Care Home: Scott House

What the care home does well All those residents seen at the home responded positively to the Inspector`s enquiries about life at the home and the services that are provided for them. It was good to hear residents speaking positively about the care and support they receive at Scott House. They said they do appreciate the friendly, relaxed atmosphere as well as the caring support of the staff group. Evidently they feel well cared for and safe. What has improved since the last inspection? The following areas have been identified in this report that has improved since the last inspection: A new format has been implemented for care planning that is better meeting resident`s needs. They are being reviewed regularly and at least once annually or sooner if needs or circumstances for the resident change. Identified building and maintenance works have been carried out as required: Bathroom no: 2 on the ground floor has a new sealed floor. Bedroom no: 18 has a new floor covering. The small toilet on the 1st floor also has a new floor covering. The ground floor bathroom has been refurbished. There has been an improvement in the documentary evidence required under Standard 34 of the National Minimum Standards that has to be gathered for all the staff members at Scott House and be held on the staff files for review and inspection. Training needs for all the staff team have been aggregated into a training matrix. A start has been made on implementing the quality assurance process. What the care home could do better: The following areas were identified as a result of this inspection that requires improvement: 1. Recording of progress being made towards meeting the individual care plan objectives for residents needs to be improved. Diary sheet entries should accurately reflect the work being done with residents in implementing the care plan objectives. 2. All staff should attend recognised external POVA training and certificated evidence be provided on the home`s training files. 3. Staff need to renew their training in Health & Safety and Food Hygiene which would assist in the maintenance of high standards in this home. 4. Inspection of the rear garden identified a need for a complete overhaul and refurbishment. 5. The Manager should revise the training matrix so that it includes dates of when staff have attended training.6. Certificated evidence of training received should be held on the files for all staff training completed. 7. The supervision record lacks sufficient detail. It should include a record of all the decisions and agreements made between the supervisor and the supervisee. 8. The home`s quality assurance process needs to be fully implemented so that it enables a level of self-audit and monitoring that may inform improvements and development targets for the home. This is a repeat requirement. CARE HOME ADULTS 18-65 Scott House 7 Warham Road South Croydon Surrey CR2 6LE Lead Inspector David Halliwell Key Unannounced Inspection 29th April 2008 09:30 Scott House DS0000025834.V362421.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 Scott House DS0000025834.V362421.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. Scott House DS0000025834.V362421.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Scott House Address 7 Warham Road South Croydon Surrey CR2 6LE 020 8686 9312 F/P 020 8668 3212 ronchiwome@yahoo.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Laurel Residential Homes Limited Nina Harman Care Home 21 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (21) of places Scott House DS0000025834.V362421.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. Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 21 16th October 2007 Date of last inspection Brief Description of the Service: Scott House is a large traditional brick built property situated to the south of Croydon, but close to the towns many community facilities. The house consists of a large lounge with open plan dining area and a conservatory. There are 15 single bedrooms and 3 double - none has en-suite facilities other than wash hand basins. There are 8 toilets, 3 bathrooms and 2 showers. There is a garden to the rear and off-road parking to the front. The stated aim of the home is to provide care for people with long term mental health problems. Scott House DS0000025834.V362421.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The star quality rating for this service 2 stars. This means that people who use these services experience good quality outcomes. This was an unannounced inspection visit of the services being provided at Scott House, made over the period of 1 day. The Inspection covered all the key standards and involved a tour of the home, a review of all the homes records and formal interviews with 2 staff, the Manager and 5 residents at Scott House. A completed AQAA was received. No enforcement activity has occurred since the last inspection in November 2007. Since the last full inspection the ownership of Laurel Homes has passed to a new company called Malvern Homes. The new company will need to ensure that there is a new Registered Person registered with the Commission for Social Care Inspection. As a result of this inspection 9 areas requiring improvements have been identified, 7 requirements and 2 recommendations. This marks an improvement since the last inspection. People who use the services at Scott House said they like to be called residents. The Inspector found the residents and staff most helpful and they are to be thanked for the assistance that they gave him over the course of this inspection visit. The average fee for a placement at Scott House is £590 per week. What the service does well: All those residents seen at the home responded positively to the Inspector’s enquiries about life at the home and the services that are provided for them. It was good to hear residents speaking positively about the care and support they receive at Scott House. They said they do appreciate the friendly, relaxed atmosphere as well as the caring support of the staff group. Evidently they feel well cared for and safe. Scott House DS0000025834.V362421.