Care Home: St Ann`s Lodge 1

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What the care home does well What has improved since the last inspection? As this is the home inaugural inspection this section will not be applicable on this occasion. What the care home could do better: All the positive comments made above notwithstanding their remains a few areas of practice the service could improve upon and thus enhance the lives of the residents, as well as keep them safe: The way in which the service records risk assessments must be reviewed to ensure the process is made far more transparent. This will enable anyone authorised to inspect care plans to determine whether or not residents rights to live as independently as possible are being respected. Professional advice must be sought from the homes local fire brigade (LFEPA London Fire and Emergency Planning Authority) about the wedging open of fire resistant doors during the day and the risks associated with this practice assessed. Any action taken in response to the outcome of this review must be recorded. This will ensure the safety of the residents. A record of every test of the homes fire alarm equipment, which should be conducted on a weekly basis, must be kept, including any action taken to remedy defects. This will ensure this equipment is appropriately maintained and the residents kept safe. Finally, the way in which the proprietor records the outcome of one to one supervision sessions she has with each member of her staff team should be reviewed and appropriate action taken to make the process more consistent and transparent. In addition, the overall performance and training development needs of all staff that work at the home should be appraised at least once a year and appropriate records kept. This will ensure an appropriately trained and supervised staff team supports the residents. CARE HOME ADULTS 18-65 St Ann`s Lodge 1 1 Lyndhurst Drive New Malden Surrey KT3 5LL Lead Inspector Lee Willis Unannounced Inspection 11th September 2008 12:00p St Ann`s Lodge 1 DS0000071535.V367129.R02.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 St Ann`s Lodge 1 DS0000071535.V367129.R02.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. St Ann`s Lodge 1 DS0000071535.V367129.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Ann`s Lodge 1 Address 1 Lyndhurst Drive New Malden Surrey KT3 5LL 020 8336 0717 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) St Ann`s Limited Gianindree Ammale Fernando Care Home 6 Category(ies) of Learning disability (6) registration, with number of places St Ann`s Lodge 1 DS0000071535.V367129.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender Either whose primary care needs on admission to the home are within the following categories: 2. Learning Disability - Code LD The maximum number of service users who can be accommodated is: 6 N/A Date of last inspection Brief Description of the Service: St Ann’s Lodge 1 is a privately run residential care home that provides accommodation and personal support for up to six generally younger adults with learning disabilities. Mrs Ann Fernando, who co-owns the service with her husband, is the registered manager and is in operational day-to-day control. This converted semi-detached property is next door to the Fernando’s other care home. Located in a suburb street in New Malden the home is very close to some good public transport links and the centre of New Malden is relatively nearby, with its wide range of leisure and community facilities. The service has its own transportation in the form of a minibus. All the residents have a single occupancy bedroom all with ensuite facilities. Communal areas consist of a large open plan lounge, kitchen/dinning area, staff sleep-in room, and a separate laundry room located in the rear garden. There are sufficient numbers of toilets and showers located throughout the home. Space on the ground floor is currently being converted into an office and conservatory. Overall, the new home is decorated to a very high standard and its soft furnishings and fittings are extremely well maintained. The garden at the rear is also well kept, despite on going building work to sink a couple of ponds. There is ample space for parking vehicles in the front drive. St Ann`s Lodge 1 DS0000071535.V367129.R02.S.doc Version 5.2 Page 5 The homes Statement of purpose, Guide, and CSCI inspection reports are available to the residents and their representatives upon request. Information received from the proprietor indicates that the homes fees are £800 per week. St Ann`s Lodge 1 DS0000071535.V367129.R02.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star . This means the people who use the service experience good quality outcomes. This was the services first key inspection and from all the available evidence we gathered during the inspection it was clear it had significantly more strengths than areas of weakness. We spent four hours at the home. During the site visit we met four people who currently reside at St Ann’s lodge 1, the owner/manager, and three people who work there. We also looked at records and documents, including the care plans for two people who had recently moved in. The remainder of this site visit was spent touring the new premises. We received nine ‘have your say’ comment cards about the home. The residents had completed four with some assistance from their representatives, two by their relatives, one by a care