Care Home: Shooters Hill Road, 156

What the care home does well This home meets all of the National Minimum Standards for Younger Adults. Residents at Shooters Hill Residential Home are very well cared for, and their physical and emotional needs are met with sensitivity and kindness. They told us that they consider themselves fortunate to be living there. The environment is comfortable, homely and maintained to a high standard. Records are accurate and well maintained, and staff and managers take pride in developing their expertise through training. Residents are involved in the day to day running of the home, they are encouraged to speak up and to say what they want. The level of activities provided both internally and externally was appropriate to the needs of residents. Residents receive good health care and medication is safely dealt with. The home is comfortable and spacious and residents bedrooms are personalised with their own possessions. Feedback from the people using the service, other professionals and relatives is also good. Residents said staff were kind, usually listened to what they had to say and acted on the information if necessary. The food provided in the home is good and all of the people spoken with on the day of the inspection said they enjoyed it. The provision of training for staff is good. There are good systems in place to support staff. Residents know who to speak to if they have any concerns. Complaints are recorded and are addressed promptly by the Manager. There are good systems in place to monitor the quality of care provided and to obtain feedback from the people using the service. What has improved since the last inspection? At the last inspection in May 2007 4 recommendations were made. One was made to ensure that residents evidence their agreement with their CPA care plans. We inspected care plans at this inspection and could see that all the residents do now sign their care plans to show that they agree with their content and have taken a part in the review of their plan. The Manager has ensured that all complaints are now recorded to indicate whether they are substantiated, partially substantiated, or not substantiated. A copy of the London Borough of Greenwich Adult Protection Procedures has been obtained by the Manager and is compatible with the homes procedures. As a part of the homes quality assurance programme annual surveys of the views of professionals involved with residents and their relatives/ advocates have been introduced as a part of the quality control mechanism. What the care home could do better: Areas identified at this inspection that need some improvement are as follows: Standard 6 It is recommended that the Manager ensures that reviews of the care plans should include sufficient detail so as to record the progress that has been made with the individual care plan objectives. Standard 9 The risks identified need to be linked with the residents care plans with clear action plans that reflect the activities that people take part in so that staff and residents can make efforts to minimise risk and promote peoples safety. This is a recommendation. Standard 23 It is recommended that all the homes staff attend the local authorities protection of vulnerable adults training offered by L. B. Greenwich. This will help staff to understand the local authorities procedures and how it links in with the homes policies and procedures. Standard 35 It is recommended that the Manager ensures that staff are asked to read the homes policies and procedures manual and all updated policies and procedures. This should be discussed individually with each member of staff in their supervision sessions. Staff should sign to say that for each individual key policy and procedure that they have read and understood it and had the chance to discuss it with their supervisor. Standard 36 The Manager must ensure that all staff receive formal supervision. It is also recommended that the staff who are to provide formal supervision receive formal staff supervision training provided by an authorised external trainer. Standard 39 With regards to the homes quality assurance process it is recommended that the Manager now produces a report that analyses the information gathered and that an action plan is drawn up that addresses any issues that have arisen from the feedback and used to inform any new developments that could be planned for this unit. Standard 42 It is required that a fire risk assessment should be carried out by the Manager and a fire emergency plan put in place. It is required that all hot water outlets be regularly checked for the temperature of the hot water in order to ensure it is within the safety limits. Records should be kept that detail all the hot water taps in the home, when they were checked and what the measured temperatures were on the date given. Key inspection report Care homes for adults (18-65 years) Name: Address: Shooters Hill Road, 156 156 Shooters Hill Road Blackheath London SE3 8RP     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: David Halliwell     Date: 2 1 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Shooters Hill Road, 156 156 Shooters Hill Road Blackheath London SE3 8RP 02083193939 02083193939 mrshem2000@yahoo.