Care Home: Shrewsbury Road (267)

Similar services:

• Ashlong House
• Norbury Crescent (30)
• Edenvale
• Wadham Avenue
• Chatsworth Care - Dawson House
• Cowden Road, 52 - 54
• Chatsworth Care - Tudor Lodge
• Foxley Lane (121a)

What the care home does well People who use the service told us that they are "happy living here" and that they "get on well" with staff. The home has produced a statement of purpose and service users guide. Potential residents are assessed by the home prior to their moving in. The home develops individual plans with each resident that are regularly reviewed. People who use the service are supported to manage their own finances wherever possible. The home holds regular residents meetings to include people who use the service in its decision making processes. Residents are supported to maintain family and personal relationships, and to engage in a range of community, leisure and occupational activities that reflect their needs, choices and abilities. A range of varied nutritious meals that reflect the choices of people who use the service are also provided. Individualised personal care is provided in a sensitive manner. Residents are supported to access a range of healthcare services. The homes medication practises are generally sound. The home safeguards and listens to people who use the service. Residents benefit from a comfortable environment that is generally well maintained. Staffs are supported to undertake external NVQ level qualifications. Residents are encouraged to participate in staff recruitment. Staffs are appropriately supervised. The homes recruitment policy and procedure safeguards people who use the service. The home has obtained appropriate insurance cover.Shrewsbury Road (267)DS0000022850.V375718.R01.S.docVersion 5.2 What has improved since the last inspection? The home has successfully addressed a number of requirements made at the previous inspection. The home has revised the format it uses for its staff rota. The homes safeguarding action plan has been fully implemented. The homes recruitment practises safeguard people who use the service. The home has commission specialist learning disability training for all permanent staff members. Staffs are on target to receive a minimum of six supervisions in the current year. The home has completed a quality assurance exercise that includes the views of people who use the service. The outcomes have been collated and published. The home has evidenced that it is supporting people who use the service to engage in more personalised community and occupational activities. The way the home records complaints has been revised. Health and safety tests required by legislation are regularly carried out and the results recorded. What the care home could do better: As a result of this inspection four requirement are restated. Individual plans must adequately address identified needs such as mobility. Potential risks should be subject to an appropriate risk assessment and management plan. Where residents are required to make healthcare decisions the home must evidence the decision making process and consider the use of medical advocates. The home must notify the Commission for Social Care Inspection of the outcome of its review of staffing levels. An additional twelve requirements were made as a result of this inspection. Where support with finances is identified, the reasons, nature and manner of support must be documented. Care plans should reflect resident`s abilities to make decisions about their own lives. Flexible staff time with residents in 1:1 sessions must be clearly recorded in individual plans. Assistance with medication must be clearly identified in the individual plan and be subject to a risk assessment. All medication must be listed on the MAR sheet. Medication expiry dates must be legible. Some minor repairs must be attended to. The home must ensure that staff is employed in sufficient numbers. The staffing roster must include details of all staff working within the home, including those providing 1:1 sessions with residents.Shrewsbury Road (267)DS0000022850.V375718.R01.S.docVersion 5.2All potentially hazardous cleaning materials must be securely stored. Fire doors must be kept closed, or fitted with appropriate automatic closures. A number of good practise recommendations are also made. Where there is a change in need a new care plan should be produced rather than notes added to the old plan. The home should monitor the amount of money held on behalf of people who use the service to ensure that excessive amounts are not removed from banks or building societies. The home should liaise with its pharmacist to ensure that all medications are accurately labelled. The home should replace its British National Formulary every two years. The home must ensure that staff is clear about the change in role regarding the former volunteer who now visits the home as the friend of some residents. Key inspection report CARE HOME ADULTS 18-65 Shrewsbury Road (267) 267 Shrewsbury Road East Ham London E7 8QU Lead Inspector Lea Alexander Key Unannounced Inspection 19th June 2009 09:00 Shrewsbury Road (267) DS0000022850.V375718.R01.S.doc Version 5.2 Page 1 This report is a review of the 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. 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 home adults 18-65 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. Shrewsbury Road (267) DS0000022850.V375718.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) 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. www.cqc.org.uk Internet address Shrewsbury Road (267) DS0000022850.V375718.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Shrewsbury Road (267) Address 267 Shrewsbury Road East Ham London E7 8QU 020 8586 7781 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) maria.dziedziurska@saharahomes.co.uk Sahara Homes Limited Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Shrewsbury Road (267) DS0000022850.V375718.