Care Home: Repton Road,73

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What the care home does well Information is provided to those using the service that enables them to make decisions about whether the home is right for them and includes the terms and conditions under which they are to live. Residents live are in an environment that values and supports them as individuals with an aim to enable them to live independently. One resident told the inspector "staff have helped me to look after myself". The staff are very aware of the needs of the residents and the support they require through comprehensive care planning and risk assessments. They also monitor individual health needs and access to appropriate healthcare professionals is ongoing. People are encouraged to make decisions and choices about the way they want to live and are supported in this. This includes the how they wish to spend their days and choices over meals and what they wish to eat. Routines are flexible and staff encourage residents to access community activities, including leisure and social interests as well as day centres for improving skills for job opportunities. Residents are able to speak to staff if they are unhappy with the care received or if they want to discuss the support they require. They are confident that they will be listened to and their concerns taken seriously and feel staff value their views. "Staff are there for me if I want to talk to them and I can always talk to Jon." Repton Rd is a well maintained home that provides people living there with a clean, comfortable and homely place to live.Staff are well trained, qualified and supervised to ensure individuals receive the care and support to enable them to keep safe and well and to reach their aims. The home is well managed by a management team who keeps people safe and looks to continuously improve the quality of care. What has improved since the last inspection? It is positive to note the way the improvements have been made to care plans and risk assessments to ensure they reflect the health, personal and social care needs of individuals and minimises risks. What the care home could do better: There are a few areas that require improvement and a number of requirements that remain unmet from the last inspection. Where residents have been assessed that the home is able to meet their needs, this must be confirmed in writing assuring the prospective resident that they will receive the required support. This remains unmet. The last inspection required a review of the individual service and a report on the findings sent to the Commission. This still has not been met and without this the manager cannot be aware of how the service can be improved for individuals. The last inspection required staff to receive training to provide knowledge and guidance on how they can care and support those with autism. This has still not been addressed. The manager is reminded that the Commission may decide to take further enforcement action if requirements remain unmet. Requirements were also made at this inspection. Medication practices and procedures must be further improved to ensure staff have up to date information and guidance on residents` needs, as well as ensuring there are sound procedures for administration for those taking medication away from the home.Staff were aware of their basic responsibilities regarding safeguarding of adults. However, this is despite the lack of appropriate procedures in the home. These must be reviewed and full guidance provided for staff to view when needed. There are also two areas that affect the health and safety residents and must be addressed without delay. Recruitment procedures must be improved to ensure staff working in the home, have undergone the required checks. CARE HOME ADULTS 18-65 Repton Road,73 Orpington Kent BR6 9HT Lead Inspector Wendy Owen Unannounced Inspection 25th October 2007 10:00 DS0000006908.V349231.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 DS0000006908.V349231.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. DS0000006908.V349231.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Repton Road,73 Address Orpington Kent BR6 9HT 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) 01689 836661 01689 836661 jon.cribbens@community-options.org.uk Community Options Limited Care Home 5 Category(ies) of Past or present alcohol dependence (5), Past or registration, with number present drug dependence (5), Mental disorder, of places excluding learning disability or dementia (5) DS0000006908.V349231.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 5 Adults with a mental disorder who may also have past or present alcohol or drug dependence 13th December 2006 Date of last inspection Brief Description of the Service: 73 Repton Road is a large two-storey semi-detached house located in a quiet residential area of Orpington. It provides care and accommodation for five adults with mental ill health. This home is part of a group of homes within the community that specialises in residential care for people within the mental ill health category. The aim is to support people to enable them to live independently. A manager and team of support workers, provide twenty-four hour care. Community Options works in partnership with the area mental health teams and Hyde Housing to provide support to service users. Service users accommodation is on both floors, accessed by steep stairs, making it unsuitable for people with significant mobility difficulties. All bathroom, toilet and bedrooms are fitted with locks that can be accessed from the outside in case of an emergency. Service users have appropriate medical cover on admission and each service user is registered with a GP of their choice, whenever possible. They also receive treatment from a range of other health care professionals as required. The fees charged are the same for all service users, if they are subject to a S117. If they are not they may be asked to make a contribution. The terms and conditions of residency detail what is included in the fees. A Statement of Purpose and Service Users Guide have been developed to provide information to those wishing to use the service. DS0000006908.V349231.