Care Home: Smitham Downs Road (7)

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What the care home does well Verbal feedback received from the vast majority of people who use the service was extremely positive about the standard of care they received at Smitham Downs Road and the attitude of staff. Typical comments included, `I like it here more now", "I would like to get my own place one day, but its good here cos staff help me out when I need it", and "some staff are better than others, but most of them are alright". People who use the service are always consulted about how the service runs and are able to influence key decisions in the home. They are fully involved in decisions about its day-to-day running and the home acts upon the results of consultation with the people who use the service and their representatives. The service has a `can do` attitude and risks are managed positively to help people using the service lead the life they want. Any limitations on freedom, choice, or facilities are always in the person`s best interests and staff actively encourages people who use the service to maintain and develop their independent living skills. This includes where appropriate, taking responsibility for shopping, planning meals, and meal preparation. The ethos of the home is that it welcomes complaints and suggestions about the service, uses these positively, and learns from them.The home has experienced relatively low levels of staff turnover in recent years and consequently the people who use the service continue to be supported by people who are familiar with their unique needs and preferences. What has improved since the last inspection? Since the home was last inspected CMG have introduced a new admissions tool. The tool has been designed to ensure that the needs of all the people who already use the service are assessed and the affect any new admissions could have on existing group dynamics within the home is carried out prior to anyone moving in. The home has a new more secure safe and a whole range of new financial checks and balances have been introduced since the service was last inspected to minimise risks associated with the financial abuse of people who use CMG services. Since the service was last inspected a rolling programme to redecorate the home and replace some of its rather worn out soft furnishings has commenced. There is now a much stronger NVQ provision with staff able to study for both the Level 2 and 3 qualifications. It was positively noted that in line with National Minimum Standards the home is on course to ensure 100% of its current staff team have either already achieved an NVQ Level 2 or above in care or are enrolled on suitable courses. The relatively new manager is suitably experienced and highly competent to run the home to ensure it meets its stated aims and objectives. The manager was able to evidence a sound understanding and application of `best practice` and clearly has good people skills and is responsive to the needs of the people who use the service. Other professionals see the manager and his deputy as an effective team who consistently provide high quality care. What the care home could do better: All the positive comments made above notwithstanding their remains a number of significant areas of practice that the provider must take action to improve the lives of the people who use the service, as well as keep them safe: All the staff that will be expected to use CMG`s new compatibility assessment tool must be trained in its use. The way in which the service keeps risk assessments and associated risk management strategies up to date to reflect people changing needs and circumstances must be reviewed.The garden shed must not be used as an outdoor shelter for people who smoke as it contravenes the new smoke free England legislation because it`s too enclosed. The home will need to speak to the people who use the service and the providers about alternative solutions to this problem. The manager suggested the possibility of having a shelter fitted across the back patio. A good range of activities within the home and community mean the service users have various opportunities to participate in stimulating and motivating activities, although the manager believes there remains scope to improve practice in this area further. Staff are appropriately supervised at regular intervals ensuring the people who use the service receive support from suitably competent and well-informed staff, although the manager also believes there is still room to improve the frequency of this. The homes fire safety arrangements need to be improved as a matter of urgency. All staff that work in the home must be appropriately trained in fire safety and be involved in at least one fire drill every six months or receive fire safety instructions in that time (Staff that work nights must participate in a fire drill or receive additional instruction at least once a quarter). Furthermore, a record of every drill conducted in the home must also be appropriately maintained. This will ensure the safety of the people using the service. Radiators within the home must be assessed for the risk they present to the people that use the service and action taken to minimise any identified risk. This will ensure the safety of the people who use the service. Finally, the situation regarding the homes deputy manager who is currently seconded to another CMG service in the area should be clarified as soon as reasonably practicable (i.e. Is the move temporary or permanent?). We agree with the manager`s comments that the service needs a good deputy to ensure the home continues to improve the lives of the people who use the service. CARE HOME ADULTS 18-65 Smitham Downs Road (7) 7 Smitham Downs Road Purley Surrey CR8 4NH Lead Inspector Lee Willis Key Unannounced Inspection 29th February 2008 10:30 Smitham Downs Road (7) DS0000025837.V353381.