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Can accommodate one named service user over the age of 65. Date of last inspection 29th January 2009 Brief Description of the Service: 267 Shrewsbury Rd is a residential home run by Sahara Homes (UK) Limited, which also runs similar homes in the area, and provides long term care and support on a 24 hour basis for four people with learning disabilities. The home states that its purpose is to support, encourage and enable each resident to realise their full capacity in choice, dignity, respect, privacy, independence, civil rights and individuality. The home is a large terraced house situated in a residential street in Forest Gate. Service users have single bedrooms with hand-basins. There is a kitchen/dining room, bathroom and shower room and a paved garden at the rear of the house. The home is within close proximity to East Ham and Green Street shopping areas and served by a range of bus routes, Upton Park and East Ham underground stations. Off-street and on-street parking is available. Current fees are in the range of £900-£1,200 per week. Shrewsbury Road (267) DS0000022850.V375718.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors carried out this inspection over the course of a day. During the inspection we spoke to residents, staff, the acting manager and responsible individual. We also looked at paperwork relating to the running of the home, including resident’s personal files and staff personnel files. The quality rating for this service is ** stars. This means that people who use the service experience good quality outcomes. What the service does well: People who use the service told us that they are “happy living here” and that they “get on well” with staff. The home has produced a statement of purpose and service users guide. Potential residents are assessed by the home prior to their moving in. The home develops individual plans with each resident that are regularly reviewed. People who use the service are supported to manage their own finances wherever possible. The home holds regular residents meetings to include people who use the service in its decision making processes. Residents are supported to maintain family and personal relationships, and to engage in a range of community, leisure and occupational activities that reflect their needs, choices and abilities. A range of varied nutritious meals that reflect the choices of people who use the service are also provided. Individualised personal care is provided in a sensitive manner. Residents are supported to access a range of healthcare services. The homes medication practises are generally sound. The home safeguards and listens to people who use the service. Residents benefit from a comfortable environment that is generally well maintained. Staffs are supported to undertake external NVQ level qualifications. Residents are encouraged to participate in staff recruitment. Staffs are appropriately supervised. The homes recruitment policy and procedure safeguards people who use the service. The home has obtained appropriate insurance cover. Shrewsbury Road (267) DS0000022850.V375718.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: As a result of this inspection four requirement are restated. Individual plans must adequately address identified needs such as mobility. Potential risks should be subject to an appropriate risk assessment and management plan. Where residents are required to make healthcare decisions the home must evidence the decision making process and consider the use of medical advocates. The home must notify the Commission for Social Care Inspection of the outcome of its review of staffing levels. An additional twelve requirements were made as a result of this inspection. Where support with finances is identified, the reasons, nature and manner of support must be documented. Care plans should reflect resident’s abilities to make decisions about their own lives. Flexible staff time with residents in 1:1 sessions must be clearly recorded in individual plans. Assistance with medication must be clearly identified in the individual plan and be subject to a risk assessment. All medication must be listed on the MAR sheet. Medication expiry dates must be legible. Some minor repairs must be attended to. The home must ensure that staff is employed in sufficient numbers. The staffing roster must include details of all staff working within the home, including those providing 1:1 sessions with residents. Shrewsbury Road (267) DS0000022850.V375718.R01.S.doc Version 5.2 Page 7 All potentially hazardous cleaning materials must be securely stored. Fire doors must be kept closed, or fitted with appropriate automatic closures. A number of good practise recommendations are also made. Where there is a change in need a new care plan should be produced rather than notes added to the old plan. The home should monitor the amount of money held on behalf of people who use the service to ensure that excessive amounts are not removed from banks or building societies. The home should liaise with its pharmacist to ensure that all medications are accurately labelled. The home should replace its British National Formulary every two years. The home must ensure that staff is clear about the change in role regarding the former volunteer who now visits the home as the friend of some residents. 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. Shrewsbury Road (267) DS0000022850.V375718.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 Shrewsbury Road (267) DS0000022850.V375718.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 2. 