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection visit took place over one day and included brief discussions with the three residents, one member of staff and the manager. The visit also included written surveys by relatives, residents and professionals from other agencies. Records were viewed and a tour of the home undertaken. Information from the Annual Quality Assurance Assessment (AQAA) and Provider monitoring visits is also included as part of the inspection. What the service does well: Information is provided to those using the service that enables them to make decisions about whether the home is right for them and includes the terms and conditions under which they are to live. Residents live are in an environment that values and supports them as individuals with an aim to enable them to live independently. One resident told the inspector “staff have helped me to look after myself”. The staff are very aware of the needs of the residents and the support they require through comprehensive care planning and risk assessments. They also monitor individual health needs and access to appropriate healthcare professionals is ongoing. People are encouraged to make decisions and choices about the way they want to live and are supported in this. This includes the how they wish to spend their days and choices over meals and what they wish to eat. Routines are flexible and staff encourage residents to access community activities, including leisure and social interests as well as day centres for improving skills for job opportunities. Residents are able to speak to staff if they are unhappy with the care received or if they want to discuss the support they require. They are confident that they will be listened to and their concerns taken seriously and feel staff value their views. “Staff are there for me if I want to talk to them and I can always talk to Jon.” Repton Rd is a well maintained home that provides people living there with a clean, comfortable and homely place to live. DS0000006908.V349231.R01.S.doc Version 5.2 Page 6 Staff are well trained, qualified and supervised to ensure individuals receive the care and support to enable them to keep safe and well and to reach their aims. The home is well managed by a management team who keeps people safe and looks to continuously improve the quality of care. What has improved since the last inspection? What they could do better: There are a few areas that require improvement and a number of requirements that remain unmet from the last inspection. Where residents have been assessed that the home is able to meet their needs, this must be confirmed in writing assuring the prospective resident that they will receive the required support. This remains unmet. The last inspection required a review of the individual service and a report on the findings sent to the Commission. This still has not been met and without this the manager cannot be aware of how the service can be improved for individuals. The last inspection required staff to receive training to provide knowledge and guidance on how they can care and support those with autism. This has still not been addressed. The manager is reminded that the Commission may decide to take further enforcement action if requirements remain unmet. Requirements were also made at this inspection. Medication practices and procedures must be further improved to ensure staff have up to date information and guidance on residents’ needs, as well as ensuring there are sound procedures for administration for those taking medication away from the home. DS0000006908.V349231.R01.S.doc Version 5.2 Page 7 Staff were aware of their basic responsibilities regarding safeguarding of adults. However, this is despite the lack of appropriate procedures in the home. These must be reviewed and full guidance provided for staff to view when needed. There are also two areas that affect the health and safety residents and must be addressed without delay. Recruitment procedures must be improved to ensure staff working in the home, have undergone the required checks. 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. DS0000006908.V349231.R01.S.doc Version 5.2 Page 8 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 DS0000006908.V349231.R01.S.doc Version 5.2 Page 9 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): 1,2,4,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is provided on the care and support offered to people who wish to use the service to enable them to make a decision if the service is right for them. The assessment process ensures staff have the information they need to support individuals and means people whose needs they cannot meet are not admitted into the home. EVIDENCE: Information is provided for those interested in using the service in the form of a Service Users Guide and Statement of Purpose. Copies of this information is provided to residents and kept, by them, in their rooms. The Statement of Purpose covers the areas required by the Regulations. There are currently three residents living in the home with three having moved on to semi-independent living in recent months. The pre-admissions procedures are comprehensive and ensure that individuals wanting to live in the home are provided with information and are assessed to DS0000006908.V349231.R01.S.doc Version 5.2 Page 10 ensure the home can meet their needs. They are also invited to visit the home as part of the decision-making process. One new resident has joined the group since the last inspection and the records relating to this person were viewed. There was good evidence of information provided in the form of assessments by Social Workers and other professionals. An assessment also took place by a member of staff from Community Options. Discussions with the residents show the home demonstrates good practice by enabling them to visit the home to see what is like to live there. A letter had also been sent to the Social Worker stating the home would offer a place to the person. However, the letter must also detail that the home confirms upon assessment that they could meet the individual’s needs. (See requirement) This provides some assurance to the individual. Residents are provided with two contracts: one for the tenancy and the other for the service offered. There was evidence that residents had received copies of the contracts and were signed by those involved in the provision of the service. DS0000006908.V349231.