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Ahmad Mungul,Mr Shemil Mungul Name of registered manager (if applicable) Mr Ahmad Mungul Mr Shemil Mungul Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 5 The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home Shooters Hill Residential Home provides 24-hour care for three adults of both sexes who have mental health problems, one of whom may be over the age of 65. The house is a large 5 bedroomed property on the main A2 close to Charlton village. It is domestic in style and not identified from the outside. There is a small parade of shops Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 5 Brief description of the care home adjacent to the Home and the G.P. surgery is next door. Buses pass the front door towards Lewisham, Blackheath and Woolwich. Each service user has their own room, which is equipped with a bed, television, fridge, wash hand basin, easy chair and wardrobe. The rooms are well decorated and the house is maintained to a high standard throughout. Communal areas include a lounge, diningmeeting room, breakfast room and kitchen. The conservatory leading off the kitchen is the designated laundry area. There is a large secluded garden with shrubs and a lawn. There is a new summer house that has been built in the garden to exercise independant living. Service users are encouraged to think of it as their home, and to live as independently as they can. Meals are provided but service users can prepare their own meals if they wish to do so. Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The stars quality rating for this service is 3 stars. This means that people who use these services experience excellent quality outcomes. Service users said that they like to be called residents. No enforcement activity has occurred with this service. This was an unannounced key standards inspection visit and was carried out over 1 day. The Inspection covered all the key standards in the National Minimum Standards. The inspection involved a review of all the homes records and interviews with the Manager and the Deputy Manager, with 2 support worker staff and we had discussions with 3 of the residents. 6 staffing files and 4 residents files were inspected as well as the policies and procedures manual for the home. Care Homes for Adults (18-65 years) Page 6 of 34 3 requirements and 5 recommendations have been made as a result of this inspection. Feedback on the recommendations was given verbally to the Manager at the end of the inspection visit. We were impressed by the very positive commitment and hard work that has been put into maintaining this home and the services it provides to people with complex mental health problems. The Manager and staff were very helpful and they are to be thanked for their assistance over the course of this inspection visit. The homes Registration Certificate with the Commission was seen displayed appropriately in the main office. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: Areas identified at this inspection that need some improvement are as follows: Standard 6 It is recommended that the Manager ensures that reviews of the care plans should include sufficient detail so as to record the progress that has been made with the individual care plan objectives. Care Homes for Adults (18-65 years) Page 8 of 34 Standard 9 The risks identified need to be linked with the residents care plans with clear action plans that reflect the activities that people take part in so that staff and residents can make efforts to minimise risk and promote peoples safety. This is a recommendation. Standard 23 It is recommended that all the homes staff attend the local authorities protection of vulnerable adults training offered by L. B. Greenwich. This will help staff to understand the local authorities procedures and how it links in with the homes policies and procedures. Standard 35 It is recommended that the Manager ensures that staff are asked to read the homes policies and procedures manual and all updated policies and procedures. This should be discussed individually with each member of staff in their supervision sessions. Staff should sign to say that for each individual key policy and procedure that they have read and understood it and had the chance to discuss it with their supervisor. Standard 36 The Manager must ensure that all staff receive formal supervision. It is also recommended that the staff who are to provide formal supervision receive formal staff supervision training provided by an authorised external trainer. Standard 39 With regards to the homes quality assurance process it is recommended that the Manager now produces a report that analyses the information gathered and that an action plan is drawn up that addresses any issues that have arisen from the feedback and used to inform any new developments that could be planned for this unit. Standard 42 It is required that a fire risk assessment should be carried out by the Manager and a fire emergency plan put in place. It is required that all hot water outlets be regularly checked for the temperature of the hot water in order to ensure it is within the safety limits. Records should be kept that detail all the hot water taps in the home, when they were checked and what the measured temperatures were on the date given. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 34 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 1 and 2 were inspected. Standard 6 is not applicable as the home does not offer intermediate care. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good information is available to help prospective residents and their representatives make an informed choice about whether to use the service. People have an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. Evidence: Standard 1 We read the Statement of Purpose and the Service User Guide and these contain information that people receive about 156, Shooters Hill Road when considering whether they want to live there. The content provides information about the aims and objectives of the home. It tells people what support with day to day needs, social, leisure and educational opportunities and the environment they can Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: expect to receive. The service user guide includes information about the complaints procedure so that residents have this information to hand should they need it. Prospective service users have the information they need to make an informed choice about whether they wish to live in the home or not. Standard 2 Inspection of 4 residents care files indicated