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The following areas were identified as a result of this inspection that requires improvement: 1. Recording of progress being made towards meeting the individual care plan objectives for residents needs to be improved. Diary sheet entries should accurately reflect the work being done with residents in implementing the care plan objectives. 2. All staff should attend recognised external POVA training and certificated evidence be provided on the home’s training files. 3. Staff need to renew their training in Health & Safety and Food Hygiene which would assist in the maintenance of high standards in this home. 4. Inspection of the rear garden identified a need for a complete overhaul and refurbishment. 5. The Manager should revise the training matrix so that it includes dates of when staff have attended training. Scott House DS0000025834.V362421.R01.S.doc Version 5.2 Page 7 6. Certificated evidence of training received should be held on the files for all staff training completed. 7. The supervision record lacks sufficient detail. It should include a record of all the decisions and agreements made between the supervisor and the supervisee. 8. The home’s quality assurance process needs to be fully implemented so that it enables a level of self-audit and monitoring that may inform improvements and development targets for the home. This is a repeat requirement. 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. Scott House DS0000025834.V362421.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 Scott House DS0000025834.V362421.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): Standard 2 - Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users needs and aspirations are being assessed by the staff at Scott House however these needs would be better informed if the referring agencies were to carry out their annual reviews of care programme approach documentation. EVIDENCE: Standard 2 – At the last inspection 4 of the 20 residents’ files were reviewed. At this inspection 1 of those 4 files was reviewed again and 3 other residents files were also reviewed. As at the last inspection not all the files had up to date Care Programme Approach (CPA) documentation. The Manager explained that this is due to some of the clinical teams that support residents not carrying out their annual reviews. The Manager said that the staff team at Scott House will continue to press for this from their colleagues in the clinical mental health teams. CPA documentation includes a full needs and risk assessment of the person and sets out care plan objectives that the care provider should be aiming to meet. Annual reviews by the placing authorities are therefore important processes that need to be carried out in order that the appropriateness of placements meeting residents needs can continue to be assured. Scott House DS0000025834.V362421.R01.S.doc Version 5.2 Page 10 The Manager explained that staff also carry out their own needs assessment process and that this includes a risk assessment that identifies any areas of risk to or for the resident. Both are reviewed either as the risks change or otherwise annually. Inspection of the 4 residents’ files selected indicated that all 4 residents had had a risk assessment carried out. This marks an improvement since the last inspection where 2 of the resident’s files inspected did not have these assessments documented. A comprehensive and up to date needs and risk assessment is an important process that helps to ensure that all the residents’ needs are being met and risks are identified. Scott House DS0000025834.V362421.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): Standards 6, 7 & 9. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection visit to this service. The individual resident’s care plans seen by the Inspector on the residents’ files do reflect the assessed needs and personal goals of the residents. They may be assured that they will be supported to make decisions about their lives with assistance as needed and that they will be supported to take risks as part of developing a more independent lifestyle. EVIDENCE: Standards 6 – 4 resident’s files were inspected and the Inspector spoke to 5 residents over the course of this inspection. Upon inspection it could be seen that the resident’s risk assessments, needs assessments, reviews and care plans have been updated in the last 3 months using the new model and format implemented by the Manager. Scott House DS0000025834.V362421.R01.S.doc Version 5.2 Page 12 The 4 residents interviewed by the Inspector confirmed that they do have a say in the care planning and review process within the home. A summary of the weekly activities