safe and understanding environment. The service has a complaints procedure that is clearly written and easy to understand. The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. EVIDENCE: This is what you told us in your Annual Quality Assurance Assessment: The home has complaints, whistle blowing, safeguarding adults and physical intervention policies in place. The safeguarding adults, complaints and whistle blowing policies are available in a user-friendly format. Staff have received Safeguarding adults training. The home did not receive any complaints since the last inspection. This is what we found during this inspection: We assessed complaints records during this key inspection; no complaints have been recorded since our lat key inspection. The complaints policy is available in pictorial form and makes reference to the whistle blowing policy. Real Life Options 90 Capel Gardens DS0000017523.V365961.R01.S.doc Version 5.2 Page 19 The policy is displayed on the notice board in the hallway and can be accessed in the service users guide. Staff spoken to told us that they would record complaints and inform the manager to deal with the complaint. All staff confirmed that they are confident that the manager would deal with complaints appropriately. Previous complaints have been recorded and dealt with according to policy and guidance and outcomes have been recorded. The home has clear Safeguarding adults procedures in place. Staff demonstrates good knowledge in regards to recording and reporting of safe guarding adult’s allegations. Previous Safeguarding adults’ allegations have been dealt with appropriately and lessons have been learned. People’s financial records and contributions have been improved. All staff have received Safeguarding adults training, which was clearly recorded and confirmed by staff spoken to during this inspection. Real Life Options 90 Capel Gardens DS0000017523.V365961.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): We looked at National Minimum Standards 24 and 30 during this inspection People using the service experience good outcomes in this area. 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. Residents are encouraged to personalise their bedrooms. All the home’s fixtures and fittings meet the needs of individuals and can be changed if their needs change. The home is well lit, clean and tidy and smells fresh. The management has a good infection control policy EVIDENCE: This is what you told us in your Annual Quality Assurance Assessment: The home reflects the taste of those who live there, pictures are displayed and bedroom are personalised. The home is easy to access and has close links with public transport facilities. The home has an allocated maintenance budget. Real Life Options 90 Capel Gardens DS0000017523.V365961.R01.S.doc Version 5.2 Page 21 This is what we found during this inspection: Capel Gardens is located in Pinner, close to bus routes and shopping facilities. The home is nicely decorated and feels homely. A member of staff showed us around the home. We viewed one of the resident’s rooms. Staff decorated the room together with the resident. Staff told us that the resident has chosen the colours, and pictures are displayed. The home has removed the keypad from the front door due to one person leaving the home. The manager is telling us that she is looking in purchasing a bell, which would alert staff if the door is opened. Curtains are fixed with Velcro as a response to resident’s behaviours. The Operation manager told us that the home is planning to break through the wall. This would allow residents and staff having direct access to the utility room, without leaving the premises. We noted the two freezers in the garage, which have a built up of ice and are in need of being defrosted. The manager told us that three bedrooms have been redecorated in the past year. The home was clean and free of any offensive odours. Controls of Substances Hazardous to Health products are safely stored in the sluice room. The laundry room is based in the garage and a semi professional washing machine and dryer is in place. Staff told us that both machine are in good working condition. The home has Health and Safety policies, infection control and Control of Substances Hazardous to Health policies in place. Real Life Options 90 Capel Gardens DS0000017523.V365961.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): We looked at National Minimum Standards 32, 34, 35 and 36 during this inspection People using the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service has a recruitment procedure that has the needs of people who use the service at its core. The recruitment of good quality carers is seen as integral to the delivery of a good service. The service has plentiful staff available at all times to support the needs, activities and aspirations of residents in an individualised and person centred way. Management prioritise training and facilitate staff members to undertake external qualifications beyond basic requirements. The home has internal developmental training, to complement formal training as part of an ongoing training plan. Staff meetings take place regularly. Supervision sessions are regular and staff find them helpful with a focus on improving outcomes for people using the service. EVIDENCE: Real Life Options 90 Capel Gardens DS0000017523.V365961.R01.S.doc Version 5.2 Page 23 This is what you told us in your Annual Quality Assurance Assessment: The home has a good record of retaining staff. The organisation is providing mandatory and job specific training. Regular team meetings, supervisions and appraisals are arranged. The organisation has comprehensive employment checks in place. Following the completion of the six months probation staff can access National Vocational Qualification in Care training. This is what we found during this inspection: We observed a staff meeting, which was attended by five staff and the acting manager. Staff told us that staffing ratios allow them to support and meet residents’ needs. The manager told us that 3 staff works in the morning, 3 staff works during the afternoon and two staff work during the night. Staff told us that they have been working together for a number of