Care Home: Strathleven Road, 94

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What the care home does well This is a very busy, demanding service where staff meet the needs of service users who have challenging behaviours, one service user requiring 1:1 staffing at all times. Nevertheless, a good quality service is being delivered and service users appear happy and well cared for. Areas where the service does particularly well include: • • • • • • • • • Detailed and thorough assessments, and several trial visits, so that the home is sure it can meet service users’ needs and that they will be happy staying at the home Clear and detailed guidelines that ensure service users’ behaviours are understood and interpreted correctly A staff team that is committed to supporting service users’ rights, dignity, privacy and independence Clearly laid out risk assessments that help service users to be safe Enough staffing so that service users can do activities they like and be taken out of the home regularly Good integration of service users into the local community Liaison with the full range of healthcare specialists so that service users’ physical and emotional health needs are met Well trained and qualified staff who are able to provide the care that service users’ need Listening and responding to service users’ and relatives’ views, and supporting them sensitively through difficulties that ariseStrathleven Road, 94DS0000022759.V376306.R01.S.docVersion 5.2 What has improved since the last inspection? The one requirement arising from the previous inspection report of 23rd August 2007 regarding the repair of the disability bath had been implemented. In addition, further improvements had taken place: • • • • The staffing establishment had been increased so that there are now 4 support workers on both the early and late shifts The flooring in the lounge has been replaced, and a new large screen television bought. All bedrooms have had new curtains and have been redecorated There are now 2 disability bathrooms, increasing choice for service users What the care home could do better: There is only one requirement arising from this inspection – that the Registered Provider must ensure that a daily record of meals provided to service users is kept. There are 5 recommendations; ensuring that all risk assessments are reviewed, trying to obtain an advocate for the one service user who has no relatives, ensuring that all health action plans are kept up to date until the new health plans are written, reinstating the previous good practice of keeping a list of specimen staff signatures in the front of the medication file, and removing the unused sluice facility at the home and replacing the two domestic washing machines with industrial washing machines that have a sluice facility. Key inspection report CARE HOME ADULTS 18-65 Strathleven Road, 94 94 Strathleven Road Brixton London SW2 5LF Lead Inspector Ms Rehema Russell Key Unannounced Inspection 25th June 2009 10:00 Strathleven Road, 94 DS0000022759.V376306.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Strathleven Road, 94 DS0000022759.V376306.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Strathleven Road, 94 DS0000022759.V376306.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Strathleven Road, 94 Address 94 Strathleven Road Brixton London SW2 5LF 0207-738 4004 0207 738 4004 manager.strathleven@southsidepartnership.org. uk www.southsidepartnership.org.uk Southside Partnership 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) Kelvin Griffith Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Strathleven Road, 94 DS0000022759.V376306.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 6 places - one of which is used for respite care Date of last inspection 23rd March 2009 Brief Description of the Service: 94 Strathleven Road is purpose built home that is fully wheelchair accessible and situated in a residential area close to a major shopping centre. It is managed by Southside Partnership, a voluntary organisation. The home is close to local shops and buses, and is a short walk from a large shopping centre with full community and public transport facilities. There is metered onstreet parking around the home. There is a paved area at the front of the house and a good-sized garden at the rear of the property. The accommodation is all on the ground floor with six single bedrooms, each with an en suite toilet and wash hand basin. At the time of inspection there were no vacancies at the home. Prospective service users receive an information pack that contains the Statement of Purpose and Service User Guide. A copy of most recent inspection report is available at request at the home. Current fees vary according to the support needs of the individual service user. Strathleven Road, 94 DS0000022759.V376306.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good, quality outcomes. This unannounced inspection took place on 25th June 2009 and was facilitated well by the staff team. The inspector toured the premises; spoke with the manager, deputy manager and two support workers; observed service users and looked at documentation and records. Service users were not able to communicate verbally with the inspector but their behaviours and body language indicated their moods and preferences. An Annual Quality Assurance Assessment form (AQAA) required had been sent to the Commission in February 2009, which was within the timescale set, but after the inspection was found to be in draft only and so was not used to inform this report. What the service does well: This is a very busy, demanding service where staff meet the needs of service users who have challenging behaviours, one service user requiring 1:1 staffing at all times. Nevertheless, a good quality service is being delivered and service users appear happy and well cared for. Areas where the service does particularly