Care Home: St Helier Avenue (374)

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What the care home does well The home continues to provide a generally good service to the present population using the service, there being an excellent rapport between them all, and a focused and respectful interaction with each person living there, related to their individual needs. Ease of communication is key for those using the service, and the home seeks to ensure that there are user friendly visual plans available as well as the formal written documents. All people living at the home have completed person centred care plans and health action plans. The home continues to respond well to equality issues, such as, for example, being comfortable with individual expressions of sexuality, and others expressing their ethnic origins through culturally appropriate celebrations. Those spoken to at the home stated they liked the home, liked their friends, and continued to be happy there. Relatives stated in their questionnaire responses that they felt the standard of the care service was good, some reflecting that it had recently improved; and communication with relatives / friends was felt to be better. One reported: `they welcome input from us`. The new manager had recently arranged a parent / carer meeting which was appreciated by respondents. In response to various questions to relatives / carers relating to good care practice, answers were consistently given in the positive `always` or `usually` brackets - none appearing in the `never` or just `sometimes` sectors. What has improved since the last inspection? The building has transformed from a service offering two people individual attention in separate flatlets alongside the core care services, into an integrated service for all the people using the service. Both of the flatlets are now ensuite rooms as part of the main building, and this has brought about a real sense of unity of purpose to the service. This newly refurbished accommodation, retaining the ensuite factor, is to a higher standard than previous, and all the ground floor is now on a level access basis. There are clearly initiatives being taken to generally improve the communal area of the premises as well. Externally, the front driveway area has improved, with a ramped slope for universal access being provided (a grab rail was also due to be installed - ensuring a `buffer` for when people initially come out of the front door), and external drainage issues, which had been a serious safety problem, are now resolved. What the care home could do better: The management situation has been inconsistent for some long while, with the previous manager of the home having intended to register with the Commission for some while, but leaving before the process was started. The new manager, Harpreet Ghatora, now being in post since early May 2009, intends to register with the Commission as manager. This long term uncertainty has inevitably raised a number of problems in the past year or more, as the staff below the manager have been relied upon to ensure the consistency of service input during the interrupted management input. The core staff members are to be acknowledged for keeping the home going so well. It is now beholden on the Regional Director and higher management to ensure that the new manager at 374 is supported to fully engage with the home and develop the service to an excellent standard, which it can surely attain. The new manager will have to ensure that paperwork and documentation is sorted and organised; folders overfilled with papers can be an administrative nightmare when trying to find / retrieve archive material which may be necessary. Key inspection report Care homes for adults (18-65 years) Name: Address: St Helier Avenue (374) 374 St Helier Avenue Morden Surrey SM4 6JU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sian Jordan-Jones     Date: 2 8 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: St Helier Avenue (374) 374 St Helier Avenue Morden Surrey SM4 6JU 02086480661 02086464165 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.caremanagementgroup.com Care Management Group Ltd (trading as CMG Homes Ltd) Name of registered manager (if applicable) Type of registration: Number of places registered: care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 8 The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Date of last inspection Brief description of the care home 374, St Helier Avenue is managed, maintained and staffed by the Care Management Group (CMG). The care home is registered with the Commission to provide residential care services for up to eight adults with learning disabilities and associated challenging behaviours. The house is a large detached brick built house with a large garden with a patio at the rear. It was converted to its current use in 1999. Situated close to the Rose Hill Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 8 0 7 0 7 2 0 0 9 Brief description of the care home roundabout on the A297 at its junction with the A217, the home is conveniently situated close to a variety of local shops, eating establishments and excellent bus links into Sutton and other local centres. There is a hardstanding at the front of the home for parking a few vehicles, and extra free on street parking is available nearby on the designated dual carriageway verges. Accommodation within the home comprises eight single bedrooms - three on the ground floor, all ensuite, and five on the first floor. There are sufficient bathroom / shower and toilet facilities located throughout the home to meet peoples needs. Communal facilities include a large dining / activities room, a separate comfortable lounge area, a conservatory at the rear of the house overlooking the pleasant back garden, a well-organised kitchen, and a laundry room. In addition, there is a staff sleeping-in room and a small office on the first floor. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We visited the service unannounced, from mid morning to late afternoon, this allowing the majority of those using the service to be personally met, alongside two shifts of staff members. The new Manager in post at the home was, sadly, away from the service - conducting an assessment of a prospective person to use the service. We were, however, ably assisted by Mr Ken Dhluni, the Deputy Manager, who on duty at the time of the visit. Time was spent looking at documentation, checking records, and reviewing the requirements set at the last inspection. We were given free access to any information requested. A number of bedrooms were seen, with the permission of their occupants, as well as all the communal facilities available. The Manager of the service, Harpreet Ghatora, had previously provided an Annual Quality Assurance Assessment (AQAA) document concerning the service to the Commission; some elements within this report are taken from that statement. The AQAA is a self-assessment that focuses on how well outcomes are being met for people Care Homes for Adults (18-65 years) Page 6 of 29 using the service, and it also gives us some up-to-date numerical information about the service. We also looked at notifications sent to us concerning incidents occurring at the home. We also received back a number of questionnaires sent out by us, these being from relatives of people using the service, from members of staff and from the people living there themselves. We are grateful to all at the home for their welcome, co-operation and hospitality during the visit. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: The management situation has been inconsistent for some long while, with the previous manager of the home having intended to register with the Commission for some while, but leaving before the process was started. The new manager, Harpreet Ghatora, now being in post since early May 2009, intends to register with the Commission as manager. This long term uncertainty has inevitably raised a number of problems in the past year or more, as the staff below the manager have been relied upon to ensure the consistency of service input during the interrupted management input. The core staff members are to be acknowledged for keeping the home going so well. It is now beholden on the Regional Director and higher management to ensure Care Homes for Adults (18-65 years) Page 8 of 29 that the new manager at 374 is supported to fully engage with the home and develop the service to an excellent standard, which it can surely attain. The new manager will have to ensure that paperwork and documentation is sorted and organised; folders overfilled with papers can be an administrative nightmare when trying to find / retrieve archive material which may be necessary. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs and aspirations of people using the service are assessed and understood, with related plans carried out at the home. A thorough and considered exploration of behaviours, expressed wishes, and identified needs ensures each person using or coming to the service is treated as an individual. Evidence: CMG have a separate Assessment Team that assesses prospective people who might be suited to use the service, and the manager is then referred people who they feel are likely to fit. It is the management responsibility to consider applicants from a compatibility point of view at the home and to evaluate the best way to approach the process of introduction and integration. The manager visits the prospective resident and they visit the home, then from this, a group of people discuss how the newcomer could be supported as they move into 374. The home has adopted a person centred approach to care planning. In most cases, a member of staff would visit where the newcomer is living, so that they get to know them, and photos of the new and the old act can as memory joggers to assist the Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: connection between the two homes and new staff faces. These steps are planned to take place before a newcomer visits the home, such visits being possibly on a phased, regular basis. The new manager was actually visiting a prospective user of the service on the day of the inspection visit - spending a number of hours appraising and familiarising themselves with the potential newcomers needs and personality. No new people have moved into the service for about a year and a half; this reflecting the stability of the user group who are currently aged between 28 and 52, there being two women and five men accommodated. Authorities placing and monitoring their cases are: Surrey County Council and the London Boroughs of: Sutton, Merton and Lewisham. Care Homes for Adults (18-65 years) Page 12 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service creates and maintains care plan & assessment documents designed to ensure that the needs of those using the service are realistically met in a individually focused way. People using the service can be assured that their rights to individuality and self expression are protected, whilst also acknowledging the community aspect of living in a shared environment. Consultation and sharing of information both involves, and takes into account, the wishes and aspirations of the individual. People can be assured that risk-taking will be an integral part of the support / protection plans put in place by the home. Evidence: We again found that the house has the necessary paperwork to ensure that each person using the service is supported with all necessary identified care services; their person centred plan using both in-house and external assessment documents, Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: alongside the observational records and other reports completed at the home during preliminary visits and during the persons induction. The Provider company offers training to staff in person centred work and also the host local authority, Sutton Council, has excellent support mechanisms for developing this focus. Each individual has a day-to-day activity chart now made accessible through a pictorial format, and also a profile of basic details, their day-to-day notes, a fully completed Health Action Plan (My Health Booklet), local authority review notes, and risk assessments - alongside the initial comprehensive assessments carried out prior to admission. All documentation relating to two people who were case