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Smitham Downs Road (7) DS0000025837.V353381.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Smitham Downs Road (7) DS0000025837.V353381.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Smitham Downs Road (7) Address 7 Smitham Downs Road Purley Surrey CR8 4NH 020 8645 0873 020 8645 0873 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.caremanagementgroup.com Care Management Group Ltd (trading as CMG Homes Ltd) Post Vacant Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Smitham Downs Road (7) DS0000025837.V353381.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th February 2007 (Random) Brief Description of the Service: 7 Smitham Downs Road is owned by CMG a specialist provider of care for adults with learning disabilities and challenging behaviour. The service provides accommodation and personal support for up to nine generally younger adults. Christian Holst has been in operational day-to-day control of the service since August 2007 and recently underwent a ‘fit’ person interview with the Commission. Located on a suburban street relatively close to the centre of Purley with its wide variety of local shops, cafes, pubs, and banks. Buses also stop very close to the home. This main part of this large detached house comprises of seven single occupancy bedrooms; a main lounge; separate dinning area; games room; kitchen; small laundry, and a ground floor office. The two bed-roomed flat attached to the side of the main building is selfcontained and has its own kitchen and ensuite shower and toilet facilities. The sloping garden at the rear of the property is well maintained. People who use the service have access to copies of the homes Statement Of Purpose, User Guide, CSCI reports and their terms and conditions of occupancy. These documents contain information about the services and facilities provided and the fees charged for them. Fees start from £1,200 a week. Smitham Downs Road (7) DS0000025837.V353381.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. From all the available evidence we gathered during this services key (main) Inspection the Commission for Social Care Inspection (CSCI) has judged the service as having significantly more strengths than areas of weakness. There are no significant areas for improvement relating to issues of poor management, although staff participation in fire drills needs to be increased as a matter of urgency. Where weaknesses have been identified the Commission is confident the relatively new manager will resolve them promptly. We spent five and a half hours at the home. During the visit we spoke with five people who use the service, the acting manager, two support workers, and a visiting National Vocational Qualification assessor. We also looked at records and documents, including the care plans for two people who live at the home. The remainder of this site visit was spent touring the premises. We did not receive any ‘have your say’ comment cards about the home. What the service does well: Verbal feedback received from the vast majority of people who use the service was extremely positive about the standard of care they received at Smitham Downs Road and the attitude of staff. Typical comments included, ‘I like it here more now”, “I would like to get my own place one day, but its good here cos staff help me out when I need it”, and “some staff are better than others, but most of them are alright”. People who use the service are always consulted about how the service runs and are able to influence key decisions in the home. They are fully involved in decisions about its day-to-day running and the home acts upon the results of consultation with the people who use the service and their representatives. The service has a ‘can do’ attitude and risks are managed positively to help people using the service lead the life they want. Any limitations on freedom, choice, or facilities are always in the person’s best interests and staff actively encourages people who use the service to maintain and develop their independent living skills. This includes where appropriate, taking responsibility for shopping, planning meals, and meal preparation. The ethos of the home is that it welcomes complaints and suggestions about the service, uses these positively, and learns from them. Smitham Downs Road (7) DS0000025837.V353381.R01.S.doc Version 5.2 Page 6 The home has experienced relatively low levels of staff turnover in recent years and consequently the people who use the service continue to be supported by people who are familiar with their unique needs and preferences. What has improved since the last inspection? What they could do better: All the positive comments made above notwithstanding their remains a number of significant areas of practice that the provider must take action to improve the lives of the people who use the service, as well as keep them safe: All the