well include: • • • • • • • • • Detailed and thorough assessments, and several trial visits, so that the home is sure it can meet service users’ needs and that they will be happy staying at the home Clear and detailed guidelines that ensure service users’ behaviours are understood and interpreted correctly A staff team that is committed to supporting service users’ rights, dignity, privacy and independence Clearly laid out risk assessments that help service users to be safe Enough staffing so that service users can do activities they like and be taken out of the home regularly Good integration of service users into the local community Liaison with the full range of healthcare specialists so that service users’ physical and emotional health needs are met Well trained and qualified staff who are able to provide the care that service users’ need Listening and responding to service users’ and relatives’ views, and supporting them sensitively through difficulties that arise Strathleven Road, 94 DS0000022759.V376306.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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. Strathleven Road, 94 DS0000022759.V376306.R01.S.doc Version 5.2 Page 7 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 Strathleven Road, 94 DS0000022759.V376306.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2, 4 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users’ individual aspirations and needs are fully assessed prior to placement. Prospective service users are supported and encouraged to visit and “test drive” the home, for as many visits as they need. EVIDENCE: There have been no new admissions to the home for several years. At the previous key inspection of 23rd August 2007 there had been two new admissions to the home and the files relating to these admissions were examined. The home had carried out very detailed assessments on both service users, which incorporated obtaining care plans both from the placing authorities and from the previous placement. The home had also obtained communication profiles from the speech & language therapist, which the registered manager had broken down for staff development purposes so that they were easier to read and understand. As further good practice the manager carried out updated speech & language and occupational therapy assessments on site after the service users had been admitted, together with relevant personnel from SLAM (South London & Maudesley hospital). The Strathleven Road, 94 DS0000022759.V376306.R01.S.doc Version 5.2 Page 9 home’s assessment covers all relevant areas of service user care, such as safe environment, communication, eating & drinking, social interaction, sleeping, personal hygiene, behaviours, moods, hobbies & interests, medication and sexuality. In addition, service users’ families attended every meeting held as part of the assessment process, evidenced from the monthly transitional plans that were drawn up. As further good practice, full risk assessments were also in place prior to admission. Both new service users had transferred from a hospital establishment that they had resided in since young. In view of this, both service users had over 20 trial visits to the home and the admission date was extended several times until everyone involved felt that the service users were ready for the move. The trial visits included day visits and overnight stays, and also joining in activities so that they were able to get to know staff and other service users. To further assist the transition, the service users’ families were encouraged to visit them at the home on the days that the service users had overnight stays, which is further good practice. Strathleven Road, 94 DS0000022759.V376306.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are clear and well written but in the process of being changed to support plans based on 7 key citizenship factors. Staff support service users to make decisions about their lives by interpreting their body language and gathering information about their likes and dislikes. Service users are supported to make choices and be as independent as possible via clearly written, thorough risk assessments although a minority of risk assessments have not had a six monthly review. EVIDENCE: The home is in the process of changing from one style of care plan to another (the new ones called Support Plans). The inspector therefore checked the care plans and the new support plans for two service users. Strathleven Road, 94 DS0000022759.V376306.R01.S.doc Version 5.2 Page 11 The “older style” care plans were divided into several sections covering areas such as Person Centred Planning, Working Guidelines, Healthcare and Correspondence. Personal Centred Planning included communication evaluation, communication guidelines, communication passport, health and special needs, risks, cultural needs and religious and spiritual needs. Working Guidelines covered areas such as health and language and activity plans, and Healthcare contained record of hospital, general practitioner and other healthcare visits. The new Support Plan Folders were based on 7 Keys to Citizenship – self determination, direction, money, home, support, community life and health. Each of these 7 key areas has a plan, which is dated and incorporates whether any action is risky and therefore whether there is a risk assessment. The Folders seen also included the previous care plans and monthly review dates. Both Folders had activity charts/rotas and daily programme reports. These care plans evidenced individual service user’s needs, how these were to be met and whether this had been achieved on a daily basis. All service users at the home have limited cognitive and communication abilities and only one can verbalise a few simple words. However, service users are able to communicate their choices and wishes by their body language and behaviours, and