that for each resident an assessment of needs had been completed by both the referring clinical teams and by the homes staff. The assessments are detailed in that they look at the care and support needs, significant history, medication and specific health care support, information about the likes and dislikes of the person and their choice of social and therapeutic activities. We saw that residents assessments are regularly evaluated on a 6 monthly basis and updated. This shows that peoples needs are monitored and reviewed. We saw that the homes key worker staff had completed full mental health needs assessments. These were written in a person centered way and each individual had signed in agreement. There were lots of useful sections to tell staff about the persons particular needs. Each person had an up to date Enhanced Care Programme Approach (CPA) on their file. This clearly detailed their needs and any presenting risk factors. This means that prospective service users individual aspirations and needs will be assessed. Care Homes for Adults (18-65 years) Page 12 of 34 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standard 6, 7 & 9 were inspected at this inspection. People using this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents may be assured that their assessed needs and personal goals will be reflected in their care plans. They may also be assured that they will be able to make decisions about their daily lives and be enabled to take risks as part of developing a more independent lifestyle with support, as they need it. Evidence: Standard 6 As a part of this inspection we looked at 4 of the residents care plans which had each been updated within the last six months. We saw that care plans were being reviewed on a regular basis to ensure that any changing needs were being addressed and met. It is recommended that the Manager ensures that reviews of the care plans should include sufficient detail so as to record the progress that has been Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: made with the individual care plan objectives. Information we saw on the care plans were broad in terms of their objectives. However they could usefully be more detailed so that care plans describe how the objective could be met and so that staff have clear guidelines on how to meet assessed needs in a way that the person prefers. We looked at some of the daily diary sheets that gave a good outline of a persons daily experiences, activities, their health and well being and any significant issues. Each person has a named key worker to support them. All of the service users have a plan of care that reflects their identified needs. Records on the residents files sampled, indicated that service users are fully involved in their individual planning meetings and supported to achieve their personal goals and aspirations. It is clear that staff work closely with each individual, their family and significant others to ensure that their preferences are responded to appropriately and the people important to them are involved with the planning of their care. Daily records are also kept which highlight any activities that residents have participated in. This all means that residents know their assessed and changing needs and personal goals are reflected in their care plans. Standard 7 The Manager told us that staff work hard to enable residents to make decisions about their lives and that they provide assistance as it is needed. We saw that residents have full involvement in their needs assessment and care planning and we were told by residents who we spoke to that they are always involved and encouraged to make their own decisions. Both the Manager and residents told us that there are regular house meetings with residents and that relevant issues are discussed concerning all aspects of life in the home and in relation to individual needs. We saw minutes of these meetings that evidenced this statement. The Manager told us that the home does not manage residents finances and records show that appointees are in place to do so for the residents. This all means that residents are enabled to make decisions about their lives with assistance as needed. Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: Standard 9 The staff we spoke with showed an awareness of risks posed to people living at the home, their vulnerability and described ways in which they help them. All the residents files contained risk assessments that are updated and reviewed regularly. The risks identified do however need to be linked with the residents care plans with clear action plans and reflect the activities that people take part in so that staff and residents can make efforts to minimise risk and promote peoples safety. This is a recommendation. Risk plans had been reviewed at timely intervals and where needs had changed. There are good systems in place for monitoring each residents physical well being. Care plans are reviewed to ensure that staff take further action to meet resident support needs. This all means that residents are being supported to take risks as a part of developing a more independent life style. Care Homes for Adults (18-65 years) Page 15 of 34 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 12, 13, 15, 16 & 17 were inspected at this inspection. Quality in this outcome area is excellent. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Residents are able to take part in age and culturally appropriate activities and are to a reasonable extent involved in local activities. Residents have appropriate relationships and their rights and responsibilities in their daily lives are recognised and respected by the staff in the unit. Residents are offered a healthy diet and they are assisted in learning cooking and food preparation skills. Evidence: Standards 12, 13, 15 & 16. Records showed that residents are offered choices of Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: activities and are supported to engage in their preferred interests and hobbies. Activity plans are flexible so that daily programmes can alter if residents wish to do something different. None of the residents attend day centres as the three longer term residents are placed outside of their placing authorities and local provision has been refused, but all are engaged in a programme of regular activities. The two other residents placed by the local authority have not been assessed as needing day centre placements. The Manager and residents told us that every year there are organised trips out, sometimes to London or to the coast or to other places of interest that residents have said that they would like to visit. These trips are discussed at the residents meetings in detail so that residents views and their approval for the trips can be agreed. We saw minutes of meetings that evidenced this does happen as described. All the residents we spoke to said that they enjoyed these excursions. Residents are free to come and go as they please. Some shop at the local shops and are known to the shopkeepers. One Resident goes to the church across the road for coffee mornings and worship, and says he is welcomed there whenever he goes; he has gained some spiritual comfort from this community link. The Manager stated that residents are supported and encouraged to stay in touch with family and friends and their wishes are respected when they choose not to have contact. The Manager stated that residents are made aware of advocacy facilities locally. Service users are enabled to conduct private telephone conversations and visitors are allowed in their rooms as long as this is pre arranged with staff members and has been discussed in a service users meeting. Residents meetings are held on a regular basis and the manager confirmed that a copy of the minutes was provided for all, including those who chose not to attend. It was evident from the notes examined that agendas were comprehensive and that individuals in attendance freely aired their views. The Manager told us that all the residents have been registered to vote and residents also told us that they had been registered to vote. This all means that residents are able to take part in age and culturally appropriate activities and that where they want to be residents may enjoy being a part of the local community. Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: Standard 17 With regards to meals and meal times there is a planned and varied 4 week menu which residents told us they enjoy. We saw the planned menu for the week ahead, the food choices selected show that a nutritional range of food is offered to residents. The Manager told us that 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. One of the residents is of Indian origin and he said that any requests he has made for Indian food are positively responded to by staff members. The Manager told us that culturally appropriate diets could be catered for upon request, as could any other special diets and it was noted that a choice is always available. The Manager told us that the home does not use a dietician in assisting with the menus but that if there was need they would do so. This all means that residents are offered a healthy diet and that they enjoy their meals and mealtimes. Care Homes for Adults (18-65 years) Page 18 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 18, 19, & 20 were inspected at this inspection. People using this service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users may be assured that they will receive personal support in the way they prefer and require, they may also be assured that their physical and healthcare needs will be appropriately met. Service users are protected by the homes policies and procedures for dealing with medicines. Evidence: Standard 18 The Manager explained that residents can choose when they get up each morning. The residents we 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. The Manager told us that residents do have a choice of their allocated key worker Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: should they so wish. Residents that we spoke to did not raise any concerns with us about their key workers in fact their comments reflected a positive view of key work support. This means that residents receive personal support in the way they prefer and require. The Manager said that residents at 156, Shooters Hill continue to receive regular input from their Community Psychiatric Nurses and from other professionals in their clinical teams. Standard 19 With regards to the health care of the residents the Manager informed us that all residents are supported to keep well through accessing appropriate healthcare support. All residents are signed up with local GP surgeries and some are registered with local dentists. The Manager told us that annual health checks take place at the GP surgeries and residents attend there. The Manager said that whether or not a resident uses the dentist is left up to the residents own decision but staff will encourage residents to use this service if required. Residents who we spoke to said that they go to see their GPs as and when necessary. The Manager told us that if residents need to use either a chiropodist or an optician then staff would assist them to do so. This all means that residents physical and emotional health needs are being met. Standard 20 The Manager told us that only he and his deputy administer medication to the residents and that they have both received appropriate training to do with the safe handling of medicines. There was certificated evidence available that confirmed this training had been given. The Manager informed us that none of the residents self administer their medications. An inspection of the medication records MAR sheets was undertaken together with the Manager. Photographs of the residents were attached to all of the MAR sheets, which helps to ensure that staff administers medications to the right resident. We did a spot audit check on the stock control system and this proved satisfactory with the levels of medications being as stated on the control sheets. A check on the storage facilities for the medication was seen to be appropriate. This all means that residents are being protected by the homes policies and procedures for dealing with medicines. Care Homes for Adults (18-65 years) Page 20 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 22 & 23 were inspected at this inspection. 