has been drawn up for each resident that links in with the care plan objectives and helps to ensure they are being actioned appropriately. This means that residents can be assured that their assessed and changing needs will be reflected in their individual plans and that they have an up to date individual plan to guide the care they are provided with by staff in the home. Following the recent review and revision of residents care plans co-ordinated by the Manager, much more of the data specified in schedule 3 under Standard 6 has now been included in the resident’s files which are also now in much improved order with information clearly identified in ordered sections. There is a photograph on file of the resident; the needs and goals of the service user have been stated on those care plans seen and there was evidence of the resident having been involved in the drawing up of the plan. These details are very important parts of the plan and are necessary so that both key workers and residents are clear about how care is to be provided to them. Recording of progress being made towards meeting the individual care plan objectives for residents needs to be improved. Diary sheet entries should accurately reflect the work being done with residents in implementing the care plan objectives. Care plan reviews will then be more able to monitor the success or otherwise of the specific care plan objectives which may then be revised to better meet the resident’ needs in the light of the review findings. Sometimes care plan objectives will be changed where it becomes apparent they are unrealistic and unachievable. This is a requirement. Residents did confirm verbally with the Inspector that they had been involved with their care plans and their reviews when these had been held. All residents confirmed that they do have a key worker and that they are able to communicate with their key workers appropriately. The Manager and staff also confirmed that all residents have a key worker who they receive support from on a regular basis. Standard 7 – Residents informed the Inspector that they are enabled to make decisions about their lives with assistance as needed. Staff were seen by the Inspector to ask residents about many different aspects of life within the home including what activities they would choose to do, any outings perhaps to the shops or as to menu choices as an example. Over the course of this inspection this was also evidenced to the Inspector through the exchanges seen between staff and the residents where staff were clearly respecting where appropriate residents to make their own decisions. The Manager told the Inspector that the residents are involved in the review of their care plans and where appropriate families or close relatives sometimes accompany the residents acting as Scott House DS0000025834.V362421.R01.S.doc Version 5.2 Page 13 advocates. The Manager told the Inspector that if the resident would like to have an independent advocate staff will arrange this for them. Regular residents meetings are held within the home and this provides an opportunity for residents to make their views known about relevant topical issues. Minutes of these meetings were seen by the Inspector. Standard 9 – As described under Standard 2 risk assessments were seen on each of the files reviewed as a part of the initial assessment and care planning undertaken by Scott House. These assessments were seen to support the residents to take acceptable risks in order to maximise their independence wherever possible. Scott House DS0000025834.V362421.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): Standards 12, 13, 15, 16 & 17. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users are enabled to take part in activities appropriate to their needs and wishes. They are also encouraged to take an active part in the community. Service users maintain appropriate personal relationships as they wish and staff do respect their rights and responsibilities recognised in their daily lives. Service users are offered a healthy diet that they seem to enjoy. EVIDENCE: Standard 12 – The Inspector found evidence that care support staff appropriately encourage the maintenance of resident’s relationships with family and friends if residents also wish to do so. The Manager told the Inspector that visitors to the home are encouraged and that they use the visitor’s book to sign in. The visitor’s book that was seen in the front entrance hall was Scott House DS0000025834.V362421.R01.S.doc Version 5.2 Page 15 evidently in regular use. The Manager also said that residents are enabled to take part in appropriate activities by the care staff. Most of the current residents living at Scott House have lived there for many years and are well established and happy. One resident told the Inspector, “this is my home, I like living here.” Another resident said, “It’s a home from home, it’s my home”. Interviews with 5 residents and 2 of the staff and the Manager said that with the closure of some of the established day centres in Croydon different and new facilities are now being used. The Manager said that 1 resident goes to a community centre where they join in physical exercises. Another resident said that they go to a local church each weekend. Some residents interviewed told the Inspector that they do not wish to use other local community services “because we are well looked after here”. The Manager told the Inspector that information is being provided by staff at the home about local activities that residents say they are interested in. Standard 13 - Interviews with residents demonstrated that they do attend some local community events although their wishes for an active community social life are somewhat limited. Information is made available and staff do encourage residents to be involved as much as possible in local activities. Some residents told the Inspector that they like to go to the local shops. The Manager said that the local shop keepers always make Scott House residents welcome and that there is a good dialogue between the shopkeepers and the staff at Scott House. Residents make full use of local public transport facilities in order to get out and about and to see friends and family. 