staff that will be expected to use CMG’s new compatibility assessment tool must be trained in its use. The way in which the service keeps risk assessments and associated risk management strategies up to date to reflect people changing needs and circumstances must be reviewed. Smitham Downs Road (7) DS0000025837.V353381.R01.S.doc Version 5.2 Page 7 The garden shed must not be used as an outdoor shelter for people who smoke as it contravenes the new smoke free England legislation because it’s too enclosed. The home will need to speak to the people who use the service and the providers about alternative solutions to this problem. The manager suggested the possibility of having a shelter fitted across the back patio. A good range of activities within the home and community mean the service users have various opportunities to participate in stimulating and motivating activities, although the manager believes there remains scope to improve practice in this area further. Staff are appropriately supervised at regular intervals ensuring the people who use the service receive support from suitably competent and well-informed staff, although the manager also believes there is still room to improve the frequency of this. The homes fire safety arrangements need to be improved as a matter of urgency. All staff that work in the home must be appropriately trained in fire safety and be involved in at least one fire drill every six months or receive fire safety instructions in that time (Staff that work nights must participate in a fire drill or receive additional instruction at least once a quarter). Furthermore, a record of every drill conducted in the home must also be appropriately maintained. This will ensure the safety of the people using the service. Radiators within the home must be assessed for the risk they present to the people that use the service and action taken to minimise any identified risk. This will ensure the safety of the people who use the service. Finally, the situation regarding the homes deputy manager who is currently seconded to another CMG service in the area should be clarified as soon as reasonably practicable (i.e. Is the move temporary or permanent?). We agree with the manager’s comments that the service needs a good deputy to ensure the home continues to improve the lives of the people who use the service. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Smitham Downs Road (7) DS0000025837.V353381.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 Smitham Downs Road (7) DS0000025837.V353381.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 People who use 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. In the main people who use this service have good information about the home in order to make an informed decision about whether the service is appropriate for them. People’s needs are fully assessed prior to admission so the individual, their representatives, and the home can be sure the placement is appropriate for them. However, the way in which the provider assesses and consults with other people who already use the service about the compatibility of new admissions needs to be significantly improved. EVIDENCE: “Its alright here”, “I Love my flat”, and “I don’t want to move out” were typical comments made by three individuals who use the service. A copy of the homes latest Statement of Purpose and Guide were produced on request. These documents clearly set out the objectives and philosophy of the service and what the people who would be using it could expect to receive. The Smitham Downs Road (7) DS0000025837.V353381.R01.S.doc Version 5.2 Page 10 manager told us the document was last reviewed in February 2008 and up dated accordingly to reflect any changes in provision. The User Guide is available in an ‘easy to read’ format, which is illustrated with all manner of colourful pictures, symbols, and photographs making it more accessible to the people who live at the home. Three people who used the service have moved out in the past 12 months leaving the relatively new manager with a large number of places to fill. We are aware that one placement broke down because the home was no longer capable of meeting their rapidly changing needs, while another latest less than three months because the home did not have all the information it needed to know about the individual in the first place. The new manager told us he was aware that CMG have developed a new compatibility assessment tool that places a greater emphasis on the unique needs and personal goals of people already using a particular service to minimise the risk of placements for new referrals breaking down. However, Christian conceded that he has not yet seen the new compatibility tool and has not received any training in its use. The manager also told us he believed all the people now residing at Smitham Downs were relatively compatible. The manager was able to provide us with an excellent example of an occasion when he felt it had been necessary to decline a referral on the grounds that they would have a destabilising affect on the home because they were not ‘compatible’ with the existing service user group. The manager told us he would always expect to visit a prospective service user in their home and be fully involved in the assessment process and work closely with CMG’s own centralised admissions team. Furthermore, Christian confirmed he would always invite a prospective new service user and their representatives to visit the home, meet the other service users, and staff before any decisions about moving in on a trial period of residency was made. Smitham Downs Road (7) DS0000025837.V353381.