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are aware of the support residents need through individualised support plans that take in to account their aims and aspirations. EVIDENCE: Each person has an individual care plan developed for staff to meet their needs. This is developed by the home with information provided from the assessment process and the individual. A support plan is also developed that addresses the individuals’ personal aims and objectives. Individuals are included in the development of the care plans and sign to show their involvement and agreement. The two people spoken to were able to tell the inspector that they were aware of the care plans developed for them and that they sat down to discuss how DS0000006908.V349231.R01.S.doc Version 5.2 Page 12 they were doing and what changes they would like to make with members of staff and their Care Manager/Social Worker. It is positive to note that the two care plans and supporting information viewed contained information on many aspects of the individuals’ health, social and personal care needs, as well as their personal aspirations. They reflect many of the issues identified in the Care Management Approach care plan. However, there are some shortfalls including management of finances, accurate reflection of personal care requirements and communication that would ensure the full support required by individuals is addressed, particularly when the home is trying to support independence through supporting people in daily living tasks. (See recommendation) Residents’ meetings are held regularly and minutes taken. The residents also have the opportunity to discuss how they wish to lead their lives during the key worker sessions. Staff interaction with residents was supportive and encouraged residents to make decisions for themselves. DS0000006908.V349231.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff promote and encourage individuals to become part of the community and support them to ensure their legal and financial rights are being met. Independence in daily living is encouraged and support provided to enable residents to fulfil their objectives of living in the community. EVIDENCE: All residents are encouraged to take part in activities in the community. Some go along to clubs, specifically aimed to support individuals and prepare them for employment. The role of the support team is one of enabling and giving the skills and confidence for social inclusion and includes assisting them in obtaining the benefits to which they are entitled. DS0000006908.V349231.R01.S.doc Version 5.2 Page 14 It is clear that each person chooses how they spend their time with some involved in leisure interests and others not. One resident told the inspector that they played in a football team set up by their care co-ordinator. They also enjoy playing their music on their “music decks” What is important to most, is the role of their family in their lives. This varies from weekend visits to regular weekly visits to the family home. With the aim of the service being to prepare people for independent living, it is natural that residents are expected to be able to prepare their meals, as well as budget and purchase foodstuffs for themselves. Staff support them in this, as well as trying to ensure they understand the importance of diet, in remaining healthy. The kitchen area enables individuals to keep their foodstuffs separate and secure. DS0000006908.V349231.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): 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are cared and supported for in a way that promotes their independence, whilst minimising risks to their health, safety and well being. EVIDENCE: All residents have a care and support plan developed detailing the support they require. This covers personal support. However, none of the current residents require any assistance, as they are all independent. Support is limited to encouraging individuals to take responsibility for personal care. There were satisfactory records of appointments to healthcare professionals, including physical and mental health support. Letters were also on file regarding appointments with specialists particularly reviewing their mental health and adjusting their medication to maintain stability. Records viewed showed regular support and visits from their care co-ordinator. DS0000006908.V349231.R01.S.doc Version 5.2 Page 16 The care plan package also includes risk assessments, with one specifically relating to the individual’s mental health and risks of relapse. The records detail how the staff should look for signs of relapse and what action to take in the event of this occurring. Medication procedures and practices were good. Records were in place for medication prescribed along with details required including allergies. The home has procedures in place for self-administration of medication whereby this is achieved in stages. Medication needs are included in the care plan and GP approval sought. Overall the procedures were good, although the inspector recommended staff had clear information on the particular stage of self-medication. Procedures are also required to be reviewed, to ensure the procedures relating to the ordering and collection of scripts by residents is addressed. (See requirement) Medication audits take place regularly where each medication is counted. These records also show the medication being received into the home, although this could also be made a little clearer. The one area of concern is where the residents have not yet begun their selfadministration programme and are reliant on staff to administer medication. Where individuals then take leave from the home ie to go home for a weekend etc, they are in effect expected to be responsible, in some way, for their administration. This is inconsistent with what occurs in the home. In this instance medication must be given in full, to a responsible person to support the individual to take it. (See requirement) All staff are provided with training and undergo a medication proficiency test before they are able to administer medication. This is recorded and reviewed each year. DS0000006908.V349231.