2 residents interviewed said, “the local transport facilities are good and we can catch the bus just down the road here”. All residents living at Scott House are registered to vote in elections and are supported by staff to do so if they wish. Evidence of this (voting forms) were seen by the Inspector given the forthcoming local elections taking place on the day after this inspection. Residents were also seen to be discussing how and where to vote with staff. The Inspector saw that some information is made available within the home about local activities for residents to take up if they wish. Standard 15 – Some of the residents interviewed by the Inspector told him that they do keep in regular contact with their families and friends. Staff were seen to encourage the residents to keep and maintain contacts with family and friends so that they benefit from having appropriate relationships. Scott House DS0000025834.V362421.R01.S.doc Version 5.2 Page 16 Standard 16 – The resident’s meetings and the daily interaction they have with staff helps considerably in identifying and respecting the resident’s rights and responsibilities. Residents confirmed with the Inspector that the home’s policy on privacy is upheld appropriately within the home. Residents are able to see their GP when they need to and to choose their GPs. Staff were seen by the Inspector to knock on residents doors before entering and service users were seen to have the opportunity to spend time in their own company as and when they wish. Some residents participate in household chores and those interviewed told the Inspector that they enjoyed these responsibilities and were all very clear as to when and what they have to do. Service users can be assured that their rights and responsibilities are respected in their daily lives. Standard 17 - With regards to meals and meal times there is a planned and varied menu which residents told the Inspector they enjoy. The Inspector saw suitably planned menus for 3 weeks ahead. Specific needs are catered for and alternative choices are provided. Residents are able to state their preferences when the menus are planned and there are discussions about this at the residents meetings, which are held regularly. The Manager informed the Inspector that some residents are involved in the purchasing of the food and with the preparation of some meals. Food monitoring sheets are in use for residents in order to monitor and ensure that they do have a varied and nutritious intake of food each week. At the last inspection a requirement was made because the recording on these sheets was seen to lack sufficient detail. This was discussed in full with the Manager and has now been met. Staff now record what each resident has actually consumed and this is linked in with the resident’s healthcare needs. Where in some cases residents do have a healthcare need which requires a reduction in fatty and high in cholesterol foods the food monitoring sheet should prove helpful and will assist in positive action being taken in order to assist in reaching the care plan objective. Working together with the residents GP and dieticians should also be considered where appropriate. Scott House DS0000025834.V362421.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): Standards 18, 19 & 20. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Personal and healthcare is provided according to service users’ individual needs. Clinical support for specific health care is provided by General Practitioners, District Nurses and by the psychiatric multi disciplinary teams as well as other specialist services such as chiropody, sight and hearing services thus ensuring that residents do have a good quality of life. EVIDENCE: Standard 18 – The Manager explained to the Inspector that residents are expected to be up and about each morning by about 9.30am so that they are able to participate in their care packages and this includes their need to take their medications at 9.30 each morning. The residents interviewed at this inspection said that they do choose when to go to bed, when to have a bath, what they wish to wear and what activities they do during the day. They were all aware of their medication times. Residents do not have a choice of their allocated key worker however the Manager said that they have a chance to discuss any issues they may have or Scott House DS0000025834.V362421.R01.S.doc Version 5.2 Page 18 which arise subsequent to the allocation of their key workers. Residents did not raise any concerns with the Inspector about their key workers. Residents at Scott House continue to receive regular input from