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 People who use 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. Care plans reflect what is important to the individual, their capabilities, and what support they need to achieve their personal aspirations. The home has excellent arrangements in place that ensures the people who use the service have every opportunity to participate in its day-to-day running and are always consulted about important decisions that affect their lives. The people who use the service are protected by the homes arrangements for assessing and management risk, which promotes their independence and choice. EVIDENCE: Smitham Downs Road (7) DS0000025837.V353381.R01.S.doc Version 5.2 Page 12 We looked at the care plans for two people living at the home. The plans were person centred and tended to ‘celebrate’ an individuals life experiences, as well as setting out clearly how their current personal, social, and health care requirements and wishes were to be met through positive interventions. One member of staff met was able to describe the care plan for the person they keyworked whose care we were case tracking. This knowledge means that service users can be confident that they will get support from people who understand their care needs. Both the care plans being case tracked had been reviewed in the past six months and up dated accordingly. It was positively noted that the manager keeps a list of all the dates of forthcoming care plan reviews to minimise the risk of them being forgotten and missed. These plans also contained comprehensive risk assessments; although the manager acknowledged that there was scope to improve the way the home reviewed them to ensure they continually reflected peoples changing needs. The manager told us he had a positive approach to addressing safety issues. Risk management strategies sampled at random had clearly been developed in the context of supporting people who used the service to take ‘responsible’ risks as part of structured programme to promote their independent living skills and life choices. The home ensures that people who use the service are consulted on a regular basis to gather information about what they ‘want’. Minutes of service user meetings revealed that these are held regularly and well attended by people using the service. Minutes showed issues regarding the home becoming nonsmoking and the use of paper towels in toilets had been put to the people who use the service for them to decide. Two people who use the service told us “they found these meetings useful” and that on the whole “staff ‘usually’ listened to what they had to say”. Furthermore, one person who uses the service had recently be given the opportunity to participate in the selection of a new member of staff and had been asked to draw up a list of questions to ask them at their support worker interview. Smitham Downs Road (7) DS0000025837.V353381.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): 11, 12, 13, 15, 16, & 17 People who use 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. A good range of activities within the home and community mean the service users have various opportunities to participate in stimulating and motivating activities, although the manager believes there remains scope to improve practice in this area further. People who use the service are actively encouraged to participate in household chores to enable them to maintain and develop their independent living skills. Dietary needs and preferences are well catered ensuring the people who use the service are provided with daily variation, choice, and nutritionally wellbalanced meals. EVIDENCE: Smitham Downs Road (7) DS0000025837.V353381.R01.S.doc Version 5.2 Page 14 Throughout the course of this inspection people who use the service were observed on numerous occasions making themselves hot drinks and meals. One person spoken to at length said it was their day to clean their bedroom, which they had agreed to do once a week. Another person who uses the service was seen doing their laundry. The manager told us everyone who lives at Smitham Downs has agreed to do certain household chores on certain days. It was evident from the comments made by the relatively new manager that he is committed to ensuring the people who use the service are actively encouraged and supported to maintain and develop the independent living skills whenever practicable. The home was a hive of actively throughout the day with people who use the service continually coming and going to various community-based educational, vocational, and recreational activities. It was positively noted that one individual who had recently resigned from a job they held was actively being encouraged by the manager to attend an interview at the local job centre to find a new one. Other people who use the service were observed having lengthy discussions with the manager to find out about opportunities to do voluntary/therapeutic work in the local community. The manager told us this was an area he felt the home could do better in The manager told us the home operates an open visitors policy without restrictions. The home retains a visitor’s