manager, and two by staff working at the home. As part of the inspection process the proprietor also completed our Annual Quality Assurance Assessment (AQAA), which tells us how the providers intend to make sure of good outcomes for the residents. What the service does well: All the written and verbal feedback received from the residents, their relatives, a care manager, and the staff working at the home was extremely positive. Some written comments included, (resident) “I love my new home”, (relative)“St Ann’s Lodge is a very happy place, (staff)“it’s a great place to work, the atmosphere is always happy”, and (a care manager) “St Ann’s is like a real home not an institution”. We agree wholeheartedly with the aforementioned comments, especially the one made by the care manager. We also think the service is particularly good at: Providing prospective new residents and their representatives with sufficient opportunities to visit the home and get a feel for the place in order to meet the other residents and staff, view their bedroom, have a meal and possibly stay over night before any decisions about moving in are taken. The layout and interior décor of this home also ensures the residents live in a non-institutional environment that is homely, comfortable, and clean. Residents are actively encouraged to see the home as their own and are very much treated as part of the Fernando’s extended family. St Ann`s Lodge 1 DS0000071535.V367129.R02.S.doc Version 5.2 Page 7 This family run service also ensures the staff team, which remains relatively small, are familiar with individual’s unique needs, strengths, and aspirations. It was also evident from the way the proprietor and her staff team interacted with the residents during the course of the visit that extremely good working relationships with one another that were clearly based on mutual trust and respect. What has improved since the last inspection? What they could do better: 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 St Ann`s Lodge 1 DS0000071535.V367129.R02.S.doc Version 5.2 Page 8 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Ann`s Lodge 1 DS0000071535.V367129.R02.S.doc Version 5.2 Page 9 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 St Ann`s Lodge 1 DS0000071535.V367129.R02.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 & 5 People who use the service experience good quality outcomes in this area. We have made this judgement using arrange of evidence, including a visit to this service. Residents and their representatives are provided with good information about the home which enables them to make an informed decision about whether or not the service is right for them and/or their loved one. The home has excellent arrangements in place to ensure the needs and wishes of prospective residents are fully assessed and that they and their representatives have every opportunity to visit and ‘test drive’ the home before any decision about whether or not the service would be ‘suitable’ are taken. EVIDENCE: One resident told us they had been given a copy of the homes Guide, which they kept in their bedroom. The homes new Statement of purpose and Guide include all the information the residents and/or their representatives need to know about the services and facilities provided. The proprietor was able to produce signed and dated contracts on request in respect of the two residents who had not recently transferred from the St Ann`s Lodge 1 DS0000071535.V367129.R02.S.doc Version 5.2 Page 11 Fernando’s former care home (St Ann’s lodge). These written contracts set out in detail the particular individuals terms and conditions of occupancy including, all the relevant parties rights and obligations, under what circumstances a placement could be terminated, and fees charged for services and facilities provided. The proprietor demonstrated a good understanding of what constituted ‘best’ practice regarding new admissions. She told us that in addition to the three people who had transferred over from the Fernando’s family home, which was no longer operating as a residential care service, two new referrals had been accepted since the opening of St Ann’s Lodge 1. The care manager who completed our survey ticked the ‘usually’ box in response to the question do assessment arrangements ensure accurate information is gathered to meet an individuals needs. The service has exceeded National minimum standards regarding new admissions by ensuring prospective new residents and their representatives (relatives and professionals) have the opportunities to visit the home as often as they choose. These visits for the homes two most recent admissions included joining the other residents for meals, attending a birthday party, and staying overnight on numerous occasions. One resident told us they had been invited to visit the home before deciding to move in. As part of the admissions process the proprietor was able to produce copies of the needs assessments carried out by care managers representing the relevant placing authority. St Ann`s Lodge 1 DS0000071535.V367129.R02.S.doc Version 5.2 Page 12 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 arrange of evidence, including a visit to this service. Care plans reflect what is important to the resident, their capabilities, and what support they need to achieve their personal aspirations. In the main residents are protected by the homes arrangements for assessing and managing identified