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. Admissions to the home are not made until a full needs assessment has been undertaken. The home provides a statement of purpose and service users guide. EVIDENCE: Previous inspections have evidenced that the home has produced a statement of purpose and service users guide. There have been no new admissions to the home since the last inspection. People who currently use the service have been in residence for some years. Previous inspections have evidenced that the home assesses residents prior to their moving in. Shrewsbury Road (267) DS0000022850.V375718.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 & 9. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual plans are easy to understand and are regularly reviewed. Residents are involved in some of the decision making processes of the home. However, when and how individual residents are able to make their own choices is not reflected in plans or recorded on the personal file. Individual plans contain little information about communication needs. Some individual plans lack basic information in areas such as finance and mobility. Some risk assessments are very basic in the information that they contain. The home consults residents about the service they receive. EVIDENCE: We examined the personal files of three people who are currently using the service. This evidenced that the home has developed individual plans for each. Shrewsbury Road (267) DS0000022850.V375718.R01.S.doc Version 5.2 Page 11 These have an easy read pictorial format. However, we were of the opinion that some identified needs such as support with finances, and in some cases mobility and communication were not adequately addressed. A requirement from the previous inspection addressing this area is therefore restated. The individual plans we saw were dated July 2008. However, there was evidence of monthly key working sessions where these plans were reviewed. There were also hand written notes added to the plan to reflect changes, but these updates had not been signed or dated. The plans we looked at contained some life history work and evidence of person centred plan. Three residents have their own bank accounts. One resident is subject to appointeeship and for a second resident the home and placing authority are reviewing the arrangements for managing their finances. We looked at the individual care plans for two people who use the service and formed the view that the home needs to include details of how it supports residents to manage their finances in these plans. Discussions with the Manager and Responsible Individual evidenced that one resident has recently had the arrangements for managing their finances reviewed, and new procedures put in place, however these developments were not reflected in their individual plan or recorded in their personal file. We looked at the financial records maintained by the home for two people who use the service. This evidenced that the home maintains a record of each transaction including the date, nature of transaction and the amount. Sampling of the financial records and available monies for one resident evidenced that at present a substantial amount of cash was being held on their behalf. We spoke with the Manager who advised that a day trip was being planned, however a breakdown of the costs involved indicated that what we considered an excess of cash would still be held by the home. We spoke with people who use the service, with the Manager and care workers. We also looked at residents personal files. This evidenced that residents have differing abilities to understand and retain information, which raises issues of capacity and consent. We formed the view that individual plans should be developed to address resident’s needs and abilities in this area. Discussion with residents, care staff and the Manager and sampling of minutes evidenced that regular residents meetings are held, where people who use the service have the opportunity to participate in the day to day running of the home. We looked at the available risk assessments available for two people who use the service. We noted that some risk assessments did not contain sufficient Shrewsbury Road (267) DS0000022850.V375718.R01.S.doc Version 5.2 Page 12 detail. For example, for one resident a risk assessment identifying aggressive behaviour had been completed, but this did not include any information on potential triggers or antecedents to aggressive behaviour. Shrewsbury Road (267) DS0000022850.V375718.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 15, 16 & 17. 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. People who use the service are supported to maintain family and personal relationships. Residents are involved in meaningful daytime activities of their choice. Residents are also involved in the domestic routines of the home. People who use the service enjoy the varied and nutritious meals that are supplied. EVIDENCE: We examined the personal files of two residents. We also spoke with residents and looked at the personal diary that one resident showed us. This evidenced increased personalisation and individuality in the activities undertaken by people who use the service. Shrewsbury Road (267) DS0000022850.V375718.R01.S.doc Version 5.2 Page 14 One resident attends a day service four days each week. In addition they receive seven hours 1:1 each Friday which they can use for activities within the home or community. Their personal file detailed their personal hobbies and interests and we were advised that the home were looking into a local dance based activity for them. A second resident attends a day service three days each week. They also attend a trampoline session one day each week and attend the local supermarket each week to assist with the house grocery shopping. Other residents do not attend local day services. One resident is supported to access the local community for activities