tracked had comprehensive paperwork fully in place. Staff members encourage people using the service to take all reasonable risks whenever possible, and to live life to the full. Risk assessments were in place for all people - this covering various aspects of support, including: personal hygiene, community presence, and specific behaviours likely to challenge. Each assessment identifies the risk, the likely consequences, and the action required to minimise the risks negative effect. Individualised guidelines (i.e. risk management strategies) for those assessed as likely to be aggressive or to self harm have also been drawn up, with the involvement of, and following the advice of, specialist professionals. Reviews and Keyworker meetings are monitored by a matrix held within the office; all people using the service have had their annual review within the past twelve months, and the house actually undertakes a six monthly overview and keyworkers compile a monthly summary of progress. Care Homes for Adults (18-65 years) Page 14 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be sure that the home provides opportunities for them to engage in fulfilling activities both outside, with local community involvement, and in the home. People are assisted to adopt a lifestyle suited to their individual needs, choices and preferences. Relatives and friends can expect a positive welcome from the home, within the context of respect for the choice and decision-making of those using the service. People using the service can expect to be provided with a good standard of nutritious and wholesome food, provided within hygienic conditions, with individual preferences acknowledged, thus ensuring that mealtimes are a pleasant and enjoyable, sociable time. Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: A number of people at the service use a day care centre in Croydon, and others are booked into regular College sessions, at SCOLA and Orchard Hill College. CMG has now also provided its own day activity centre, which two people use and enjoy. Many residents enjoy swimming, and the majority goes bowling as a leisure activity - and cycling at the Croydon Arena is also used. Cinema trips are also a popular daytime or evening activity. Aromatherapy and arts and crafts sessions are also provided within the home. Visits to the seaside and countryside are ongoing regular features and when people are taken home for the weekend, others sometimes go for the ride, which is well enjoyed, and they sometimes stop for refreshments en route. A new accessible vehicle, to replace the current people carrier, is due for delivery to the home very shortly. Holidays are also undertaken, either to centres abroad or in this country, such as Centre Parcs. People engaging in some of these more costly activities part-fund these trips alongside contributions from CMG. A number of individuals also have oneto-one breaks with parents / carers. Relatives and friends of people living at 374 receive a positive welcome; all but two people have close contacts with relatives or friends, with a significant number going home for bank holidays / weekends at varying frequencies. People using the service have been involved in very regular consultation meetings about the service itself; the information is then written up in both words and using symbols to make the information more accessible to all. Cultural needs continue to be specifically identified for the one person currently with minority ethnic needs; this covers personal care input by the keyworker and others, and also ensures that their cultural connections / celebrations are maintained, such as recognising significant calendar dates. We found that mealtimes remain a positive community event at the home, where both service users and staff eat and share together - the latter modeling appropriate behaviour, and ensuring that the experience is good for each and every person at the table. The inspector once again shared food with the community at lunchtime, and clearly this relaxed routine was the everyday experience of the home. Whilst all were afforded choice and preferences, healthy eating was clearly on the agenda and supplies were plentiful and well balanced; dislikes are actively acknowledged. The home has recently been awarded a 4-star rating by the local authority for Very Good Food Safety Management. Care Homes for Adults (18-65 years) Page 16 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be assured that their personal, health care and emotional needs will be recognised and met by the support provided by the home staff, where appropriate through timely medical practitioner interventions, and through the homes longer-term assessment and focus on the health care planning programme. The systems regarding medication adopted by the home ensure the general safety and consistent treatment and support for each service user. Evidence: The observed personal care and support of individuals provided by staff members was appropriate, friendly, and sensitive to their needs. Routines were flexible, and guidance, observation and support offered were generally second nature to them, working alongside people, whilst integrating any necessary assistance. People using the service clearly choose their own clothes and initiate their own activities of choice; they are supported in activities and day-to-day routines by staff and have a more focused relationship with their keyworkers. Health Action Plans are in place for each individual, this enabling a more focused and Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: involving health care process; ensuring that service users are empowered and engaged with the wider issues affecting them in relation to healthcare, to the point of making personal choices about accepting appointments or not. Annual Health Checks were due to be in place by the end of July 2009. The manager is keen to encourage greater engagement of individuals with these Plans; staff members encourage engagement, especially if there is fear or anxiety about taking up an appointment. Medication records and storage were examined, and found to be well kept, though advice was given to thin out the medication file, to ensure