risk, although there remains significant scope to improve the way the service records the outcomes of these assessments. This will ensure staff have all the information they need to promote residents independent living safely. EVIDENCE: It was evident from the two care plans selected for case tracking that they are person centred and look at all areas of an individual’s life. One resident told us their keyworker had helped them “write stuff in their care plan”. This St Ann`s Lodge 1 DS0000071535.V367129.R02.S.doc Version 5.2 Page 13 individual also knew where their care plan was kept and told us they could access it whenever they liked. Care plans viewed included a lot of detailed information about these resident’s unique strengths, their preferred method of communication, and likes/dislikes. The plans were ‘easy to read’ as they were both written in plain language and illustrated with all manner of pictures and symbols. Residents meetings are held at regular intervals, which are well attended. Residents discussed their feelings about their new home and the new person centred care plan format at the last meeting. The proprietor demonstrated she had a positive approach to managing risk. Mrs Fernando told us she was keen to enable those residents who were willing and capable of doing so to take ‘responsible’ risks as part of a structured programme to help them maintain and develop their independent living skills. Both staff who completed our surveys wrote the home was good at supporting the residents to become more independent. However, the homes approach to recording assessed risk is variable. Consequently, care plans did not always include a record of the risks associated with residents accessing the wider community, using public transport, self-medicating, or having their own front door key for example. St Ann`s Lodge 1 DS0000071535.V367129.R02.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 People who use the service experience good quality outcomes in this area. We have made this judgement using arrange of evidence, including a visit to this service. People who use the service are involved in meaningful daytime activities of their own choice. Meals are varied and nutritionally well balanced ensuring the dietary needs of the residents are well catered for. EVIDENCE: 100 of the surveys returned by the residents and their relatives had ticked the ‘always’ box in response to the question, ‘can you or your loved one make decisions about what they do in the day, evening and at weekends’. On arrival at the home all the residents were either out attending sessions at a local day centre, or involved in an in-house activity either with staff or on their own. For example, one resident was observed helping staff make a cake for a St Ann`s Lodge 1 DS0000071535.V367129.R02.S.doc Version 5.2 Page 15 birthday party, while others were either reading or watching television in main lounge. In the afternoon a member of staff was observed supporting one resident to get ready to go out for a walk in the local community, which was identified in the activity section of their care plan as something they enjoyed doing. The proprietor told us they were planning to have a beauty makeover session in the evening, which one resident told us they looked forward too. The atmosphere in the home during this site visit felt extremely relaxed and congenial. A lot of books, magazines, board games, and art resources were also noted during a tour of the lounge. Records of the activities the two people whose care was being case tracked revealed that had participated in all manner of community based activities throughout the summer including, several trips to the theatre, the cinema, a local jazz club, pubs, parks, and the coast. The proprietor told they had held two BBQ’s in the garden in August in spite of the wet weather. The home has its own vehicle to enable the residents to get out and about. Care plans contain the names and relationships residents have with their families. The homes visitors book is kept in the entrance hall, which showed residents relatives regularly visit the home to attend social evenings and care plan reviews. One resident told us they were good a beating eggs, which staff let them do when they want. All the residents met told us they liked having the Fernando’s dog around. Typical comments made by two residents about the meals provided included, “the food was usually ok”, and “I can choose what I have for lunch”. The lunchtime meal of pasties and salad served on the day of this site visit looked appetising and nutritionally well balanced. The proprietor told us the residents take it in turns to choose what is on the menu each day. If a resident does not fancy the meal offered on the day and it is not their turn to decide the menu they are entitled to choose an alternative dish. A record of the food actually consumed by the residents at mealtimes confirmed they always had a choice of meals at mealtimes. A wide variety of fruit was noted in a large bowl on the kitchen table during a tour of the premises. Residents met told us they could help themselves too fruit and hot drinks whenever they liked. St Ann`s Lodge 1 DS0000071535.V367129.R02.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. 