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. Arrangements for complaints and protection from abuse are well managed and ensure that service users feel listened to and safe. Evidence: Standard 22 We saw a clear and properly structured complaints procedure that enables residents and other people to make a complaint or compliment. A proper record book is in place that is used to record any complaints made. 3 complaints had been received since May 2007 and had been dealt with appropriately. The good practice recommendation made at the last inspection was seen to have been implemented meaning that all complaints are now recorded to indicate whether they are substantiated, partially substantiated, or not substantiated. The complaints procedure contains all of the relevant and necessary information and is readily available to the people who live there, their relatives and other visitors. No particular trends or themes emerged fro these complaints and all were resolved satisfactorily. Residents who we spoke to said that they are aware of who to go to if they feel Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: unhappy and are provided with the necessary support to air their views or concerns. This all means that residents feel their views are listened to and acted upon. Standard 23 Residents are protected from abuse by a range of methods including the policy on protecting vulnerable adults; the principles of care that the Manager enforces and by the regular training of staff. We checked the training records and saw certificated evidence that showed that half of the staff group had attended appropriate training on safeguarding and protecting vulnerable adults. However it is strongly recommended that all the homes staff attend the local authorities protection of vulnerable adults training offered by L. B. Greenwich. This will help staff to understand the local authorities procedures and how it links in with the homes policies and procedures. The homes procedures for the reporting allegations of abuse were available for inspection and staff were aware of these procedures. No allegations of abuse have been drawn to the attention of the Commission since May 2007. The Manager is reminded that any allegations of abuse or any serious incidents must be reported to the Commission via Regulation 37 reports. Staff recruitment includes checking criminal records (CRB) and the Protection of Vulnerable Adults Act (POVA) list. The Manager told us that the agencies policy links in with that of the local authority the London Borough of Greenwich. This all means that residents are being protected from abuse, neglect or self harm. Care Homes for Adults (18-65 years) Page 22 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 24 & 30 were inspected. People using this service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents at 156, Shooters Hill live in a homely, comfortable and safe environment. The home is also clean and hygienic. Evidence: Standard 24 As a part of this inspection we looked at all areas of the home to assess the quality of the environment and decor. 156, Shooters Hill Road is nicely decorated and well maintained with a welcoming atmosphere, and made comfortable with homely communal spaces. The decor, fixtures and fittings are in good order with furniture to suit residents needs. Some of the residents were happy to show us their bedrooms. Each one was furnished comfortably and reflected their individual lifestyles, interests and tastes. House rules do not allow people to smoke in their bedrooms and there is designated space in the new summerhouse for the smokers. General maintenance throughout the home was seen to be very good. The home has a Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: large rear garden that includes a summerhouse. The garden is mainly laid to lawn with a shrub border. It is enclosed and affords the residents some privacy. The home was seen to be clean and no odours were noted. This means that residents live in a homely and comfortable environment. Standard 30 The home has an infection control procedure in place. A review of all the homes staffing files and other training information indicated that only 1 member of the 6 staff have not received training to do with infection control. Understanding infection control and how to take preventative measures is seen as important so that staff know the required standards and what measures and controls need to be in place to achieve the standards. As has already been stated, at the time of this inspection the home was seen to be clean and tidy, hygienic and free from offensive odours. Systems are in place to ensure that the spread of infection is controlled and minimised. Laundry facilities were seen to be appropriate for this home in order to meet the 5 residents needs. Hand washing facilities are appropriately provided to ensure staff can use them where appropriate. This helps to ensure the protection of the residents health and to ensure that the home is clean and hygienic. Care Homes for Adults (18-65 years) Page 24 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 32, 34, 35 & 36 were inspected. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by competent and qualified staff. Staff are being provided with the necessary induction and training with which to competently perform their work duties. They are being protected and kept safe by the use of appropriate recruitment policy and procedures. Records are being maintained as required. Staff need to receive formal 1:1 supervision. Evidence: Standard 32 We inspected a range of the homes staffing records and 6 staffing files were inspected including a recently appointed member of staff. The Manager told us that all the staff group hold an NVQ qualification or equivalent and at this inspection certificated evidence was available for inspection. Inspection of the staffing files indicated that all the care staff have achieved their National Vocational Qualifications at level 2, 3 or 4. The newest member of staff is studying at present for her NVQ level 2. Staff interviewed confirmed that they hold their NVQ qualifications. Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: This all means that residents are supported by competent and suitably qualified staff. Standard 34 This is a family run business and 4 of the 6 staff are family members. Inspection of the records show that 156, Shooters Hill does have in place appropriate polices and procedures. All 6 of the staffing files were checked. These contained the required legal checks and documentation which shows that the home takes care to recruit staff correctly. All this helps to ensure that the well being, health and security of service users is being protected by the agencies policies and procedures on recruitment and selection of staff. Standard 35 The Manager has put in place a programme of induction for all new staff that covers staff roles and responsibilities, and key policies and procedures. Induction is ongoing for up to 4 - 6 weeks with observation, shadowing from an experienced staff member and ongoing assessment. The Manager told us that the staff induction training does include fire, manual handling, food hygiene and health and safety. With regards to staff competency it is important that all staff are familiar with the homes policies and procedures. However staff have not been asked to review the key policies and procedures for the home. Whilst we recognise this is carried out at the induction stage it is recommended that the Manager ensures that staff are asked to do so and then when policies and procedures are updated in the future these should be discussed individually with each member of staff in their supervision sessions. Staff should sign to say that for each individual key policy and procedure that they have read and understood it and had the chance to discuss it with their supervisor. The Manager explained that there is a good training programme provided for the staff group. Certificated evidence was seen on the 6 staffing files inspected that confirmed these staff had attended the following training courses: 1. Infection control, 2. Health and safety, 3. Fire safety, 4. Manual handling, 5. Food hygiene, 6. POVA, 7. Dementia care, 8. Epilepsy awareness. Staff who we spoke to said they found the training useful in helping them to undertake their roles in the home more effectively. This all means that residents individual needs are being met by appropriately trained staff. Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: Standard 36 6 staff files were inspected in relation to staff supervision, however no records were seen to show that this takes place on a regular basis. This has to do with the family run nature of the business The Manager told us that while staff do not receive formal 1:1 supervision as such in the home, all staff receive informal supervision where pertinent issues are discussed. Staff confirmed this when we spoke to them. However we explained to the Manager that he should ensure that all staff receive formal supervision. The Manager told us that both he and the Deputy Manager would be most likely to carry out formal supervision in future. It is recommended that they attending formal staff supervision training provided by an authorised trainer. It is also a requirement of this inspection that all staff receive properly structured supervision. The Manager should ensure that staff supervision happens every 6 - 8 weeks. The agenda for supervision should cover the following issues in discussion: Key work with residents Training needs Personal issues. Notes of the supervision meetings should be taken as a record and kept on staffing files. Staff should be asked to sign their supervision records as confirmation that they agree with what has been discussed and agreed. Staff should be given a copy of the minutes for their information. The Manager told us that he will carry out all annual appraisals of staff competencies. When we interviewed staff members they told us that they felt well supported in the home and felt that the management team were helpful when they had concerns or problems arising in their work. Residents should be able to benefit from well supported and supervised staff. Care Homes for Adults (18-65 years) Page 27 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This service is well managed. The views of the residents are sought and they underpin all self monitoring, review and development by the home. The home provides a stable environment where people are listened to, they feel safe and their views are respected. Evidence: Standard 37 The Homes Manager, the proprietor and his wife are all well qualified and competent to run the Home. Certificates of registration, insurance and health inspections are displayed appropriately, records are in good order, and were immediately available for inspection. Policies and procedures had been updated and well maintained. Evidence was available that both managers are keen to update their practice and to improve the service, for example they now involve residents in the selection of new staff members and are proactive in seeking new training opportunities for themselves. Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: All residents in the home benefit individually from the way the Home is run, by the consistency and dedication of staff, and feedback suggests that the residents consider themselves fortunate to be living there. This means that residents benefit from a well run home. Standard 39 The Manager explained to us about the quality assurance processes being used within the unit to ensure that residents views underpin all self-monitoring, review and development by the unit. A variety of feedback questionnaires are being used to gain feedback (on issues to do with the quality of services provided at 156, Shooters Hill) from the residents and from multidisciplinary professionals from the clinical teams and from visitors to the home. We saw the completed and returned survey forms that were sent out last year. Feedback was positive in its detail from all the groups. It is recommended that the Manager now produces a report that analyses the information gathered and that an action plan is drawn up that addresses any issues that have arisen from the feedback and used to inform any new developments that could be planned for this unit. The report could be sent out to all the participants of the survey for their information, it could also be integrated into the homes annual development plan that the Manager showed us at this inspection. This means that residents can be confident their views underpin all self monitoring, review and development undertaken by the home. Standard 42 The Manager told us that new staff receive some training at induction to do with the homes fire equipment and fire safety; food hygiene and infection control. The London Fire Brigade carried out a full check of this home in July 2008 at which some issues of concern were raised. These have been addressed by the Manager and the London Fire Brigade have revisited the home to check on progress and have stated that they are now satisfied with the resolution of the issues they had previously raised. It is requirement that a fire risk assessment should be carried out by the Manager and a fire emergency plan in place as the last one was done in 2008. Environmental Health carried out an inspection in 2009 within the home and as a result have awarded it 4 stars or a very good rating. Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: The Manager showed us the policies and procedures manual that includes polices on health and safety, risk assessment, moving and handling and fire risk awareness. Certificates were seen by us for the following services that are installed in the home, certificates which state that these systems have been checked by appropriate professionals since the last inspection were found to be satisfactory and fit for purpose. 1. Boiler / gas 2. Electrical system check 3. Fire alarms 4. Emergency lighting system 5. Fire fighting equipment 6. Portable electrical equipment Inspection of the fridges and freezers in the home showed us that food is being appropriately stored, labelled and dated. It is required that all hot water outlets need to be regularly checked for the temperature of the hot water in order to ensure it is within the safety limits. Records should be kept that detail all the hot water taps in the home, when they were checked and what the measured temperatures were on the date given. We were shown records that indicate fridge and freezer temperatures are being recorded appropriately. The building was seen to have appropriate security measures in place and at the time of this inspection there were no fire doors wedged open. This all means that the health, safety and welfare of residents and staff are being promoted and protected. Care Homes for Adults (18-65 years) Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 31 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 36 35 The Manager must ensure that all staff receive formal supervision. In order to meet the NMS. 01/06/2010 2 42 13 It is required that all hot 01/06/2010 water outlets be regularly checked for the temperature of the hot water in order to ensure it is within the safety limits. Records should be kept that detail all the hot water taps in the home, when they were checked and what the measured temperatures were on the date given. In order to meet the NMS. 3 42 23 It is required that a fire risk assessment should be carried out by the Manager and a fire emergency plan put in place. In order to meet the NMS. 01/06/2010 Care Homes for Adults (18-65 years) Page 32 of 34 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 It is recommended that the Manager ensures that reviews of the care plans should include sufficient detail so as to record the progress that has been made with the individual care plan objectives. The risks identified need to be linked with the residents care plans with clear action plans that reflect the activities that people take part in so that staff and residents can make efforts to minimise risk and promote peoples safety. This is a recommendation. It is recommended that all the homes staff attend the local authorities protection of vulnerable adults training offered by L. B. Greenwich. This will help staff to understand the local authorities procedures and how it links in with the homes policies and procedures. It is recommended that the Manager ensures that staff are asked to read the homes policies and procedures manual and all updated policies and procedures. This should be discussed individually with each member of staff in their supervision sessions. Staff should sign to say that for each individual key policy and procedure that they have read and understood it and had the chance to discuss it with their supervisor. It is also recommended that the staff who are to provide formal supervision receive formal staff supervision training provided by an authorised external trainer. 2 9 3 23 4 35 5 36 Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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