of their choice, and sampling of their personal diary evidenced that this occurred approximately three times per week. A fourth resident has varying abilities, and we were advised that their activities are mainly based within the home according to their abilities on that particular day. All residents are encouraged to attend local restaurants or pubs with staff support for a weekly meal out. Residents are also encouraged to attend the local weekly Gateway social club one evening per week. Examination of the personal file of one resident evidenced that monthly discussions with their key worker addressed community and leisure activities. As a result of these discussions an individualised day trip was being arranged. Sampling of the minutes of residents meetings evidenced that community activities for residents were regularly discussed, and as a result of residents feedback outings of their choice had been arranged. Discussions with the Manager and residents evidenced that each receives 1:1 sessions with care staff. However, the individual plans we saw did not accurately reflect the dates and timings of these sessions. Discussion with people who use the service, with the Manager and sampling of personal files evidenced that residents are supported to maintain contact with their families. Discussion with people who use the service and care workers evidenced that residents choose when to be alone or in company, and when not to join in an activity. Discussion with residents and the Manager evidenced that the meals appearing on the menu are discussed and agreed at a weekly residents meeting. Staff use pictorial aids to support residents to choose the meals they would like to eat. Shrewsbury Road (267) DS0000022850.V375718.R01.S.doc Version 5.2 Page 15 We spoke with residents and looked at the homes record of meals provided. This evidenced that a range of varied and nutritious meals is provided that reflect residents preferences. Residents told us that they enjoyed the meals provided. Shrewsbury Road (267) DS0000022850.V375718.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. 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. Personal support is responsive to the varied needs of people who use the service. Residents are supported to access healthcare services. However, the home must evidence that residents are fully supported to make informed decisions about healthcare treatments. The home must also ensure sound medication practises at all times. EVIDENCE: Discussion with people who use the service, care staff, the manager and sampling of individual plans evidenced that detailed information relating to the assistance residents require with personal care is recorded in the individual plan, and that these reflect residents actual needs. Discussion with care staff evidenced a good understanding of how to promote dignity and respect whilst assisting with personal care. Shrewsbury Road (267) DS0000022850.V375718.R01.S.doc Version 5.2 Page 17 We examined the healthcare records of two people who use the service. For each we found a record of medical appointments and their outcome. During our site inspection we noted that a stock of sugary foods is maintained in the homes medicine cupboard for specific use should a resident experience a hypoglycaemic episode. One resident we case tracked was evidenced as being referred for a surgical procedure. Discussion with them and the care staff on duty evidenced that some steps had been taken to explain to the resident what was going to happen and to obtain their consent. However, this information was not recorded in their personal file and it was not evidenced that a medical advocate had been requested. Previous inspections have evidenced that the home has developed a medication policy that complies with National Minimum Standards. Discussion with the Manager and examination of the homes current medication stocks evidenced that at the time of this inspection no residents were prescribed controlled drugs. We examined the medications available for residents, and compared these with the Medication Administration Record (MAR) sheet. We found that the MAR sheets were generally in good order. However, “as required (PRN)” medication was not listed on the MAR sheet for one resident. We also noted several minor issues with regards to medication that we would recommend the home address. We noted that the expiry date on one resident’s aqueous cream was illegible. A diabetic product prescribed to one resident had been labelled by the pharmacist “as applied by nurse”, when care staff were in fact applying. We also noted that the homes British National Formulary (BNF) was out of date. One person who uses the service administers their own insulin to manage their diabetes. This is identified in their plan and subject to a risk assessment. However, discussions with the resident and the manager evidenced that they receive support in monitoring their blood sugar levels; however the precise nature of this assistance was not explicitly identified in their individual plan or subject to a risk assessment. Shrewsbury Road (267) DS0000022850.V375718.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. 