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 arrange of evidence, including a visit to this service. Suitably robust arrangements are in place to ensure the residents receive personal support in the way they prefer and require, and that their unique health care needs are continually recognised and met. Policies and procedures for handling medication are sufficiently robust to keep the residents safe. EVIDENCE: The two care plans examined in depth set out in detail how the home intended to meet these particular residents health care needs. The outcome of all the appointments they attend with various health care professionals are also well maintained by staff. It was positively noted that input from an occupational therapist had been sought to assess one individual’s mobility needs. St Ann`s Lodge 1 DS0000071535.V367129.R02.S.doc Version 5.2 Page 17 No accidents or incidents involving the residents have occurred since the home was opened. The proprietor told us she had recently ordered a new accident book in order to keep carbon copies. She also demonstrated a good understanding of when external agencies such as the CSCI and the relevant placing authorities should be notified without delay about the occurrence of significant incidents involving residents within the home. No recording errors were noted on medication administration sheets sampled at random. All the medication held by the home on resident’s behalves is securely stored away in a locked metal cabinet in the kitchen. The proprietor told us the home does not currently handle any ‘as required’ or Controlled drugs. St Ann`s Lodge 1 DS0000071535.V367129.R02.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. 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 arrange of evidence, including a visit to this service. The homes arrangements for dealing with concerns and complaints are sufficiently robust to ensure the residents and their representatives feel their views will be listened to and acted upon. The residents are protected from abuse and neglect because the home has sufficiently robust procedures in place that are understood by the staff. EVIDENCE: The homes complaints log revealed that no concerns have been raised about its operation since it was opened. The proprietor told us any complaints she received about the home would always be taken seriously and dealt with in a timely manner. Similarly, there have been no allegations of abuse disclosed about the home since it opened. The one member of staff informally interviewed during this visit told us they had received abuse training as part of their induction and demonstrated a good understanding of what constituted abuse and who they should notify if they witnessed or suspected it. Up to date records of resident’s finances were produced on request. The proprietor told us their care managers representing the relevant funding authority frequently audited these records at regular intervals. St Ann`s Lodge 1 DS0000071535.V367129.R02.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 arrange of evidence, including a visit to this service. Residents live in a safe and well-maintained environment that is homely, comfortable, and hygienically clean. Resident’s bedrooms are very personalised and contain all the furniture and fittings that matches their unique tastes and lifestyles. EVIDENCE: A lot of the original features have been maintained in this converted semidetached property ensuring it is a very homely place for the residents to live. During a tour of the premises a lot of photographs of the residents, various ornaments, and flowers were noted in communal areas. The home is also very well lit, and smelt very clean and fresh. St Ann`s Lodge 1 DS0000071535.V367129.R02.S.doc Version 5.2 Page 20 All six bedrooms viewed were furnished and decorated to a good standard. One resident told us they had asked the manager to paint their bedroom pink because it was their favourite colour. The layout of the home ensures the residents can choose to spend time alone in the privacy of their own bedrooms, which all have ensuite facilities, or with the rest of the group in the main lounge or open plan kitchen. The proprietor told us the work on the new ground floor office and conservatory should have been completed by the end of 2008. Progress made to achieve this aim will be assessed at the homes next inspection. It was positively noted that based on the wishes of all the residents the owners were in the process of sinking two new fish ponds in the rear garden, which was highlighted as one residents hobby in their care plan. The proprietors are commended for ensuring this individuals interests continue to be met. The proprietor told us all the homes relatively new baths and showers had been fitted with fail-safe thermostatic mixer valves that prevented temperatures exceeding 43 degrees Celsius. The temperature of hot water emanating from an ensuite shower facility located on the ground floor was found to be a safe 40 degrees Celsius when tested at 14.00. The homes washing machine located in the outside laundry is capable of washing clothes at appropriate temperatures in accordance with environmental health standards. St Ann`s Lodge 1 DS0000071535.V367129.R02.