book. Staff appropriately maintains an excellent record of all the food consumed by the people who use the service. A lot of positive feedback was received from the people who use the service about the meals provided. Typical comments included “we can all choose what we what to each at menu meetings held every Sunday”, “foods ok here”, and “I have to make my own mash and pasties here”. One person told us they were going to have beef burgers instead of the meal advertised on the published menu for the day because they didn’t like beef stew. People who smoke do so in a shed in the garden. The shed is too enclosed and therefore does not comply with the new smoking ban legislation. The manager told us eh will talk to all the people who use the service about looking into alternative forms of shelter, including fitting a cover over the garden patio. Smitham Downs Road (7) DS0000025837.V353381.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 People who use 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. Suitably robust arrangements are in place to ensure the people who use the service receive personal support in the way they prefer and require, and that their unique physical and emotional health care needs are continually recognised and met. Policies and procedures for handling medication are sufficiently robust to keep the people who use the service safe. EVIDENCE: All the service users met during this visit were suitably dressed in wellmaintained clothes that were appropriate for the season. One service user told us they always chose the clothes they wore each day. Since the homes last inspection new health care records have been developed that are stand-alone documents, which set out in detail a service users medical history and the outcome of all their appointments with various health care professionals. Like the new care plan format this single bound document is Smitham Downs Road (7) DS0000025837.V353381.R01.S.doc Version 5.2 Page 16 illustrated with all manner of pictures and is written in plain language to enable it to be better understood by both service users and staff. Staff maintain detailed records of all the accidents and significant incidents involving the people who use the service. These records showed that a number of significant accidents and incidents had occurred in the home in the past 12 months, resulting in 3 unplanned admissions to hospital, three strategies meetings convened by the local authorities safeguarding adults team, and the breaking down of two placements. Nonetheless, records showed that staff on duty had appropriately dealt with this relatively high number of significant events at the time and all reported to the relevant agencies, including the Commission without delay. No recording errors were noted on medication administration records (MAR) sheets sampled at random. These records reflected current medication stocks held by the home on service users behalves, which were securely stored in a locked metal cabinet in the office. The manager told us that one person who currently resides at the home is able to self-administer their medication to a degree and is actively encouraged to do so in order to help them achieve their personal goal of gaining greater independence. The home has excellent protocols in place for the appropriate use of as required medication and staff spoken with aware that this type of medication should only ever be used as a ‘last resort’ when other managing challenging behaviour approaches had failed. Smitham Downs Road (7) DS0000025837.V353381.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People who use 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 arrangements for dealing with complaints, allegations of abuse, and incidents of challenging behaviour are understood by staff, thus ensuring the people who use the service feel listened too and safe. EVIDENCE: Records are kept of any concerns or complaints received and we saw that these were well maintained. The records showed all the matters raised had been followed up by the home in a timely fashion and appropriate action taken to resolve them. The complaints policy and procedure is displayed on a notice board in the hallway and is part of the guide for the people living there. The current policy is also available in an ‘easy’ to read format that the people who use the service can understand. Typical comments made by the people who use the service about the ability of staff to listen included “I talk to my keyworker if I am unhappy”, and “staff listen to me”. Throughout the course of this inspection the manager was observed on several different occasions taking his time to politely and professionally deal a number of wide ranging queries people who used the service put to him. Care plans being case tracked contained very detailed and specific risk management strategies to help staff effectively deal with challenging behaviour. Records showed that all the homes staff had updated their dignified Smitham Downs Road (7) DS0000025837.V353381.R01.S.doc Version 5.2 Page 18 management of conflict training and that further training course had been booked for staff to attended CMG’s new prevention and management of challenging behaviour course. Suitably trained staff has used physical intervention techniques twice in the last year to deal with a significant incident involving someone who uses the service. Records of these events showed