staff were observed to interpret and respond to these during the inspection. Examples of decisions made by service users included one service user choosing not to go to his end of college celebration, one service user refusing to eat a meal she didn’t like, and another service user requesting to change his trousers for a pair he preferred to wear. Another example is that one service user saw contemporise using weights and expressed a desire to use them himself so staff are working with physiotherapy to try to achieve this. Guidelines are also present on care plans so that new/agency staff who are not so familiar with service users are also able to interpret service users’ wishes. In addition, staff have gained information about service users’ likes and dislikes from their families. In these ways, service users’ behaviours and staff’s knowledge of their preferences influence the day to day running and other aspects of life at the home. Staff were able to describe the significance of the different behaviours of individual service users very well, and to demonstrate how they enable service users to make choices and decisions. All risk assessments are kept in one file, with a section for each service user. Risk assessments seen were thorough and clearly laid out and the majority had been reviewed six/seven monthly. There were a few older risk assessments that had not been reviewed, and it was not clear whether this was an oversight or whether the risk assessments were no longer valid/necessary. See Recommendation 1. Strathleven Road, 94 DS0000022759.V376306.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 14, 15, 16, 17 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported to access age, peer and culturally appropriate activities, to take part in spiritual and leisure activities and to be part of the local community. Appropriate personal relationships are encouraged and supported, service users’ rights are protected and they are offered a healthy and varied diet. However, staff should keep a record of actual daily meals provided. EVIDENCE: Service users are supported to fulfil their spiritual needs, for example by attending places of worship when their families indicate that this is their wish and service users are willing to do so. Recorded evidence was seen of a service user attending Church twice a month, plus one service user choosing to change to another denomination Church from the one he used to attend. Service Strathleven Road, 94 DS0000022759.V376306.R01.S.doc Version 5.2 Page 13 users’ abilities to learn life skills are limited by their cognitive and physical disabilities, however one service user likes to clear the dining table and another undertakes hoovering, making his bed and loading the laundry with staff assistance. Service users are also quite assertive about their needs around the home, indicating these to staff through their behaviours such as bringing a coat to indicate they wish to go out or wheeling themselves off to their rooms to do drawing or to listen to music. Staff also use pictures cards to enable service users to express their desires and preferences in regard to food and activities. Service users are supported to attend a local educational facility, accompanied by staff, where they take classes such as creative expression, music therapy, cookery and drawing. Service users are also taken to culturally appropriate events and outings, depending on their individual backgrounds and their choice. For example, one service user has an evening meal at a culturally appropriate restaurant, another is taken to a specialist hairdresser. Leisure activities attended regularly include walking to the park, visiting the cinema, visiting cafes and restaurants and going to social clubs. Service users also access the local community via shops, public houses and sports facilities. One service user has a motorbility car which is used to take him on drives out. An arrangement has been made for other service users to make a contribution to costs and so also to be able to use the vehicle. Indoors, service users listen to music, watch television and videos and draw, with one service user enjoying writing simple words. Throughout the inspection, service users were observed to come and go about the home at choice, using the living room, their bedrooms and the kitchen/dining room as they wished. Although most service users choose to go to bed by 10pm most evenings, one prefers to go to bed earlier, another stays up later and often gets up during the night, and one particularly likes to lie in late in the mornings. All but two of the service users have family members who are supported and encouraged by staff to visit regularly. Documentation evidenced that staff liaise closely with service users’ families in regard to service users’ care, whilst protecting service users’ rights, privacy and best interests. There was evidence of relatives being invited to and attending care reviews, and of staff keeping relatives informed of any relevant care issues. Service users’ rights are protected by their external representatives such as a parent/relative/social worker. There is only one service user who has no relative and currently, he also does not have an advocate, so it is recommended that staff try to obtain one for him to ensure that he has an external person to protect his rights. See Recommendation 2. However, the home always calls a best interest meeting for service users whenever necessary, for example when a hospital admission is needed. The home does not employ a cook so staff cook all meals. As staff are from a variety of ethnic backgrounds they are able to provide culturally suitable meals Strathleven Road, 94 DS0000022759.V376306.R01.S.doc Version 5.2 Page 14 if this is what service users want. Service users have all been at the home for several years and so staff are familiar with their likes and dislikes. They are also able to describe how each service user expresses their food preferences, either with verbal or body language. On the day of inspection the lunch was well prepared and presented, smelled good and appeared to be enjoyed by service users. Staff said that they have a basic menu of meals that all service users enjoy, with alternatives available, but they are not currently recording these. The home must keep a daily record of what each service user eats, so that the Commission and other interested parties can ascertain whether individuals are receiving a varied, nutritious and well balanced diet. See Requirement 1. Strathleven Road, 94 DS0000022759.V376306.