their Community Psychiatric Nurses (CPN) and other mental health professionals. A CPN was seen visiting some of the residents at the time of this inspection. Standard 19 – With regards to the health care of the residents the Manager informed the Inspector that all residents are supported to keep well through accessing appropriate healthcare and associated mental health care support. All residents are signed up with one of the local GP surgeries and some are registered with a local dentist. The Manager said that whether or not a resident uses the dentist is left up to the resident’s own decision but staff will encourage residents to use this service if required. Residents who spoke with the Inspector said that they go to see their GPs as and when necessary. Resident’s health checks are usually undertaken by the GP at their surgeries. An optician regularly visits the home and provides eyesight checks for all residents and there is access for residents to the chiropody services. Community nurses also visit residents at the home and administer medication as required. Standard 20 – The Manager told the Inspector that only shift leaders administer medication to residents within the home. The home’s policies and procedures manual was inspected and seen to contain appropriate policies for the control of medication. The Inspector reviewed the records for the administration of medication to residents and these were seen to be appropriately completed and in line with the home’s policies and procedures. A stock take check was carried out by the Inspector together with the Manager and the levels of medication held within the home appropriately matched the MAR sheet records. The Inspector was also told that the Boots Pharmacy do an inspection every 6 months and that their reports are satisfactory. The Manager told the Inspector that the staff who administer medication all have to have received the appropriate training in medication and that this is a part of the overall agencies training plan. Staff training records showed that the shift leader staff had received this training within the last 3 to 4 years. It is recommended that this training should be refreshed every 3 years so as to ensure that staff are up to date with best practices and legislation changes to do with administering medications. Staff interviewed confirmed that they had received this training. Scott House DS0000025834.V362421.R01.S.doc Version 5.2 Page 19 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): Standards 22 & 23 - Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users can be assured that their views will be listened to and acted upon appropriately. They can also be assured that they will be protected from abuse, neglect and self-harm. EVIDENCE: Standard 22 – Residents told the Inspector that they feel their views are listened to and acted upon. They also all said that if they had a complaint they know the procedure to be followed and would do so if they needed to. Staff interviewed confirmed to the Inspector that the residents were all aware of the complaints process and that the whole staff group took any issues raised by residents seriously. The complaints record was reviewed by the Inspector, no complaints had been made since the last inspection visit. Standard 23 - The home has an adult protection policy (POVA) in place. The Manager informed the Inspector since the last inspection there had not been any newly trained staff with POVA training. It was explained that the L.B.Croydon’s training was very hard to access and that recently there has not been any opportunity to send staff on Croydon’s POVA training. The Manager went on to explain that a new opportunity has now arisen with the local NHS mental health teams that are providing some POVA training. The Manager said that all Scott House staff will be attending this training over the year ahead. Scott House DS0000025834.V362421.R01.S.doc Version 5.2 Page 20 At the last inspection it was recommended that all staff receive POVA training from an outside recognised trainer at least once every 2 years. Certificates of staff attendance would be required in order to evidence this. This recommendation was made because regular training in this area would mean that staff are better aware of what abuse is and the safeguards in place for the protection of the residents should they need them. This has now been made a requirement that all staff should attend recognised external POVA training and certificated evidence be provided on the home’s training files. The policies and procedures manual for the home includes a whistle blowing policy and a policy on dealing with violence and aggression. Understanding the policies and procedures is a part of the staff induction process and staff are asked to sign to say that they have read and understood the policies and procedures. A review of staffing records held on staff files by the Inspector confirmed that all staff had signed such an agreement. The home does look after residents’ money and the Inspector reviewed the financial records for these transactions that all were in order. All transactions are dated and signed for by both staff and residents to confirm satisfaction by all parties. The Inspector found no anomalies. At a previous inspection it was recommended that an inventory for residents’ valuable belongings be drawn up and maintained and kept up to date by key workers for all residents’ belongings