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. The homes complaints procedure is prominently displayed. Complaints received are appropriately investigated and recorded. Care staff demonstrated a sound understanding of safeguarding issues. EVIDENCE: We noted that an easy read copy of the homes complaints policy was displayed in the communal hallway. Previous inspections have evidenced that the homes complaints policy complies with National Minimum Standards. We looked at the homes complaints policy. This evidenced that since the last inspection the home has received two complaints. We noted that the date, nature of complaint and the investigation undertaken and its outcome were comprehensively recorded. We spoke to residents who told us that if they were unhappy about anything at the home they felt comfortable telling staff about this. Discussion with residents, the manager and sampling of relevant documentation evidenced that their have been no adult protection concerns since the last inspection. Discussion with the manager evidenced that the Shrewsbury Road (267) DS0000022850.V375718.R01.S.doc Version 5.2 Page 19 home has fully implemented its own safeguarding plan since the last inspection. Discussion with care staff evidenced a sound understanding of the types of abuse vulnerable people may experience, and their responsibilities should they have any safeguarding concerns. Shrewsbury Road (267) DS0000022850.V375718.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30. 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. Residents have their own bedroom that they are able to personalise. The home is generally well maintained with a range of communal and private spaces. EVIDENCE: The home is situated in a large terraced house. There is a large entrance hall with a communal lounge located off. The lounge has a range of comfortable seating and is equipped with a TV and stereo. The walls are decorated with pictures of residents. One resident’s bedroom is located on the ground floor, along with a shower room with WC and hand basin. A large kitchen diner with access to the garden Shrewsbury Road (267) DS0000022850.V375718.R01.S.doc Version 5.2 Page 21 is also located on the ground floor. From the hallway there is access to a large cellar that is used for storage. Access to the first floor is via a staircase, and on the upper level there are three resident’s bedrooms, a small office and staff sleep in room. A bathroom with tub, mixer taps, hand basin and WC is also located on the first floor. Residents are supported to personalise their bedrooms with photographs and mementos. Some minor repairs were identified during the course of the inspection, and these are listed in the requirements section of this report. Whilst we were visiting the home we found the premises to be clean, hygienic and free from offensive odours. Shrewsbury Road (267) DS0000022850.V375718.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are generally happy with the care that they receive. Staffs are scheduled to commence training programmes this summer for core areas. Staffs are also encouraged to undertake external NVQ level qualifications. The homes recruitment procedure safeguards people who use the service. However, the home must ensure that the staffing rota accurately reflects the situation within the home and that sufficient staffs are on duty to ensure the quality of service provided to residents. EVIDENCE: The Responsible Individual and Manager told us that the home employs three permanent staff and one bank staff. The home operates three shifts over a 24 hour period. All care staff employed within the home have obtained NVQ level 2 or above. Shrewsbury Road (267) DS0000022850.V375718.R01.S.doc Version 5.2 Page 23 A previous inspection had required the home to submit written evidence of a review of staffing levels. This was not available at the time of this inspection, and the requirement is therefore restated. We looked at the homes staffing rota, at resident’s individual plans and also spoke with the manager, care staff and residents. This evidenced that each resident has some 1:1 time with care staff each week, and to facilitate this additional staff are on duty. During our visit to the home we observed an additional member of staff report on duty and spend 1:1 time in the community with a particular resident. However, we noted that the homes staffing rota did not include these 1:1 sessions. Since the last inspection the layout of the homes staffing rota had been revised. The rota includes the times the Manager will be on duty and identifies which staff will be covering which shift. One member of staff is on duty for each shift. A single member of staff is on duty for sleeping night cover. We noted from the current staffing roster that on occasions staff are on duty by themselves for extended periods, for example one member of staff appeared on the rota as on duty continuously from 10am on Saturday morning until 10pm on Sunday evening. During this period they would be on duty by themselves from 5pm on Saturday until 10pm on Sunday. We were concerned that this extended period of duty without cover for breaks could have a detrimental impact upon the quality of care provided to people who use the service. Since the last inspection the home has developed a process where residents can be involved in the selection of new staff members. We spoke with one resident who had been involved in this process and they told us that they had enjoyed the experience and found it helpful. We examined the personnel files for two care workers. These evidenced that the home obtains two satisfactory references and an enhanced Criminal Records Bureau (CRB) check for staff. Discussion with care workers and sampling of the personnel file also evidenced that care workers receive copies of their employment terms and conditions. We looked at the training records for two permanent care workers. This evidenced that one had completed medication training since the last inspection. The Responsible Individual told us that the homes three permanent care workers were scheduled to commence 5 days learning disability training in July 2009, and that this would also provide refresher training in key mandatory areas including food safety, infection control, first aid, moving and handling and safeguarding. Shrewsbury Road (267) DS0000022850.V375718.R01.S.doc Version 5.2 Page 24 Since the last inspection the homes former volunteer has started visiting some residents as a friend. We would recommend discussion with all care staff to ensure they are clear of this change of status. Sampling of supervision records and discussion with staff evidenced that the home is on target to provider a minimum of six supervisions in the current year. Shrewsbury Road (267) DS0000022850.V375718.R01.S.doc Version 5.2 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 & 43. 