the technique had been appropriately used as a last resort when all other deescalation approaches had failed. As previously mentioned three vulnerable adult protection case conferences have been convened by the Local Authority to explore a number of different concerns raised about inappropriate behaviour occurring between people who use the service and toward members of the public. These matters have now all been resolved and in the two cases where potential risk of abuse was judged to be ‘high’ appropriate action was taken. Two people who used to use the service have subsequently moved on to placements where staff have the necessary specialist knowledge and skills to meet these individuals complex needs more effectively. The home has a new more secure safe and a whole range of new financial checks and balances have been introduced since the service was last inspected to minimise risks associated with the financial abuse of people who use CMG services. The manager also told us two staff at the end of each shift now undertakes financial audits. The manager demonstrated a good understanding of these new financial monitoring arrangements and told us she has already attended CMG’s own training on managing services users monies. Smitham Downs Road (7) DS0000025837.V353381.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28 & 30 People who use 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 décor, fixtures, and fittings are kept in good condition, which ensures the people who use the service live in a relatively homely and comfortable environment. The homes arrangements for controlling infection are sufficiently robust to ensure the people who use the service also live in a very clean and safe environment. EVIDENCE: All the outstanding premises requirements identified at the homes last inspection have been met in full, which included the uneven driveway at the front of the house being levelled and a handled fitted to the patio door at the rear of the property. Smitham Downs Road (7) DS0000025837.V353381.R01.S.doc Version 5.2 Page 20 People spoken to were happy with their environment. Typical comments included “I’ve decided to repaint my bedroom a new colour” and “I’ve got all the things I need in my flat”. We saw the home provides the people who use the service with a relatively pleasant and comfortable place to live. Furnishings and fittings remain domestic in appearance and are well maintained. The main lounge remains the most popular venue for people who use the service to congregate when they are not in their bedrooms. During the inspection CMG’s maintenance man was repainting skirting boards in the hallway. The manager told us as part of a rolling programme to up grade the whole house funds had already been earmarked for several rooms to be redecorated, new carpets laid in communal areas and some new curtains hung in bedrooms. The manager also told us plans were being discussed to refit a new kitchen. Progress on all these matters will be assessed at the homes next inspection. The one bedroom viewed with the occupant’s permission was decorated to a good standard and contained all the furniture and fittings to meet National Minimum Standards. The person who occupant the room told us they had enough storage space to keep their belongings and that they quite liked the view they had of the garden. During a tour of the premises it was noted that most of the homes radiators are uncovered and may present a risk to people that use the service. The potential risks to people who use the will need to be assessed and appropriate action (if required) taken. Records are appropriately maintained of hot water temperature taken at regular intervals. The temperature of hot water emanating from a bath located on the first floor was noted to be a safe 38 degrees Celsius when tested at 14.30. The home was very clean and hygienic on the day we visited. The laundry has been supplied with a small wash hand basin. Smitham Downs Road (7) DS0000025837.V353381.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 People who use 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. Sufficient numbers of very experienced and competent staff are employed on a daily basis to support the needs, activities, and aspirations of the people who live at the home. The homes recruitment procedures are sufficiently robust to minimise the risk of service users being harmed by people who are ‘unfit’ to work with vulnerable adults. Staff are appropriately supervised at regular intervals ensuring the people who use the service receive support from suitably competent and well-informed staff. The manager believes there is room to improve the frequency of staff supervision sessions and plans to increase to one a month. EVIDENCE: Smitham Downs Road (7) DS0000025837.V353381.R01.S.doc Version 5.2 Page 22 On arrival four members of staff comprising of three support workers and the manager were on duty. Staff spoken with told us this ratio was sufficient to meet the needs of the people currently living at Smitham Downs. The staff on duty also seemed to work well together and seemed to have a good rapport with the people who use the service. Feedback received from most people who use the service about the attitude of staff was generally very positive. Typical comments included, “I liked my keyworker a lot, but they left”, “I get on better with some staff than others, which the manager said