more tidy and careful management of the documents; some paperwork was really unnecessary in the immediate file, making it unwieldy and cumbersome. Archiving is also important in respect of medication records, and this thinning process will be beneficial for that reason, too. Medication administration processes were observed - and clearly followed best practice. Boots the Chemist have provided training for staff in management of medication, and also visit the service from time to time. The home works also closely with the psychiatrist / psychologist where necessary to ensure, where behaviours were a cause for concern, such issues could be addressed. Care Homes for Adults (18-65 years) Page 18 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service and their relatives or advocates can be assured that their comments or complaints will be taken notice of, investigated and acted upon within the homes stated procedural timescales. The home provides adequate support and guidance on Safeguarding to people using the service, their advocates and traiing to staff, to ensure that those using the service are protected from harm, neglect and any form of abuse. Evidence: The Complaints Procedure is openly displayed and available in symbols and large print. Complaints are recorded and logged and are dealt with promptly, in line with the CMG protocol. Relatives were clearly aware of the Complaints Procedure, and felt comfortable to make comment - such as at the recent relatives and carers meeting which had been held by the new manager. Adult Protection issues have been handled well by the home in general. Where safeguarding issues have been raised, the Commission has been involved in monitoring the home and the managing company for their conduct, and we are satisfied that the issues have been handled competently and demonstrating a sound knowledge of supporting the individual(s) concerned. People using the service generally receive help with managing their financial affairs, Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: some having a greater capacity in this regard than others. Records in this regard are well kept; the home having audits undertaken by staff from CMG Head Office, thus providing an external overview and independent check, as well as figures being checked during Regulation 26 visits by representatives of the person in control. Care Homes for Adults (18-65 years) Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can expect to live in a clean, warm and comfortable environment increasingly designed to meet their individual needs, and providing good services and domestic facilities for communal living. People using the service can be assured that the home is a safe environment in which to live, without unnecessary risk to themselves or staff. Evidence: The service has again moved on, with significantly improved facilities for three people resident on the ground floor, who now all have ensuite facilities - and have access directly into the home itself, on a level surface throughout the ground floor. The communal areas remain bright and have interesting decor, the manager seeking to introduce more pictures and stimulating aspects to the home. The lounge and dining areas are comfortable and in a generally well maintained state. People using the service have control, to some degree, around their own private space, with a number having been involved in the decoration of their rooms; four bedrooms have been redecorated recently, thanks to making good work after a leak in the roof. The home was generally found to be clean and odour free at the time of the visit - and warm and comfortable for people using the service. Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: We found the rear garden has been greatly improved, and was being well used during the summer; the pond has been filled in and grassed, and the general garden area is now being more safe and inviting to spend time in. The frontage of the house has been improved, with the introduction of a wheelchair friendly, ramped walkway, which is due to be provided with a grab rail down its length very soon. Drainage problems have also been solved, through this work raising the area around the front door where water used to accumulate and create hazardous conditions. Once the grab rail is in place, this will provide some degree of protection to people just being able to race out of the door directly towards St Helier Avenue, which can be a busy and hazardous road. As reported also in the management section, a review of the servicing and maintenance records for the house showed that all necessary contracts and visits were up to date, this ensuring the overarching safety of people using the house. All emergency equipment was up to date with checks, including all new fire fighting equipment provided throughout. Electrical sign offs to the works undertaken when integrating the two previous independent living flatlets within the home itself were also available. Care Homes for Adults (18-65 years) Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be assured that they will be supported at all times by staff who are experienced, duly competent, and well-trained, and provided in sufficient numbers to meet peoples identified needs. The homes recruitment processes and staff support mechanisms are organised so as to ensure the safety, protection and wellbeing of those using the service. Evidence: Staffing levels at the house are provided with a daytime minimum of four workers to the seven people resident within the home. The managers input is generally supernumerary. Two staff members are available on site at night: one awake - and one, on call, asleep. Currently six permanently employed day care staff are augmented by five bank staff and three bank night staff; these are regularly used to ensure the essential continuity / familiarity in care. All bank staff are long term familiar workers, many of whom have worked at 374 for some time. Examination of the staffing rota showed that permanent staff worked many extra hours each week; sometimes long days. Although this should be alleviated once the recruitment process is implemented fully, vigilance remains necessary until the staff numbers increase again. Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: Three full time day support worker posts and two night care worker posts were vacant at the time of the visit. Recruitment advertisements have been placed in the local Job Centre. The Head Office HR department assists with recruiting to these vacancies; interviews are conducted locally, with often a manager from another service also being involved. Staff training continues, with the home accessing local authority training as well as that provided by the registered provider. Staff training in NVQ at Level 2 or above has become more focused, with the proportion of staff members who are qualified in Care at NVQ level 2 or above to over 50 of the staff team, therefore meeting the current National Minimum Standard. Staff training in Emergency First Aid has been provided, ensuring that First Aid cover continues to be provided 24/7, with most of the staff being qualified. Staff supervision had inevitably fallen apart as a consequence of the departure of the previous manager and the lack of time for the deputy to maintain all the management focuses in the interim; such processes were now returning to normal and were noted to be consistent, with a chart of two-monthly 1:1 meetings showing that of most were clearly going to achieve the six sessions over the span of the coming year. Staff meeting minutes for the home were seen, and are now planned to return to the required six times a year minimum. Care Homes for Adults (18-65 years) Page 24 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service operates within management systems that ensure that people using the service benefit from a well-run and competently managed environment. Quality is assessed through both the quality assurance and complaints mechanisms embodied in the Companys policies and procedures, both contributing to the wellbeing and safety of those resident at the home. People using the service can be assured that generally their rights and interests are well served and protected through the homes approach to record keeping, adherence to policy & procedure, and day-to-day conduct of the home. People using the service can be assured that their welfare and health and safety are safeguarded through the homes knowledge base, monitoring and adherence to related legislation and guidance. Evidence: The home Manager - Harpreet Ghatora - has clearly quickly established herself within Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: the home and the staff team, and with those using the service, and has stabilised the service well. It is expected that she will be submitting her application for registration to the Commission as soon as practicable. The uncertainty / instability in the management post at the home has inevitably raised a number of problems in the past year or more, as the staff below manager level have been relied upon to ensure the consistency of service input during this interrupted management input. It is now beholden on the Regional Director and higher management to ensure that the new manager at 374 is supported to fully engage with the home and develop the service to an excellent standard, which it can surely attain in the future. A comprehensive Quality Assurance file is in place at the home, and the contents are a challenge to any new manager coming into a service which has had a succession of temporary managers. User involvement and carer involvement is clearly part of her agenda, however; she has had meetings to consult them both - and to seek ideas for developing the service. This is impressive for somebody relatively new to the service. A user-friendly annual Service user questionnaire is also circulated by CMG each year (also to relatives / friends / other professionals). Evidence of records of the unannounced visits by representatives of the registered provider were noted to be a little patchy, and as stated above, the providing company cannot afford to neglect the home in its (re-)formative stages under new management. It is hoped that 374 will be able to evidence high levels of support in the immediate future. The report format is designed to reflect the Commissions Key Lines of Regulatory Assessment (KLORA) - to encourage self-auditing. Such visits involve checking documentation and the premises - and also cover interviewing both service users and staff. Financial checking is also part and parcel of the agenda for each visit. CMG has a comprehensive set of policies and procedures which cover the broad spectrum of needs identified for a care homes operation; they have a clear focus and the guidance provided is comprehensive. Health & safety aspects of the home were generally well under control; all servicing and maintenance documents / contracts showed all necessary issues were checked and up top date. Fire alarm systems were now being regularly checked after a small spate of gaps earlier in the year, and fire drills were regularly staged. Other relevant checks for the premises were also being well maintained; clearly a number of systems are sufficiently in the routine of the service to keep going even in times of duress. Care Homes for Adults (18-65 years) Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 Once the final new bedroom is completed and put into use, the Statement of Purpose and Service User Guide for the home should be revised and provided to all interested parties, to reflect the change of purpose to the home and the removal of the independent living units. Bathrooms would benefit from having a refurbishment / makeover within the next year. Staffing levels and the amount of overtime worked by individuals must be monitored to ensure that people using the service do not suffer a detriment due to staff not taking adequate breaks. The home would benefit from current paperwork being reviewed and tidied up to ensure that documentation is kept carefully, especially papers which form part of an organizational statutory archive (e.g. maintenance certificates), or relating to an individual person using the service (e.g. medication records). 2 3 27 33 4 41 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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