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home are valued as individuals and are able to raise concerns and approach staff if they are not happy with the care and support provided. Staff have an understanding of how they can protect people from abuse. However, lack of updated procedures means there is a potential for vulnerable people to be at risk through lack of appropriate guidance. EVIDENCE: Procedures to manage complaints and adult protection have been developed. The suggestions and complaints procedure is on display in the hall and available in the Statement of Purpose and Service Users Guide. There is a system for recording and investigating complaints although there have been no complaints in the last year only compliments. Residents’ meetings and key workers meetings are also forums for individuals to raise any concerns or issues. Those residents spoken to all said that they were able to speak to staff or the manager if they were unhappy and all were approachable. The Adult protection procedures viewed were in need of reviewing, as required at the last inspection. The ones headed client abuse and Whistle-blowing were DS0000006908.V349231.R01.S.doc Version 5.2 Page 18 dated 10/01. The client abuse procedure referred to Community Options guidelines on Abuse. This could not be located. The Department of Health “No Secrets” guidelines were available as were Bromley Inter-Agency Guidelines on abuse. (See requirement) Staff attend adult protection training during their induction and are expected to read and sign to say the have read the procedures. It is clear that the organisation takes any allegations seriously and would ensure they are investigated. DS0000006908.V349231.R01.S.doc Version 5.2 Page 19 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): 24,27,28,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Repton Rd provides a warm, homely and comfortable environment for those living there that meets with their individual needs. EVIDENCE: Repton Rd provides a well-maintained, clean and comfortable environment for those living there. The layout and size meets the needs and number of this resident group. Communal areas comprise of two lounges; one smoking and one non-smoking and a kitchen, laundry, bathroom and WCs. Individual rooms are decorated wherever possible to residents’ choices, although this is not always possible. Rooms contain basic bedroom furniture DS0000006908.V349231.R01.S.doc Version 5.2 Page 20 with residents able to bring in personal belongings and entertainment equipment, as they wish. The decoration and furnishings are of a reasonable standard and the furnishings ensure the environment has a homely and comfortable feel rather than an institutional look. A new hallway and stair carpet has recently been provided to replace the tired looking carpet. The three residents spoken to were happy with their rooms and the communal areas. The kitchen area enables people to prepare and cook their meals with individual secure storage for their foodstuffs. They are able to take meals either in the kitchen or the dining room. Areas viewed were of a good standard of cleanliness with no offensive odours. DS0000006908.V349231.R01.S.doc Version 5.2 Page 21 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have the skills, are competent to ensure they can meet individuals’ needs and ensure their continued well-being. People are protected through sound recruitment practices, although there are potential risks when the manager does not assure himself that these checks have been completed. EVIDENCE: Community Options has a reputation for being committed to the training of staff. The evidence provided through this inspection demonstrates this. Staffing levels are satisfactory, particularly with the current numbers and with staff continuing to support clients living independently at a supported living environment. The project is staffed by a manager, deputy and four support workers. DS0000006908.V349231.R01.S.doc Version 5.2 Page 22 Residents are encouraged to be independent and often need the support of staff initially to access community activities and appointments. This is an integral part of the staffing levels. All staff, with the exception of the newest member of staff are qualified to NVQ 3 or above. The deputy manager has also achieved the Registered Managers’ Award that is equivalent to NVQ 4. Staff are provided with core training including fire, moving and handling; first aid and food hygiene. The deputy manager maintains a record of this training and when updates are due. Service specific training is also provided and records viewed showed a range of training that meets the needs of the current residents. Examples of specific training include: relapse prevention skills, dual diagnosis, listening and counselling, managing deliberate self-harm and suicide, recovery training and challenging behaviour. Core training is provided in moving and handling; fire, medication, food handling, first aid, adult protection and health and safety. It is disappointing that autism training has not taken place yet with one event cancelled. There is evidence that this has been rearranged with a confirmed date for staff. (See requirement) All new staff undertake a five day induction at Head Office where core training and some specific training takes place. This is a certificated course and covers company induction, mental health awareness, medication, support planning, moving and handling and user participation. A new member of staff spoken to has yet to undertake this training but has received in house training in the form of orientation to the home, emergency procedures and the needs of the residents. An audit of recruitment practices was also undertaken. Home managers and members of Community Options are involved in the interviewing of new staff. It is good practice to include residents in this process. (See recommendation) Head Office staff are responsible for carrying out most of the checks for the recruitment of new staff. A sample of personnel files had been checked previously at the Community Options Head office. The practices are satisfactory. However, the manager must be in receipt of confirmation in writing that they have carried out the required checks. Without this he cannot be assured that residents are fully protected. (See requirement) Evidence has been provided since the visit date showing appropriate checks have been carried out. DS0000006908.V349231.R01.S.doc Version 5.2 Page 23 The organisation must also review their recruitment procedures to ensure they reflect current practice and regulations. (See requirement) DS0000006908.V349231.