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff provide sensitive and flexible personal support and service users’ physical and emotional health needs are met. Service users are protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: Observation during the inspection indicated that staff treat service users with respect and are sensitive to their privacy and dignity. Staff were also observed to encourage and support service users to be independent, within the limitations of their mental and physical disabilities. Documentary evidence showed that staff seek specialist support and advice from occupational therapists, physiotherapists, the behavioural support team, the community nurse and any other relevant specialists as service users’ needs require. All service users were well groomed and age-appropriately dressed, with appearance and clothing that reflected their personalities and choice. Strathleven Road, 94 DS0000022759.V376306.R01.S.doc Version 5.2 Page 16 Documentary evidence indicated that service users are supported to access the full range of healthcare professionals as needed, such as the general practitioner, dentist, optician, hospital consultants, speech therapist and physiotherapist. The previous care files each had a Health Action Plan but on one file seen there was no record of it being updated since December 2007, although a list of medical appointments since then had been kept. The new care plans have health as one of the 7 keys of citizenship but these have not been developed for all service users yet. In the meanwhile, the home should ensure that the previous Health Acton Plans are reviewed and kept up to date. See Recommendation 3. Documentary evidence was seen of best interests meetings being held for service users who need medical treatment but do not have the cognitive ability to give permission, nor a parent/guardian who can do this. Risk assessments had been written for health issues where necessary, for example regarding choking, skin infections and catheters. The storage, administration and recording of medication was checked, including a tablet count, and no problems were found. Staff said that medication is checked on every shift and that currently all staff are having their medication practice reviewed during medication training. As good practice the medication records file has a picture of each service user and a PRN (as needed) medication sheet with full information about administration, authorisation and possible side effects. Further good practice is that one service user is being helped to self-medicate and that staff noticed another service user’s seizures had increased since a change in her medication and resolved this by visiting the GP and having the medication changed. A new medicines cabinet has been bought and is waiting to be mounted on the wall. However, the good practice of keeping a list of specimen staff signatures in the front of the medication records file appears to have been stopped, and it is recommended that this is reinstated. See Recommendation 4. Strathleven Road, 94 DS0000022759.V376306.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a clear and thorough complaints procedure and carers’ views are listened to and acted upon. Service users are protected from abuse, neglect and self-harm. EVIDENCE: There is a clear and detailed complaints procedure which meets all requirements of regulation. No formal complaints have been received by the home, or the Commission, in the last year. The home now keeps a second complaints book for service users (“Customers”) that staff can fill in on behalf of service users. Staff are able to describe how each individual service user expresses their dissatisfaction with any situation, either verbally or through their behaviours, and in this way they are able to understand any concerns or complaints on their behalf. All staff have been trained in the prevention of abuse of vulnerable adults and staff spoken had a good understanding of the different forms of abuse, what to do if abuse was suspected, and the procedures that would follow. There is an effective abuse policy and the home has a copy of the local authority’s Adult Protection procedure. There is currently one service user at the home who exhibits aggressive behaviour that could cause harm to other service users or the public. He is given 1:1 staffing and there are working guidelines on how to manage his aggressive behaviour. Strathleven Road, 94 DS0000022759.V376306.