Care Home: Stanmore House

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What the care home does well There was positive feedback from all involved parties, including service users, relatives and care professionals. One service user clearly stated, "I like living at Stanmore House." All communicated satisfaction with living there. One relative noted through surveys that their relative "is very happy there." Service users are supported to make meaningful choices about their lifestyles through the service. This includes through being offered a wide variety of community recreation options that are of interest to them, and through there being enough staff to support with this. One relative noted a strength of the home being that "they care about the service users` daily activities." Service users fedback very strongly about the wide-variety of activities that they pursue. Regular reviews of each service users` care plan objectives, goals, and risk assessments take place. This helps service users to be clear about the individual support that staff are expected to provide them. Service users are provided with a comfortable and clean home that has been redecorated in many areas since the last inspection. What has improved since the last inspection? The majority of staff have now received formal training courses in a majority of appropriate areas, including for health & safety, emergency first aid, and prevention of abuse. This helps with the provision of effective and safe support to service users. The support of community health and care professionals have been acquired to help individual service users, for instance a psychologist`s support to a service user and training to the staff team. This has helped with the effectiveness and consistency of support to service users. There are now clear guidelines to staff and service users about how staff will provide positive support to service users in particular challenging situations. It is noted that there have been clear decreases in the support needs of some service users, for instance resulting in the withdrawal of the community support team to one service user as that team`s input is no longer needed by the service user. This means that the support by the home is meeting the service user`s needs very well. There are now regular quality checks about the care provided, including with service users and their families. This helps the service respond to the individual and collective needs and wishes of service users. What the care home could do better: An immediate requirement notice was sent to the manager shortly after the inspection. This was because a number of necessary recruitment records were not in place at the time of the visit. The manager was consequently able to explain and supply about the checks in almost all cases, but admitted that one staff member was short of a second written reference. This was duly addressed. Any future people employed must always have two appropriate written references in place, to help ensure that service users are not supplied with staff who could potentially be abusive. Some of the staff team have not yet had training in challenging behaviour from a recognised body. This hinders the staff team from working consistently and effectively with service users whose behaviours at points may be considered challenging. There has been multi-agency agreement for the use of particular sanctions in respect of one service user in certain defined scenarios. Any use of sanctions towards the service user must be clearly and separately recorded about, so that reviews of the effectiveness and appropriateness of the sanctions can easily take place. There is a full list of requirements and recommendations at the back of this report. CARE HOME ADULTS 18-65 Sudbury Care Homes 12 Binyon Crescent 12 Binyon Crescent Stanmore Middlesex HA7 3NF Lead Inspector Clive Heidrich Key Unannounced Inspection 14 and 15th November 2007 16:15 th DS0000065181.V351690.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 DS0000065181.V351690.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. DS0000065181.V351690.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sudbury Care Homes 12 Binyon Crescent Address 12 Binyon Crescent Stanmore Middlesex HA7 3NF 020 8537 3829 020 8537 3829 sudburycarehomes@ntlworld.com 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) Kevin Tyahooa Kevin Tyahooa Care Home 3 Category(ies) of Learning disability (3) registration, with number of places DS0000065181.V351690.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th September 2006 Brief Description of the Service: Stanmore House is a residential home providing personal care and accommodation for 3 people with learning disabilities. At the time of this inspection there were no vacancies at the home. The home aims to provide a normative life for the service users and enable them to enjoy all the facilities and amenities available within the community. The home is situated in a quiet residential area of Stanmore and is close to public transport and shops. The ground floor accommodation consists of a lounge, dining room, conservatory, kitchen, one bedroom with en suite, and one toilet. There is an enclosed garden to the rear of the property. The first floor accommodation consists of two single bedrooms, one staff bedroom, bathrooms and toilets. The home has its own transport that enables service users to access the wider community. Please contact the provider for information about fee levels and the Service User Guide DS0000065181.V351690.