years and are very familiar with peoples needs. Staff come from different cultural and educational backgrounds. The home is fully staffed with a staff compliment of 14. Four staff hold their National Vocational Qualification in Care and six currently work towards this, this exceed minimum requirements. We looked at three staffing files during this inspection. The required documentation such as Criminal Records Bureau checks, references, application forms are kept centrally and can be obtained on request. Staff told us that they had to provide references and documentation to obtain a Criminal Records Bureau check. An up to date recruitment procedure is in place and evidence shows that the procedure has been followed. We looked at training and development plans and spoke to staff. Staff told us that training provided by the organisation is very good. All staff has received food hygiene, manual handling, First Aid, Safeguarding adults, Medication and Health and Safety training. Staff who have been working at the home for a while have received training refreshers. Staff told us that they have to do a induction based on Learning Disabilities Award Framework standards. Training records viewed during this inspection are of good standard and up to date. Staff told us that they are doing their National Vocational Qualification in Care and are very well supported by the management of the home in achieving this qualification. We looked at three staffing files all had records of supervisions and appraisals in place. The average of supervisions provided is six, which is minimum requirement. Staff attends regular team meetings and informed us that they feel very well supported by the management. Real Life Options 90 Capel Gardens DS0000017523.V365961.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): We looked at National Minimum Standards 37, 39 and 42 during this inspection. People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The manager has the required experience and is competent to run the home. The manager leads and supports a strong staff team who have been recruited and trained to a high standard. The Annual Quality Assurance Assessment contains clear, relevant information that is supported by a wide range of evidence. The home works to a clear health and safety policy. All staff are fully aware of the policy and are trained to put theory into practice. Regular random checks take place to ensure they are working to it. EVIDENCE: Real Life Options 90 Capel Gardens DS0000017523.V365961.R01.S.doc Version 5.2 Page 25 This is what you told us in your Annual Quality Assurance Assessment: The Portable Appliances Test Certificate will expire in July 2008, the Landlords Gas Safety Certificate has been updated in February 2008, and Fire equipment and detections systems are checked regularly. Regular provider visits are undertaken and Health and Safety is audited quarterly. The manager has attended Mental Capacity Act training. The home has met all Commission for Social Care Inspection requirements from the last inspection. This is what we found during this inspection: The registered manager has been promoted to Regional Manager in May 2008, the organisation informed us in writing about this. The deputy manager was successful and has been appointed as the acting manager. The interview for the permanent post is planned for September 2008. Staff spoke very positive about the appointment of the acting manager and she confirmed that all staff are very supportive towards her. A valid and current insurance certificate is displayed in the office. The acting manager has a wide range of experience, but is in need of obtaining her National Vocational Qualification in Care Level 4 and Registered Managers Award. The home has an annual improvement plan in place, which is reviewed quarterly and is based on Commission for Social Care Inspection outcome groups. The food budget has been increased, due to the increase in food prices. The home has forwarded the previous annual development plan, which demonstrates residents’ involvement in this process. The home is encouraging people using the service to take part in regular residents meetings and stakeholders’ surveys are sent out annually. The home is undertaking weekly and monthly Health and Safety checks. Certificates are in place and information provided in the Annual Quality Assurance Assessment is confirmed. Staff spoken to had a good understanding of Health and Safety procedures and responsibilities. The London Fire and Emergency Planning Authority visited the in 2005 and no concerns have been noted. The fire risk assessment is up to date and call points are checked weekly. During 2006/07 the home had four fire drills, during 2007/08 the only recorded drill was on 07/11/2007. Real Life Options 90 Capel Gardens DS0000017523.V365961.R01.S.doc Version 5.2 Page 26 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 4 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 X 34 3 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 2 X Real Life Options 90 Capel Gardens DS0000017523.V365961.R01.S.doc Version 5.2 Page 27 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 YA24 Regulation 23(2)(c) Requirement The registered person must ensure that freezers are regular defrosted as this could lead to them not working properly and food not being stored safely. The registered person must ensure that the acting manager is obtaining the necessary qualifications to manage a care home and register with the Commission for Social Care Inspection. The registered person must ensure that a minimum of four fire drills are arranged per year, to provide a safe and secure environment for people using the service. Timescale for action 15/08/08 2. YA37 8&9 31/12/08 3. YA42 23(4)(e) 15/08/08 Real Life Options 90 Capel Gardens DS0000017523.V365961.R01.S.doc Version 5.2 Page 28 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 YA20 Good Practice Recommendations The responsible person should not use labels on Medication Administration Sheet as recommended by the Royal Pharmaceutical Society. Real Life Options 90 Capel Gardens DS0000017523.V365961.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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