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 arrange of evidence, including a visit to this service. Overall, residents can be sure that they will be kept safe because there are more than enough competent and experienced staff on duty at all times. Residents and their representatives also have confidence in the staff team because all the correct checks have been carried out to minimise the risk of people being employed to work at the home who are ‘unfit’ to support vulnerable adults. Resident’s benefit from being supported by a well-supervised staff team, although the proprietors approach to recording the outcomes of staff supervision sessions and annual appraisals is variable, and will need to be significantly improved. This will ensure the supervision and annual appraisal process is made more open and transparent. St Ann`s Lodge 1 DS0000071535.V367129.R02.S.doc Version 5.2 Page 22 EVIDENCE: All the support workers who were on duty at various times throughout this site visit were observed interacting with the residents in a very caring and respectful manner. 100 of the residents and their relatives who completed our surveys ticked the ‘always’ box in response to the question, ‘do staff treat you well’. They also ticked ‘always’ or ‘usually’ boxes in response to the question, ‘do carers listen to what you have to say’. One resident wrote, “staff are like my friends”. Three members of staff, including the proprietor, were all on duty on arrival. This matched the duty roster for that day. Both the staff who completed our surveys ticked the ‘always’ box in response to the question, ‘is there enough staff employed to meet the residents needs’. The proprietor told us there is always at least two staff on duty throughout the day, which is sufficient to meet the needs of the current resident group. At night one member of staff sleeps-in and a second member who must be capable of reaching the home within 20 minutes is designated as on-call. However, this on-call system will need to be made more transparent as it was not always evident which member of staff was assigned as on-call each night. The home has employed two new members of staff since opening. The rest of the staff team transferred over from the Fernando’s former care home. Documents obtained by the proprietor in respect of these individuals were made available on request and included: completed job application forms; two written references (including one from there previous employers); up to date criminal records bureau (CRB) and Protection of vulnerable adults checks (POVA); and photographic proof of their identities. 100 of staff who completed our surveys responded ‘yes’ to the question, ‘did your induction cover everything you needed to know about the job before you started’. One new member of staff met told us their induction had been very thorough and that they had ‘shadowed’ an experienced member of staff before working on their own. The same members of staff who had returned our surveys also wrote they were ‘always’ given up to date information about the needs of the residents and felt they had been given training that was relevant to their role. Furthermore, a care manager ticked the ‘usually’ box in response to our question, ‘do staff have the right skills and experience to meet individuals social and health care needs’. Staff records sampled at random revealed the vast majority had received training that was relevant to their role as support workers. Sufficient numbers of staff have received training in National Vocational Qualification in care - Level 2 or above, fire safety, first aid, basic food hygiene, health and safety, safeguarding vulnerable adults, handling medication, and makaton. St Ann`s Lodge 1 DS0000071535.V367129.R02.S.doc Version 5.2 Page 23 We strongly recommend the proprietor carries out a thorough training needs and development assessment of her entire staff team to enable anyone authorised to inspect staffing records to determine whether or not the homes staff team are suitably qualified to perform their duties. 100 of staff who completed our surveys responded ‘regularly’ to the question, ‘does your manager meet with you to give you support and to discuss how you are working’. The proprietor told us she spends a lot of time at the home and therefore is constantly liaising with her staff team on a daily basis. A relatively new member of staff confirmed this good practice. However, records of the more formal one-to-one supervision sessions held between the manager and her staff were variable. Furthermore, no records are kept of the appraisals each member of staff should be receiving at least one a year in respect of their overall performance and training needs. We recommend staff recording be significantly improved to make the practice more consistent. Records were produced on request to show staff meetings were being held at regular intervals. Minutes revealed they had been well attended and had covered a variety of topics that were relevant to the running of the home and the needs of the residents. St Ann`s Lodge 1 DS0000071535.V367129.R02.