that are kept in their bedrooms. Evidence that this has since been carried out was seen by the Inspector. Inventories had been signed and dated by the residents concerned in agreement to the contents. This should add to the measures already in place to ensure the protection of the resident’s property. Scott House DS0000025834.V362421.R01.S.doc Version 5.2 Page 21 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): Standards 24 & 30 - Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users do live in safe and comfortable surroundings and said that they are happy living in this environment. Service users may be assured that the home is clean and hygienic. EVIDENCE: Standard 24 – A tour of the premises together with the Manager covered all areas of the home including, with their permission several of the residents bedrooms. They told the Inspector that they are happy with their rooms. The general impression of the environment and décor of the home was found to be clean, hygienic and free from any unpleasant odours. Since the last inspection good progress has been made in meeting a number of maintenance issues that were identified at that time. Scott House DS0000025834.V362421.R01.S.doc Version 5.2 Page 22 Bathroom no: 2 on the ground floor has had a new and sealed floor as required and this should help to prevent a health hazard to the residents. Bedroom no: 18 the carpet that was badly urine stained and has been replaced with a lino floor covering. The small toilet on the 1st floor also now has a new floor covering that was badly compromised by urine spillages. The bathroom on the ground floor has been completely refurbished and is now a fully tiled shower room. The tour of the premises included inspection of the rear garden that identified a need for it’s renewal and refurbishment. This is a requirement. The existing state of the lawn is poor and has been badly worn away by constant foot wear. The flowerbeds are overgrown need ongoing maintenance and upkeep. The overall effect of all this does nothing to lift the spirits and is depressing. The Inspector asked the Manager if there may be a possibility of starting a gardening project with residents as appropriate that could help to achieve this need as well as helping residents gain some helpful skills and knowledge. Standard 30 – The home was seen to be clean and hygienic. Policies and procedures were seen to be in place and the laundry area is sufficiently far from the food preparation area to avoid any potential for cross infection. Appropriate hand washing facilities are provided for staff and residents who use the facilities. Staff have recently undertaken training in Infection Control and it is recommended that they now need to renew their training in Fire Safety and Food Hygiene which would assist in the maintenance of high standards in this home. Scott House DS0000025834.V362421.R01.S.doc Version 5.2 Page 23 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): Standards 32, 34, 35 & 36. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users can be assured that they will be supported by competent and qualified staff. They may be assured that they will be supported and protected by the home’s recruitment and supervision policy and procedures. Staff training and staff supervision practices still need improvements to be implemented. EVIDENCE: Standard 32 - The Manager informed the Inspector that there have been no new staffing recruits at Scott House since the last inspection. One member of staff has transferred to Scott House from another home that is part of the company group of homes in Croydon. The Manager explained that as a part of the induction process all staff are issued with job descriptions and are asked to read and discuss the homes policies and procedures. Evidence of this was seen by the Inspector on staff files and from discussions with staff interviewed. The Manager told the Inspector that all the staff team will be NVQ qualified by the end of the year. Staff interviewed confirmed with the Inspector that they Scott House DS0000025834.V362421.R01.S.doc Version 5.2 Page 24 are completing their NVQ training and some evidence of NVQ training certificates was seen in the office records. However inspection of 4 of the 10 staff groups’ files did not evidence all the training that both the Manager and the staff told the Inspector that they had completed. Staff files should include certificated evidence for all training undertaken by staff. This is a requirement. Standard 34 - The Manager told the Inspector that the home does have a recruitment policy and procedure and that all staffing posts are filled by application and interview. Evidence of these processes being used was seen by the Inspector on the staffing files. A review of 4 of the staffing files evidenced: 1. That suitable application forms are completed as a part of the process. 2. Usually 2 references are obtained including one from the last employer. 3. All staff files reviewed by the Inspector had proper CRB checks that had been carried out for staff employed within this home. 4. Other official documentary evidence confirming the identification of staff either in the form of a passport, birth or marriage certificate needs to be held on file. 5. Training certificates and other evidence of qualifications gained by the staff member should also be held on the staffing files such as that for NVQ training. 