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The manager kindly provided the CSCI with a detailed Annual QualityAssurance Assessment (AQAA) document in advance of this unannounced inspection. Surveys were then sent to the manager to distribute. At the time of this inspection, two relatives’ surveys, five health and social care professional surveys, and one staff survey had been received and considered. Their comments are included throughout the report, and are much appreciated. This inspection took place across two weekdays in mid-November. It lasted six hours in total. The focus was on inspecting all of the key standards, and with checking on compliance with requirements from the last inspection report. The inspector met with all of the residents individually, gaining a variety of opinions about living in the home. The inspection process within the home also involved discussions with staff, checks of the environment, and the viewing of a number of records. Feedback was provided to the manager at the end of the visit. An immediate requirement notice was then sent to the manager straight afterwards, to highlight some urgent issues about staff recruitment. See standard 34 for more detail. The inspector thanks all involved in the home for the patience and helpfulness before, during, and after the inspection. What the service does well: What has improved since the last inspection? DS0000065181.V351690.R01.S.doc Version 5.2 Page 6 The majority of staff have now received formal training courses in a majority of appropriate areas, including for health & safety, emergency first aid, and prevention of abuse. This helps with the provision of effective and safe support to service users. The support of community health and care professionals have been acquired to help individual service users, for instance a psychologist’s support to a service user and training to the staff team. This has helped with the effectiveness and consistency of support to service users. There are now clear guidelines to staff and service users about how staff will provide positive support to service users in particular challenging situations. It is noted that there have been clear decreases in the support needs of some service users, for instance resulting in the withdrawal of the community support team to one service user as that team’s input is no longer needed by the service user. This means that the support by the home is meeting the service user’s needs very well. There are now regular quality checks about the care provided, including with service users and their families. This helps the service respond to the individual and collective needs and wishes of service users. What they could do better: An immediate requirement notice was sent to the manager shortly after the inspection. This was because a number of necessary recruitment records were not in place at the time of the visit. The manager was consequently able to explain and supply about the checks in almost all cases, but admitted that one staff member was short of a second written reference. This was duly addressed. Any future people employed must always have two appropriate written references in place, to help ensure that service users are not supplied with staff who could potentially be abusive. Some of the staff team have not yet had training in challenging behaviour from a recognised body. This hinders the staff team from working consistently and effectively with service users whose behaviours at points may be considered challenging. There has been multi-agency agreement for the use of particular sanctions in respect of one service user in certain defined scenarios. Any use of sanctions towards the service user must be clearly and separately recorded about, so that reviews of the effectiveness and appropriateness of the sanctions can easily take place. There is a full list of requirements and recommendations at the back of this report. DS0000065181.V351690.R01.S.doc Version 5.2 Page 7 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. DS0000065181.V351690.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 DS0000065181.V351690.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): 2, 3 and 4. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service has appropriate procedures of acquiring information about prospective service users, assessing their needs, and enabling trial visits. This all helps to ensure that the service can meet the needs of anyone who moves into the home. EVIDENCE: The pre-admission documentation of the newest service user was checked. It showed that the social worker had supplied a written report on the person’s needs, and that the manager had also assessed the person’s needs in advance of them starting trial visits at the home. The manager’s process was appropriately detailed, but would benefit from stating who provided the information and when, to better show who was involved in the process. There were also records of the first visit of the service user that had been signed by the service user, their next-of-kin, and the manager. The manager noted that the service user had visited three times before moving in. Records showed that the process was not rushed. One survey was received from a social worker. It noted satisfaction with the service’s pre-admission information gathering and service-planning. DS0000065181.V351690.R01.S.doc Version 5.2 Page 10 There was strong feedback about how service at the home meets individual needs of service users. Service users spoke positively about the home, one for instance expressing some strong views to the inspector about their previous placement, but communicating satisfaction with where they are now living. Relatives’ surveys noted that service users’ needs are always met. One person noted, “the manager and staff are wonderful, they are so caring and deserve a medal.” This feedback, combined with the many active lifestyle options made available to service users, general observations of appropriate care and support, and trained staff who are provided in sufficient numbers, shows that the service is capable of meeting individual needs. DS0000065181.V351690.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 and 9. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users are provided with strong standards of individual care and goalplanning that clearly involves them. Individual risks are appropriately monitored. These processes collectively guide staff to provide individualised and up-to-date support to service users in a way that enables service users to make significant decisions about their lifestyles. EVIDENCE: Service users were seen to be able to make decisions within the home during the inspection, for instance in terms of going out, choosing whether or not to speak with the inspector, and in terms of freedom of movement around the home. Service users raised no significant concerns with the inspector about being able to make choices. Survey feedback from relatives, care professionals and home staff all indicated that the service at the home supports people to live the life they choose, one independent person for instance stating that “clients choose/plan their menu for the week.” An example provided by the DS0000065181.V351690.R01.S.doc Version 5.2 Page 12 manager was that service users went out shopping for the