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, 39 & 42 People who use the service experience good quality outcomes in this area. We have made this judgement using arrange of evidence, including a visit to this service. Residents and their representatives have confidence in the care home because a suitably qualified and experienced owner/manager jointly runs the service with her equally competent husband. Sufficiently robust quality assurance and monitoring systems are in place to enable the residents and their representatives to positively influence the homes daily operation and future development. The residents, their guests, and staff are kept safe from avoidable harm because the home has sufficiently robust health and safety arrangements in place. However, there is scope to significantly improve the homes fire containment measures. St Ann`s Lodge 1 DS0000071535.V367129.R02.S.doc Version 5.2 Page 25 EVIDENCE: The proprietor has a wealth of experience as a former adult placement carer and the co-owner/manager of two family run residential care homes for adults with learning disabilities. Mrs Fernando has achieved a National Vocational Qualification Level 4 in management and care. She was also able to demonstrate a good understanding of the unique needs and wishes of the residents, the majority of whom have lived with the Fernando family for many years when Mr and Mrs Fernando were adult placement carers. Mrs Fernando’s very open and hands-on approach to running the home has enabled her to develop excellent relationships with the residents, their relatives, and her staff team. Furthermore, Mrs Fernando’s husband and both her adult children, who are all well known to the majority of the residents having lived and worked with three of them for many years, also continue to be actively involved in the day-to-day running of the home. The proprietor was able to produce a questionnaire she had developed specifically for the resident’s relatives to ascertain their views about how they felt the home was being run. Feedback received thus far was extremely positive about the standard of care their loved ones were being provided at the home. The homes record of fire drills showed they were being routinely carried out on a monthly basis and involved all the residents and staff on duty at the time. However, the recording of the outcome of weekly tests of the homes fire alarm system was variable. Furthermore, during a tour of the premises it was noted that wedges were being used to prop open two fire resistant doors connecting both the lounge and kitchen to the entrance hall. The wedges were immediately removed on request at the time of the site visit and it was agreed this practice should cease until the proprietor had sought professional advice from the London Fire and Emergency Planning Authority (i.e. the homes local fire brigade) about the ‘appropriateness’ of this action. The practice must be risk assessed as a matter of urgency. Up to date Certificate of worthiness were made available on request to show that suitably qualified engineers had checked all the homes gas installations, fire extinguishers and alarms, portable electrical appliances, and electrical system in the past twelve months. During a tour of the kitchen it was noted that all items of food kept there were correctly stored in line with basic food hygiene, including items taken out of their original packaging, which were correctly labelled and dated. St Ann`s Lodge 1 DS0000071535.V367129.R02.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 4 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 4 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 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 3 15 4 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 2 X St Ann`s Lodge 1 DS0000071535.V367129.R02.S.doc Version 5.2 Page 27 N/A 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 YA9 Regulation 13(4) Requirement The way in which the service records risk assessments must be reviewed to ensure the process is far more transparent. This will enable anyone authorised to inspect care plans to determine whether or not residents rights to live as independently as possible are being respected. Timescale for action 01/11/08 2. YA42 23(4)(c)(i) Professional advice must be 01/11/08 sought from the homes local fire brigade (LFEPA - London Fire and Emergency Planning Authority) about the wedging opening of fire resistant doors during the day and the risks associated with this practice assessed. Any action taken in response to the outcome of this review must be recorded. This will ensure the safety of the residents, their guests, and staff. 17(2), Sch A record of every test of the 4.14 homes fire alarm equipment, which should be conducted on a DS0000071535.V367129.R02.S.doc 3. YA42 01/11/08 St Ann`s Lodge 1 Version 5.2 Page 28 weekly basis, must be kept, including any action taken to remedy defects. This will ensure this equipment is appropriately maintained and the residents kept safe. 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 YA33 Good Practice Recommendations The way in which the service identifies which member of staff is designated on-call each night should be reviewed to make these arrangements more open and transparent. How the home assesses its staff teams knowledge and skills should be reviewed in order to make the process of identifying the team’s strengths and training development needs more open and transparent. The way in which the proprietor records the outcome of one-to-one supervision sessions she has with each member of her staff team should be reviewed and appropriate action taken to make the process more consistent and transparent. In addition, the overall performance and training development needs of all staff that work at the home should be appraised at least once a year and appropriate records kept. This will ensure an appropriately trained and supervised staff team supports the residents. 2. YA35 3. YA36 St Ann`s Lodge 1 DS0000071535.V367129.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Ann`s Lodge 1 DS0000071535.V367129.R02.S.doc Version 5.2 Page 30 - 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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