6. Staff files should include signed and dated copies of their contracts. At the last inspection a requirement was made that documentary evidence required under Standard 34 of the National Minimum Standards be held on the staff files for review and inspection. Good progress on this has been made by the Manager and this should help to ensure that recruitment practices meet the required standards. The Manager is reminded that ongoing monitoring and review of the staffing files will be required in order to ensure that they are kept to this standard. Staff interviewed confirmed that all have a contract of employment and that they understand their terms and conditions as well as their roles and responsibilities within the home. Standard 35 - The Manager informed the Inspector that a structured induction programme is offered to all new staff. As has already been indicated in this report the Manager told the Inspector that there have been no new staff employed at Scott House since the last inspection except for a staff transfer from another unit. The Manager told the Inspector that they had been given an induction specific to the function of Scott House and their new role within the unit. Scott House DS0000025834.V362421.R01.S.doc Version 5.2 Page 25 The Manager informed the Inspector that there is an overall training and development plan and budget for the 3 units that make up the Malvern Company Group of homes in Croydon. At the present time the Manager said that disaggregating the information specifically for one home out of the 3 was not possible. However it has been indicated to Managers by the new management team that they will have both their own budget and training plans in the near future and that individual managers will be responsible for the training and development of their own staff teams. At the last inspection it was suggested that the Manager draw up training files for each member of staff that identifies what training that individual has achieved and when; what their training needs are that need to be met and evidence of the training courses attended. The Manager explained to the Inspector that some training information is held individually on staff files and other training information is contained in one central staff training file. The Manager also showed the Inspector a training matrix that contains all the information about the staff group identifying what training they have received. However it is recommended that the Manager revise the matrix so that it includes dates of when staff have attended training. Only when this has been done will it be fully useful to the Manager as a tool that identifies what training staff have received and when. This will help the Manager identify future staff training needs and give a complete picture “at a glance”. Standard 36 - From discussions with the Manager and from interviews with 2 staff it is clear that at present staff receive ongoing supervision and support in the work they undertake and a supervision record is maintained that is signed by both parties. The Manager told the Inspector that a new format has been drawn up that will help to ensure all the appropriate areas of discussion are covered in the supervision sessions. Inspection of 4 of the staff files evidenced the new format is being used. However the record made of key areas of discussion is still too brief and lacks sufficient detail. It should include a record of all the decisions and agreements made between the supervisor and the supervisee. The Manager agreed with the Inspector that there is still work to be done in continuing to improve the quality of staff supervision in the home. It is essential for the successful delivery of care to residents as well as providing job satisfaction for staff, that supervisors help them to monitor their work with individual service users and analyse the success or not of care plan outcomes in meeting their residents’ needs. The requirement that was made for supervision at the last inspection therefore remains in place. Scott House DS0000025834.V362421.R01.S.doc Version 5.2 Page 26 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): Standards 37, 39 & 41. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users benefit from a well run home and when completed the quality assurance process will ensure that service users can be confident that their views and those of other relevant people underpin the development and review of the home. The health and safety of service users and staff are protected by the policies and working practices in the home. EVIDENCE: Standard 37 – At this inspection the Manager told the Inspector that she has the Registered Manager’s Award [at Level 4]. Scott House DS0000025834.V362421.R01.S.doc Version 5.2 Page 27 The Inspector has seen the Managers job description that covers all the requirements set out under the Standard 37.3. Standard 39 - The Inspector spoke to the Manager about the development of the quality assurance system referred to in the last inspection report. The Manager told the Inspector that feedback questionnaires were sent out to staff in April 2008; visiting professionals; other visitors and that questionnaires are about to go to residents and that they will receive appropriate support from their support staff to help complete them. The Manager explained that the information collected will form a part of the home’s internal quality assurance process. The Inspector asked whether an