colour of paint, for recent redecoration in the home. A particular strength of the service is with enabling service users meaningful choice around activities, occupation, and community involvement. This is through the provision of very many community recreation options and enough staff to support chosen pursuits. This is explored in more detail under standards 12-14. Each service user has a care plan in place dating from 2007. The plans explain objectives, the support needed, and anticipated outcomes. This includes such individual issues such as health needs, communication abilities, and community support needs. There are also records of strengths and preferences of the service user, for such things as leisure and clothing. Care plans are signed by the service user, their next-of-kin, and the manager. They are reviewed at least every six months, with clear input from the service user and their next-of-kin also at this stage. There are additional recorded goals for each service user in place, with reviews and revisions to these by keyworkers every couple of months. The goals reflected the individual personalities of each service user. Individual risk assessments are in place and reviewed three-monthly for each service user. They relate to appropriate individual issues, for instance household tasks, community support, and specific behaviours. The manager noted that each service user is provided with a copy of their care plan. One service user spoken with was able to confirm their involvement in the care plan and its reviews. One staff member noted that, “there is always up-to-date information available” in respect of care plans. Records of regular formal review meetings were also in place. These involved the service user, relatives, the manager and key staff, and relevant care professionals. One included the summary statement from the chair, that the service user “is well looked-after at the moment.” DS0000065181.V351690.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): 12, 13, 14, 15, 16 and 17. People who use the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service at the home provides service users with a great deal of opportunity to pursue recreational and occupational activities in the community. Links with family are encouraged and enabled. Service users’ rights and responsibilities in the home are recognised, and appropriate meals are provided. This all enables service users to have individualised and satisfying lifestyles living in this home. EVIDENCE: A strength of the service is that it enables service users to attend different day services and other daytime occupations. At the time of the visit, it was explained that transportation is provided to enable two service users to attend two different day services in Ealing, and to support the third service user with other leisure and skills development work, often in the community. The manager explained that they have helped a couple of service users to acquire voluntary work in separate local shops. Staff provide support to the DS0000065181.V351690.R01.S.doc Version 5.2 Page 14 service user there until all agree that it is not necessary. One service user attended a work-placement qualification course that lasted a year. Another service user tried this work placement but chose not to continue attending. Weekend computing course has been recently acquired for some service users. The service at the home also provides service users with a significant variety of community leisure pursuits. For instance, service users went to a local recreational club just after the inspector left on the first day. Service users told the inspector about going to aircraft museums, the library, and the gym, with staff support. One service user kindly showed the inspector both a video of them using a motorbike, and of various photos relating to this hobby. Discussions between them and the manager established that whilst the service user’s family provides the majority of support here, the service at the home does also support the service user to attend biking events independently. The manager explained that one service user attends church regularly at the weekend. Other service users are welcomed along if they wish to go. Efforts were made to find a church in the wider community that exactly matched the faith of the service user. This was achieved, and the service user now chooses to attend there occasionally, however there are also now strong links with the other church and hence the choice to continue there is often made. There was also positive survey feedback from a community professional about how the service supports religion, namely “The care service has shown respect to each service user’s beliefs.” The manager explained that all service users have active contact with family. The service at the home supports service users with transportation where needed. It is noted that the home has a car that service users can use when those staff who can drive, or the person employed to drive, are present. There was positive survey feedback about how well the service meets the diverse and individual needs of service users. One health professional for instance stated that “the care home takes the service user’s disability into consideration at all times to help promote his independence.” Service users all confirmed to the inspector that they are supported to visit and keep in touch with family. One service user was seen to make a phone call during the visit, which he was seen to undertake by himself. There was survey feedback from relatives to confirm that the home keeps them well-informed and that visits are enabled. The manager noted that service users have been encouraged to feel responsible for the upkeep of the house, which has prompted attitudes that are more independent. For instance, one service user now washes, dries and irons their own clothes with support. DS0000065181.V351690.R01.S.doc Version 5.2 Page 15 The manager explained that keys to the house, their bedroom, and a lockable space within the room, have all been made available to service users. Individuals have used these as wished. The menu for the week contained some pictures relating to the food, to assist people with knowing what was planned for. The menu was seen to be reasonably nutritious. Only one service user requests culturally-appropriate food, which the manager explained is addressed through occasional trips to restaurants and through his family sending specific food parcels. DS0000065181.V351690.