he will take into account when I get a new keyworker”, and “I know the new manager has a great sense of humour because he used to be my keyworker”. The home continues to experience relatively low staff turnover and has therefore only needed to recruit one new member of staff in the past 12 months. The new member of staffs file contained a completed job application form stating their full employment history; their interview score; one written reference; and confirmation that CMG’s Human Resources Department had seen an up to date Criminal Records Bureau and Protection of Vulnerable Adults checks in respect of this individual; and photographic proof of their identity. The manager told us that although this individual had already been offered the position of support worker they would not be permitted to commence working at the home until they had supplied the organisation with a second satisfactory reference in line with good recruitment protocols. The manager demonstrated a good understanding of the checks that needed to be carried out on new staff and the importance of asking appropriate questions at face-to-face interviews. Staff have access to a very good programme of training. The manager has carried out a training needs and strengths assessment of his entire staff team, which revealed very few gaps in staffs’ knowledge and skills. Mandatory training is provided in a number of areas including manual handling, first aid, food hygiene, safeguarding adults, managing challenging behaviour, and medication handling training. The manager is aware that more staff need to up date their fire safety training. Additional workshops are provided on specialist areas as previously mentioned and there is a strong NVQ provision with staff able to study for both the Level 2 and 3 qualifications. It was positively noted that in line with National Minimum Standards well over 50 of the homes current staff team have either already achieved an NVQ Level 2 or above in care or were enrolled on suitable courses. The manager is evidently committed to ensign his staff team are all NVQ trained and is well on the way to achieving this aim with only one fulltime and one part time member of staff currently not studying for this award or the equivalent. Smitham Downs Road (7) DS0000025837.V353381.R01.S.doc Version 5.2 Page 23 Two staff spoken with at length told us suitably trained senior members of staff supported them at regular intervals. Their staff files showed they had each received three recorded supervisions with a senior member of staff in the past six months in line National Minimum Standards (i.e. At least one session every two months). The manager told us he believed staff supervision was an essential tool for driving up standards in a residential care home and was therefore committed to increasing the frequency of staff supervision to one a month. Smitham Downs Road (7) DS0000025837.V353381.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42 People who use 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 have confidence in the care home because it is well run by suitably experienced and very competent manager, although a decision about the future role of the homes deputy manager needs to be taken sooner rather than later. People know that their opinions are central to how the home develops and reviews their practice because there are good quality assurance systems in place. Sufficiently robust health and safety systems are in place to ensure the people who use the service are safeguarded. Smitham Downs Road (7) DS0000025837.V353381.R01.S.doc Version 5.2 Page 25 EVIDENCE: The relatively new manager has considerable knowledge and experience of working in residential care settings in a management capacity as well as working for Social Services Departments as a Care Manager. Furthermore, the manager worked at Smitham Downs many years before as a support worker and keyworked at least one person who still lives there. The manager told us he only has three more units to complete in order to achieve his Registered Managers Award, which he hopes to do by June 2008. Progress on tis matter will be assessed at the homes next inspection. The manager told us his deputy, who ran the home very competently in the absence of a registered manager for some considerable time, is currently seconded to another CMG home in the area. It was clear from comments made by the manager that he works well with his deputy and he believes they their different management approaches compliment one another. It is unclear whether or not the homes deputy will be returning to Smitham Downs Road. We agree with the manager that the home needs a competent deputy to take it forward to the next level and will be monitoring the secondment situation closely. A decision about the deputy manager’s position needs to be made sooner rather than later. The manager was able to describe a clear vision for the home as well as sound understanding and application of ‘best practice’. Strengths the manager has include being extremely responsive to the needs of the people who use the service. From comments made by the manager throughout the course of this inspection it was evident that he is committed to ensuring the people who use the service have every opportunity to maintain and developed their independent living skills and do as much for themselves as reasonably practicable in order to help them achieve greater