analysis of the feedback information has been carried out and the Manager told the Inspector that this is yet to be done. Some discussion was then had with the Manager as to what other elements could be used to inform the process, some suggestions included were: • A review of any complaints made. • A review of any accidents that have occurred. • Issues raised by residents at community meetings. • Issues raised by staff at staff meetings. • Commission for Social Care Regulatory inspection report feedback. A summary and analysis of the key points arising from the above could then be used to inform an annual development plan for the home. Different areas or themes could be targeted on an annual basis that over a longer period would inform all the key areas of service provision. The Manager said that she would be developing and implementing the above process in the near future. Although some progress has been achieved since the last inspection in that feedback questionnaires have now been sent out, no information has been received or analysed that enables a level of self-audit and monitoring that may inform improvements and development targets for the home. This should enable the key stakeholders to be confident that their views underpin all selfmonitoring, review and development at Scott House. The previous requirement therefore remains in place. This is a repeat requirement and enforcement action may be taken if this is not now met within the new timescale. Standard 42 – The Inspector was shown information to do with relevant Health and Safety legislation. Policies and procedures were also seen for Health and Safety, risk assessment, moving and handling and fire. The Manager informed the Inspector that all staff receive training in first aid and infection control. This was supported by staff interviewed that confirmed that they had received training in these areas. Scott House DS0000025834.V362421.R01.S.doc Version 5.2 Page 28 Up to date and satisfactory pass certificates were seen by the Inspector for: Boiler & Gas – September 2007 Electrical installation – February 2004 Portable electrical appliances – April 2008 Fire alarms – October 2007 Fire equipment – March 2007 now due for re-testing. A water and legionnaires test was last carried out in October 2007 – satisfactory. Records were seen by the Inspector that confirmed regular tests had been carried out for the: Fire alarm - weekly Fire drill – 29.2.08 Emergency lighting – 6 monthly – last February 2008 Fridge and freezer temperatures records were checked and records indicate that they came within the acceptable ranges. Accident records were checked by the Inspector. They had been completed appropriately and Regulation 37 notices sent out as required. Hot water temperatures were also checked and records indicated that they also came within the acceptable range. At the time of this inspection no fire doors were seen to be wedged open and the building appeared to be secure. All of the above information means that residents benefit from a competently run and accountable management of the services at Scott House. Scott House DS0000025834.V362421.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 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 2 X X 3 X Scott House DS0000025834.V362421.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes. 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 YA6 Regulation 14 Requirement Recording of progress being made towards meeting the individual care plan objectives for residents needs to be improved. Diary sheet entries should accurately reflect the work being done with residents in implementing the care plan objectives. All staff should attend recognised external POVA training and certificated evidence be provided on the home’s training files. Inspection of the rear garden identified a need for a complete overhaul and refurbishment. Documentary evidence of training received by staff must be held on the staff files for review and inspection. Staff supervision - supervision notes must be maintained regularly and kept on staff files, also that areas of discussion in supervision must include the areas already discussed but that are to do with the: Monitoring of work with individual service users and the analysis of care plan outcomes, DS0000025834.V362421.R01.S.doc Timescale for action 01/06/08 2. YA23 13 01/03/09 3. 4. YA24 YA32 23 18 01/09/08 01/06/08 6. YA36 18 01/09/08 Scott House Version 5.2 Page 31 7. YA39 10 Support and professional guidance, and the Identification of training and development needs, Annual appraisals. Full implementation of a quality assurance system is required that enables a level of self-audit and monitoring and that may inform improvements and development targets for the home. This should enable the key stakeholders to be confident that their views underpin all selfmonitoring, review and development at Scott House. This is a repeat requirement. 01/11/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA32 YA35 Good Practice Recommendations It is recommended that some externally provided training be laid on for staff on Fire safety and Food hygene. It is recommended that the Manager revise the training matrix so that it includes details of when staff have attended training. Scott House DS0000025834.V362421.R01.S.doc Version 5.2 Page 32 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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