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service provides service users with strong standards of health and medication support, so helping service users to address any health needs. Personal support is appropriately individualised, which helps service users to maintain dignity. EVIDENCE: Service users were seen to be offered appropriate personal support where needed during the inspection, albeit that service users are relatively independent in this respect. Service users’ appearance did not make them stand out, which suggests that support is provided by staff if and when needed. Survey feedback from community professionals all fedback positively about whether the service respects service users’ privacy and dignity. One relative noted in respect of the home’s support to service users, that “they are very caring.” There was appropriate documentation about the health support for each service user within their files, based on records made by staff and correspondence from health professionals. This included liaison with a DS0000065181.V351690.R01.S.doc Version 5.2 Page 17 psychiatrist, the GP, opticians, dentists, and specialist workers from the local learning disability team. The correspondence included one case of the worker withdrawing, as their services were no longer needed just a few months after the service user moved in, and also from the psychiatrist in respect of positive support at the home. Records also showed that minor ailments are appropriately addressed, such as taking the service user to A&E as a precaution following a minor accident. The manager noted that some service users are refusing the services of a podiatrist with respect to foot-care. Hence training is being planned for staff, so that they can work at home with service users in respect of simple foot-care tasks where needed. Health professional surveys fedback very positively about how the service helps service users with health needs. One person for instance stated that the home “always put the service users’ care first.” Care professional feedback was similarly positive about the medication support that the home provides. None of the service users self-medicate. A pharmacist supplies 28-day blister packs of medications. These are stored in a secure, wall-mounted cupboard. There are records of consent by service users, to be supported by staff with their medications. Medication is recorded about when delivered, including for when individual prescriptions are acquired in-between the regular 28-day deliveries. There was a stock of factual information sheets relating to the medications, available for checking if needed. There was no excess stock observed. Checks were made of the complex medication supplies of one service user. Administration records tallied with prescription label instructions. There are recorded weekly stock-checks of medications. A sample check of one medication found there to be a discrepancy of two tablets, which could be explained by noting that the time of the stock-check is not recorded. It is recommended that the time of the check be recorded, to help ensure accuracy. A prescribed nasal-spray was seen to have had a date of discard added to it, relative to when it was first used. This is good practice. The spray is used on an as-needed (PRN) basis. There should be guidance on the circumstances of its use in the medication file, to help ensure that it is provided to the service user as per the expectations of its use. The manager explained that all staff attended a day’s training with the pharmacist. New staff are assessed within the home by senior staff, before being enabled to give out medications alone. It is recommended, as evidence of this process, that there be documentation of it. DS0000065181.V351690.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Both of them. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The complaints procedure is openly available for use by service users, which helps ensure that any problems with the service are addressed. The service is almost able to ensure that service users are appropriately protected from abuse. There are a number of improved systems in place, but monitoring and staff training are not quite sufficient to provide service users with appropriate levels of protection. EVIDENCE: There are details about the complaints process on display in the home. A book for recording complaints is openly available by the front door. The manager reviews it every three months. There were two complaints in it since the last inspection, both raised by service users, both about the effectiveness of appliances in the home. Both issues were seen to be resolved. There have been no complaints raised through the CSCI since the last inspection. The manager noted that the service has improved by welcoming complaints rather than seeing them as a negative issue. Survey feedback confirmed that everyone knows about the complaints process and has faith in it. One person noted that, “the manager responded appropriately when my client raised concerns.” There were a number of documents in place as the home’s abuse policy, within the policy file. This included extracts from the local council’s Safeguarding guidance. It was recommended to the manager to review the documentation, DS0000065181.V351690.R01.S.doc Version 5.2 Page 19 and revise it into one clear policy for use at the home, to make it easier to follow. It was positive to note that a council guidance brochure on abuse prevention was seen to be available for one service user in their room. The manager stated that all staff attended abuse-awareness training through Ealing Council. The staff training grid and a sample certificate confirmed this. The manager stated that there have been no abuse referrals since the last inspection. None have been made through the CSCI. The manager explained how the guidance for working positively with one service user has been updated, in respect of their behaviours that can challenge. There were clear written guidelines in support of this. The manager noted that the guidance was set up in conjunction with community health professionals and the service user, and that it was the most effective so far. It was difficult to monitor the use of the agreed sanctions in place from this, as there were no separate or overview records of this. Any use of the sanctions must be clearly recorded