control over their lives. Comments from staff about the management of the home included “he’s very approachable”, “a good listener” and “he’s got the best interests of the people who use the service at heart”. The home is commended for ensuring staff meetings are held on a monthly basis. This exceeds National Minimum Standards that requires homes to hold at least six a year. These meetings were always well attended by staff are cover a wide variety of topics including the changing needs of the people who use the service and worker roles and responsibilities. The quality assurance systems CMG have introduced in recent years cover every aspects of life in the home and use the views of major stakeholders to monitor how successful or not the home has been regards achieving its stated Smitham Downs Road (7) DS0000025837.V353381.R01.S.doc Version 5.2 Page 26 goals. An annual quality assurance report for 2007 was produced on request, which contained a lot of feedback from the people who used the service about the standard of care they received at the home. Documentary evidence in the form of Regulation 26 reports showed monthly inspections continue to be carried out by CMG’s regional managers. In addition to these reports members of CMG’s relatively new quality assurance team also undertake quarterly quality monitoring assessments. All the reports referred to above were found to be extremely thorough, although the providers could do better at following up issues identified as a result of their quality monitoring visits. The manager has completed a comprehensive fire risk assessment of the building, which had recently been up dated to reflect any changes in provision. The homes fire records revealed that the fire alarm system continues to be tested on a weekly basis. However, the record also showed no fire drills had been undertaken for over six months contrary to fire safety Regulations. People who use the service told us they had all participated in a fire drill recently when the fire alarm was set off in the middle of the night. The manager must remind his staff team to record all the fire drills, planned or otherwise, that people who use the service and staff participate in. Up to date Certificates of worthiness were made available on request to show that suitably qualified engineers had checked the homes fire alarms and extinguishers in the past year. During a tour of the kitchen it was noted that all items of food were correctly stored in line with basic food hygiene standards. A set of multi-coloured chopping boards was also observed being used for the safe preparation of food. Smitham Downs Road (7) DS0000025837.V353381.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 X 2 X LIFESTYLES Standard No Score 11 4 12 3 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 X X 2 X Smitham Downs Road (7) DS0000025837.V353381.R01.S.doc Version 5.2 Page 28 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA2 Regulation 9(2)(b)(i) & 18(1) Requirement All staff, including the manager, who will be expected to use CMG’s new compatibility assessment tool must be trained in its use. This will ensure all the people who use the service are kept safe. Timescale for action 01/04/08 2. YA9 13(4) & 14(2) The way in which the service 01/04/08 keeps risk assessments and associated risk management strategies up to date to reflect people changing needs and circumstances must be reviewed. This will ensure the needs of the people who use the service continue to be met. Shelters used by people who smoke must comply with new smoke free England legislation (i.e. Not be enclosed). This will ensure the health of the people who use the service. Radiators within the home must be assessed for the risk they present to the people that use the service and action taken to minimise any identified risk. This DS0000025837.V353381.R01.S.doc 3. YA16 13(4) 01/04/08 4. YA24 13(4)(a) 01/04/08 Smitham Downs Road (7) Version 5.2 Page 29 will ensure the safety of the people who use the service. 5. YA23 18(1) & 23(4)(d) All staff that work in the home must be appropriately trained in fire safety. This will ensure the people who use the service are kept safe. All staff that work in the home must be involved in at least one fire drill every six months or receive fire safety instructions in that time (Staff that work nights must participate in a fire drill or receive additional instruction at least once a quarter). Furthermore, a record of every drill conducted in the home must also be appropriately maintained. This will ensure the safety of the people using the service. 01/06/08 6. YA42 17(2), Schedule 4.14 & 23(4)(e) 15/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP16 Good Practice Recommendations People who choose to smoke should be provided with suitable shelter that meets the new smoking legislation and enables them to smoke in more comfort outside. This will ensure peoples social needs are met. The situation regarding the homes deputy manager who is currently seconded to another CMG service in the area should be clarified as soon as reasonably practicable (i.e. Is the move temporary or permanent?). 2. YA37 Smitham Downs Road (7) DS0000025837.V353381.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Smitham Downs Road (7) DS0000025837.V353381.R01.S.doc Version 5.2 Page 31 - 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. 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