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. The home has appointed a suitably qualified and experienced manager. The home has sound health and safety practises and carries out and records necessary health and safety checks. EVIDENCE: Since the last inspection a permanent, full time manager has been appointed in post. At the time of this inspection they were on sick leave, and in their absence the deputy manager from another Sahara Home was covering their post on a part time basis. We were advised by the responsible individual that the manager had yet to commence the registration procedure. Shrewsbury Road (267) DS0000022850.V375718.R01.S.doc Version 5.2 Page 26 We were told that the permanent appointed manager has obtained NVQ level 4. The home has recently developed an easy to read quality assurance feedback survey. The results from this have been collated and the outcomes published. The home maintains a log of fridge and freezer temperatures. We looked at this and found that the temperatures are recorded daily and maintained within acceptable parameters. The home also maintains a log of water temperatures. We looked at this and found that temperatures are tested and recorded regularly, and are again maintained within acceptable parameters. We also looked at the homes fire records. These evidenced weekly tests of the homes smoke alarms take place with the outcome recorded. The home also carries out regular fire evacuation drills and records the outcome of these. During the course of our inspection we noted that several fire doors within the home were wedged open, and that some potentially hazardous cleaning materials were not securely locked in a cupboard. The home has obtained appropriate insurance cover and displays its current insurance certificate. Shrewsbury Road (267) DS0000022850.V375718.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CONCERNS AND COMPLAINTS CHOICE OF HOME Standard No 1 2 3 4 5 Score 3 3 X X X Standard No 22 23 Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 2 3 2 X ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 2 3 Version 5.2 Page 28 Shrewsbury Road (267) DS0000022850.V375718.R01.S.doc 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 15 Timescale for action Individual plans must adequately 30/10/09 address identified needs such as mobility. This is a restated requirement. The previous target of the 28/05/09 was not met. 2. YA7 16 & 20 Where support with finances is identified, the reasons, nature and manner of support must be documented. Care plans should reflect resident’s abilities to make decisions about their own lives. Potential risks should be subject to an appropriate risk assessment and management plan. This is a restated requirement. The previous target of the 28/05/09 was not met. 5. YA13 16 Flexible staff time with residents in 1:1 sessions must be clearly DS0000022850.V375718.R01.S.doc Requirement 30/10/09 3. YA7 12 30/10/09 4. YA9 13 & 14 30/10/09 30/10/09 Shrewsbury Road (267) Version 5.2 Page 29 recorded in individual plans. 6. YA20 13 Where residents are required to make healthcare decisions the home must evidence the decision making process and consider the use of medical advocates. This is a restated requirement. The previous target of 28/05/09 was not met. 7. YA20 13 Assistance with medication must be clearly identified in the individual plan and be subject to a risk assessment. All medication must be listed on the MAR sheet. Medication expiry dates must be legible. 30/10/09 30/10/09 8. 9. 10. YA20 YA20 YA24 13 13 13 & 23 30/10/09 30/10/09 The hole in the wall (caused by a 30/10/09 door handle) in one residents bedroom must be repaired. Broken door locks and handles must be repaired or replaced. The home must notify the Commission for Social Care Inspection of the outcome of its review of staffing levels. This is a restated requirement. Previous targets of the 30/06/08 and 28/05/09 were not met. 30/10/09 30/10/09 11. 12. YA24 YA33 13 & 23 18 13. YA33 18 The home must ensure that staff is employed in sufficient numbers. The staffing roster must include details of all staff working within DS0000022850.V375718.R01.S.doc 30/10/09 14. YA33 18 30/10/09 Page 30 Shrewsbury Road (267) Version 5.2 the home, including those providing 1:1 sessions with residents. 15. YA42 13 All potentially hazardous cleaning materials must be securely stored. Fire doors must be kept closed, or fitted with appropriate automatic closures. 30/10/09 16. YA42 23 30/10/09 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 YA6 YA7 Good Practice Recommendations Where there is a change in need a new care plan should be produced rather than notes added to the old plan. The home should monitor the amount of money held on behalf of people who use the service to ensure that excessive amounts are not removed from banks or building societies. The home should liaise with its pharmacist to ensure that all medications are accurately labelled. The home should replace its British National Formulary every two years. The home must ensure that staff is clear about the change in role regarding the former volunteer who now visits the home as the friend of some residents. 3. 4. 5. YA20 YA20 YA35 Shrewsbury Road (267) DS0000022850.V375718.R01.S.doc Version 5.2 Page 31 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: 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. Shrewsbury Road (267) DS0000022850.V375718.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!