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run with sound systems in place for ensuring the health and safety of those living there although outdated procedures mean staff may not have the up to date information on what is best practice. It is run with an open and inclusive approach that enables residents and staff to give their views on the quality of care could be improved. EVIDENCE: DS0000006908.V349231.R01.S.doc Version 5.2 Page 25 The manager currently in post is an experienced manager within the organisation at a project manager and senior manager level. He is a qualified Social Worker with specific interests in mental health issues and has achieved the Diploma in Management Studies/NVQ 5. He has undertaken a variety of training over the years including core and training specific to the needs of the people the organisation provides support to. Jon is also a trained counsellor and has, in the past, worked as a volunteer counsellor working with people with alcohol problems. The process for application for registration has commenced with a Criminal Records Bureau application sent in August 2007. This must be chased up to progress the registration. The feedback received from residents, relatives and staff provided positive comments on the way the home is managed and the support given by the manager and senior staff to those living and working within the service provision. During the visit the manager demonstrated a positive and open approach and willingness to listen to residents and staff. The Providers monitor the quality of care through delegating monthly monitoring visits to managers in the group undertaking the visits and writing the reports. The report itself would benefit from more information provided in the different categories rather than just detailing initials of residents and staff who they have spoken to. The organisation is also accredited to Investors in People and Excellence in Business, both external quality assurance systems aiming to improve the quality of care through different mediums. The organisation has recently been successful in re-accreditation with Investors in People. The organisation also carries out a review of the whole service that includes a survey of staff and users of the service. The last review was undertaken in 2006 and the outcome produced in the form of pie charts etc. There is no detail of the outcomes for each of the individual services and therefore any shortfalls may be addressing other services and not their own. There must be a system for reviewing the individual service, along with the organisational objectives to ensure shortfalls are addressed. (see requirement) The staff survey showed there to be good procedures in place for the supervision and monitoring of staff. Formal supervision takes place regularly and staff feel supported and encouraged to develop their skills and knowledge DS0000006908.V349231.R01.S.doc Version 5.2 Page 26 to meet residents’ needs and ensure they are prepared for progress within the company. A sample of health and safety records were viewed and found to be, in the main satisfactory. However, since the fitting of a new carpet some of the fire doors have not been able to close fully, leaving a very small gap. The manager is currently addressing this and the Commission require confirmation that this has been addressed. (See requirement) Viewing of the hot water records also showed there to be an issue with the hot water temperature in the kitchen. This is recorded as running to 43 degrees rather than the 60 degrees required for the cleaning of crockery and reducing the risk of infection. (See requirement) Community Options have developed a Business Plan for all the services and copies of these are in each home. The registration certificate and in date Employers Liability were both on display. DS0000006908.V349231.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 3 5 3 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 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 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 2 x 2 3 3 X x 2 x DS0000006908.V349231.R01.S.doc Version 5.2 Page 28 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 YA2 Regulation 14 Requirement The Registered provider must ensure that written confirmation is provided to state that they are able to meet the assessed needs of the prospective service user. This is a repeated requirement with timescale of 01/04/07 expired. Timescale for action 01/01/08 2 YA20 13 3 YA20 20 4 YA23 13 Medication procedures must be 01/01/08 reviewed in relation to the ordering and collection of prescriptions. The administration practices 01/12/07 must be reviewed for those who are taking medication whilst away from the home to ensure residents health is maintained. Adult protection procedures must 01/01/08 be reviewed and updated in line with current good practice. This is a repeated requirement with timescale of 01/04/07 expired. The Registered provider must 01/01/08 ensure that staff are provided with Aspergers training to ensure they are able to fully meet the needs of the individual. DS0000006908.V349231.R01.S.doc Version 5.2 Page 29 5. YA35 18 This is a repeated requirement with timescale of 01/06/07 expired. 6 YA34 19 The manager must have 01/12/07 confirmation in writing from the employer that new staff have undergone the required checks to ensure they are safe to work in the home. Procedures must be reviewed to reflect the requirements of the Regulations The Registered provider must 01/01/08 ensure that the individual service is reviewed regularly and a report of the outcome of the review provided to the Commission. Any review must include consultation with the service users. This is a repeated requirement with timescale of 01/06/07 expired. The hot water temperature in kitchen must be hot enough to ensure bacteria is killed off. Please inform the Commission when this is addressed. All fire doors must be able to fully close when the fire alarm is activated. Please inform the Commission when this is addressed. 16/11/07 7. YA33 24 8 YA42 23 9 YA42 23 16/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA6 Good Practice Recommendations Care plans should be fully reflective of the individual needs in health, personal, social, financial and communication needs of residents. DS0000006908.V349231.R01.S.doc Version 5.2 Page 30 2. 3 YA33 YA34 Minutes of meetings should detail the action being taken and by whom. Residents should be involved in the recruitment of staff that may be working in their home. DS0000006908.V349231.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection SE London Area Office River House 1 Maidstone Road Sidcup Kent DA14 5RH 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 DS0000006908.V349231.R01.S.doc Version 5.2 Page 32 - 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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