about separately, so that reviews of the effectiveness and appropriate use of the sanctions can easily take place. The home has a physical aggression policy that covers the general actions to take if any service user is physically aggressive. The policy limits staff to avoiding restraint or physical intervention unless in emergency, as staff are not trained in this respect. Alternate, holistic strategies are encouraged. There have been a small but significant number of occasions of physical aggression by a service user towards staff and other service users. Appropriate records are kept of this, although sometimes within daily records and at other times on accident/incident forms. The manager should consequently: • Ensure that record-keeping about incident are always recorded in relevant places such as the accident/incident file. • Ensure that those staff who have not yet had formal training on behaviours of service users that challenge, promptly receive this training, so that the whole team is able to work consistently and appropriately. Four staff had had this training at the time of the visit. • Consider whether staff need training on appropriate breakaway techniques, to help ensure that they can retain sufficient control of incidents. The records of the looked-after money of two service users were checked. They were clear, accurate, and up-to-date. Receipts were in place. Where a bank-book was available, it was possible to trace withdrawals from it into the service user’s records in the home. The manager makes regular checks of the books. He also explained service users’ Next-of-Kin have access to make checks of the records where applicable. DS0000065181.V351690.R01.S.doc Version 5.2 Page 20 Discussions with the manager established that there is no clear recorded statement of what service users have to pay for and what the service pays for, expect in contracts with commissioning authorities. No concerns had been raised about this, but a lack of clear statement could lead to future difficulties. It is recommended that details about what service users are expected to pay be added to the Service User Guide, so that service users and their families can be clear on this. DS0000065181.V351690.R01.S.doc Version 5.2 Page 21 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 and 30. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is appropriate to service users’ needs, through the provision of equipment and facilities that provide a homely, clean and safe environment. EVIDENCE: The inspector toured the communal areas of the building, and was invited to view one service user’s bedroom. The home was seen to be clean, tidy, and appropriately maintained from the start of the visit. The home is comfortable, bright, and airy. It provides enough light and ventilation. It is accessible and meets the needs of the current service users. None of the service users raised concerns about the general environment when asked. The manager noted that most communal areas have been redecorated since the last inspection. This includes retiling of the bathroom upstairs. There has been new flooring in one service user’s room. The kitchen has also been deepcleaned. DS0000065181.V351690.R01.S.doc Version 5.2 Page 22 The home has a domestic washing-machine and tumble-drier. The manager reports that most staff have had training on infection control, to help prevent cross-contamination and uphold appropriate hygiene standards. DS0000065181.V351690.R01.S.doc Version 5.2 Page 23 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 and 35. People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users are supported by a capable and appropriately-trained staff team in sufficient numbers to be effective in meeting service users’ collective needs. The hiring of staff who work in the home is occasionally not undertaken appropriately. This could lead to unsafe people working with service users. EVIDENCE: Feedback from surveys was very positive about the staff team, in terms of having the skills and experience to support service users properly. For example, one relative stated, “We think they do a good job at all times.” Observations of staff during the visit found them to be appropriate in their manner with service users, for instance one person being clear to say goodbye to all service users before leaving work. Records showed that two staff have NVQ qualifications at level 2 in care. Two staff are registered to start the course in 2008. Their completion would represent 50 of the staff team, which shows adequate progress towards the expected standard. DS0000065181.V351690.R01.S.doc Version 5.2 Page 24 The manager stated that the home has a 12-week induction process through the National Training Organization. It includes a shadowing process of approximately two weeks, depending on the needs of the new staff member. Records of this process were seen to be appropriate. A training grid showed that essential courses have been undertaken by the vast majority of staff, including for manual handling, emergency first-aid, and fire safety. A sample of the certificates for one person found all expected courses to be in place and dating from 2006 or 2007. There were also planning records for acquiring specific training relative to the needs of service users, for instance in effective communication and on care planning. Rosters for the first two full weeks of November showed that there are always two staff working between at least 7am and 9pm, when service users are present at the home. Levels drop to one staff during the daytime, supporting one specific service user, along with the manager being present to help cover. One person sleeps-over. Two staff work throughout the weekend. There is additionally a driver who recently started work, to assist with transportation to and from day services and potentially with other trips. The manager noted that the staff team cover any gaps in the roster and hence agency staff have not been needed. There has also been low levels of staff turnover. Staffing levels are consequently judged as reasonable. The recruitment files of three newer staff members were checked. At the time of the visit, there were a significant number of gaps within the checks, for instance with references, Criminal Record Bureau (CRB) checks and identification checks. This could lead to unsafe people working with service users. An immediate requirement letter about this was sent to the manager straight after the inspection. The manager responded to each point, explaining overall that the remaining paperwork had in fact been at the service’s other home. He also noted that one necessary written reference had not yet been acquired and that the involved staff member would not work until that had been addressed. Evidence was consequently supplied that addressed these issues, so showing that people are usually hired with appropriate checks. The only issue that must be improved on is making sure that two appropriate written references are in place before anyone starts employment. The home’s recruitment policy should be reviewed and updated to ensure that it specifically itemises the necessary recruitment checks listed in the legislation. This is to help ensure that all of these checks are followed before employing any new staff members. The current policy falls short for instance in specifically mentioning CRBs and PoVA-Firsts, except for students, and does not include about acquiring a reference from the last care-employer if an applicant has such an employer within their employment history. DS0000065181.V351690.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The standard of management at the home is very service-user focussed. Quality assurance systems have been set up to help ensure that the views of service users and others are taken into account in the service’s development and hence better meet service users’ individual needs. Health and safety processes at the home help to ensure that people there are protected. EVIDENCE: The registered manager has completed the NVQ level 4 in care, and has a degree in business studies. He is enthusiastic about the support of service users, especially in exploring facilities and activities available in the locality. He has successfully applied for registration of a similar care home close by recently, which he is also the manager for. DS0000065181.V351690.R01.S.doc Version 5.2 Page 26 Relatives’ surveys noted that they are always kept up-to-date about the home and their relative there. One person stated, “the manager and staff are wonderful, they are so caring and deserve a medal.” Service users similarly fedback positively overall. The social worker survey fedback very positively about the overall service, highlighting communication as a strength of the service. Similarly, a health professional noted, “The care service are excellent at communication and providing updated information as it changes.” The pre-inspection paperwork provided strong evidence of a quality-auditing process that involve service users, their relatives, and external agencies. The manager reported receiving a great deal of feedback from this, which matches with the high number of CSCI surveys received as part of this inspection process. A sample of the service’s feedback forms were seen. These tended to reflect positively on the home. The home was seen to have appropriate health & safety processes at the last inspection, for instance in terms of training, policies, and through environmental adaptations such as thermostatic valves to control hot water temperature. The pre-inspection paperwork, and inspection observations, provided enough additional evidence to show that health and safety systems remain sufficiently in place to protect people using the home. For instance, key professional checks for such things as gas and fire safety are recorded as having happened in 2007, which is appropriately up-to-date. DS0000065181.V351690.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 X 2 3 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 X 3 X 3 X X 3 X DS0000065181.V351690.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA23 Regulation 18(1) Requirement Management must ensure that all staff receive training in challenging behaviour from a recognised body. Previous timescale of 1/11/06 not met. This is so that the whole staff team are able to work consistently and appropriately. Any use of sanctions towards 15/01/08 service users must be clearly and separately recorded about, so that reviews of the effectiveness and appropriateness of the sanctions can easily take place. Appropriate written references 14/12/07 must be acquired directly from two relevant people, before employment of any current or future staff member begins. This is to help ensure that, as far as reasonably practicable, service users are not supplied with staff who could potentially be abusive. Timescale for action 01/04/08 2 YA23 17(2) sch 4 pt 12(b) 3 YA34 19 sch 2 pt 3 DS0000065181.V351690.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA2 YA20 YA20 Good Practice Recommendations The manager should adjust the assessment processes to ensure it clarifies who provided the information and when, to better show who was involved in the process. It is recommended that the time of the weekly medication stock-check be recorded, to help ensure accuracy. There should be guidance in the medication file on the circumstances of use of any as-needed medication, to help ensure that it is provided to the service user as per the expectations of its use. The process of assessing new staff before they are enabled to give out medications alone should be documented about, as evidence of capability. The home’s substantial abuse policy documentation should be reviewed, to revise it into one clear policy that is straightforward to follow. There should be a clear and consistent place for incidents of aggression to be recorded about, to help ensure that monitoring includes all cases. Consideration should be given as to whether staff need training on appropriate breakaway techniques, to help ensure that they can retain sufficient control of incidents. It is recommended that details about what service users are expected to pay be added to the Service User Guide, so that service users and their families can be clear on this. The staff recruitment policy for the home should be reviewed and updated to ensure that it specifically itemises the necessary recruitment checks listed in the legislation, to help ensure that all of these checks are followed before employing any new staff members. This includes for Criminal Record Bureau checks and reference checks. 4 5 6 7 8 YA20 YA23 YA23 YA23 YA23 9 YA34 DS0000065181.V351690.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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. 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