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28, 29, 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a homely, comfortable and safe environment, with attractive and comfortable bedrooms that are personalised and suit their needs and lifestyles. There are sufficient bathrooms, which are adapted to suit service users’ disabilities. The communal lounge is attractive and comfortable, and there is a large and easily accessible back garden. The home is clean and hygienic throughout and there are adequate laundry facilities. EVIDENCE: The home is safe, accessible and well maintained. It is purpose built with few architectural features but staff have ensured that the communal areas and majority of bedrooms are attractive, comfortable and homely. New attractive flooring, suitable for wheelchairs yet homely, has been provided throughout. Strathleven Road, 94 DS0000022759.V376306.R01.S.doc Version 5.2 Page 19 There is also a new large television for the lounge, which service users were enjoying, and new blinds. The garden is very large and staff do well to keep it tidy and useable. It was well kept on the day of inspection, with a new swing and some gazebos, and the inspector was told that service users have enjoyed using it this summer. All bedrooms were seen and found to be spacious and personalised according to individual service users’ needs and interests. In addition, staff have put up wall charts in some bedrooms which set out the service user’s daily activities using pictures of the service user undertaking each activity. They are attractive and ideally suited for service users with learning disabilities. Staff have also framed pictures of service users with their families, put up service user’s drawings on their walls, and obtained specially adapted furniture and facilities for individuals. Four bedrooms have en-suite facilities and the other two are located next door to a bathroom. All bedrooms have had new curtains this year. There are two communal bathrooms. One is very large and adapted for people with physical disabilities. It is fully wheelchair accessible. It has a bath which lifts up so that staff do not have to remain bent down in order to assist service users with bathing. There was a long standing problem with this bath in the past but the inspector was pleased to find that it has finally been fixed and is working properly. Staff have also had the shower, which was not used, taken out which will provide even more space once re-tiling has taken place. The communal lounge has been further improved this year and staff have rearranged the furniture so that it is even more spacious. There is a new, very large television and new flooring and it is now attractive and homely. On the day of inspection the home was found to be clean and hygienic throughout. The laundry facilities are in a separate room, opposite the office and far away from the kitchen/diner. Staff label all clothes, towels and flannels, so that service users always retain their own belongings. There are two industrial dryers but although there are also two washing machines, one adapted for people with visual disabilities, both are domestic machines. The previous inspection recommended that the sluice, which needs replacement, is removed and this recommendation is repeated after this inspection. See Recommendation 5. Strathleven Road, 94 DS0000022759.V376306.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported by a competent and effective staff team, that is well trained and qualified and regularly supervised. Service users are protected by the Registered Provider’s recruitment policy and practices and by the extensive training programme provided. EVIDENCE: The staff team has been increased to 17, which allows for 4 support workers on the early shift, and 4 on the late shift. There is also a Manager, a Deputy Manager, one senior support worker and two waking night support workers. The deputy has attained NVQ Level 4, the senior and 5 support workers have attained NVQ Level 3 and the 3 new support workers have begun LDaf training. The home has therefore exceeded the recommended training target, and also exceeded it with qualifications at a higher level than recommended. Staff spoken with demonstrated a good knowledge of individual service users’ characteristics, moods and behaviours and of how to manage challenging Strathleven Road, 94 DS0000022759.V376306.R01.S.doc Version 5.2 Page 21 behaviours. The staff team is mixed in terms of gender and cultural and spiritual background, and so is ideally suited to a similarly mixed client group. There is a high rate of staff turnover and sickness leave at the home, which reflects the level of challenging behaviour and the physical demands of caring for 6 service users of whom 4 are wheelchair dependent and the majority cannot weight bear. Nevertheless, staff said that there is good teamwork at the home. Team meetings are held fortnightly and recorded minutes were seen. The manager, deputy and senior support worker have weekly management meetings, and key worker meetings are held monthly with the manager. The Registered Provider has a recruitment policy that meets all of the requirements of legislation. The Deputy, who joined the home at the end of February 2009, described the recruitment procedure he had undergone, and demonstrated that a thorough and safe recruitment procedure took place. The Registered Provider also provides an induction programme that meets all of the requirements and recommendations of legislation. The Registered Provider has a very thorough and comprehensive training programme, incorporating in-house and external courses, which is also available to bank and agency staff. All mandatory training is updated annually, and a range of other relevant training is available throughout the year. Within the first 6 months of joining the home, staff are trained in challenging behaviour and epilepsy, which are particularly relevant to the client group. Further training needs are discussed during supervision and staff are directed to look through the training book to find courses they wish to attend. Each member of staff has an individual recorded training profile. Strathleven Road, 94 DS0000022759.V376306.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from a well run home and from a management team who are committed to providing a high quality service. Service users views are sought within the limits of their cognitive disabilities and the views of their relatives and carers are also regularly listened to and acted upon. The health, safety and welfare of service users is promoted and protected. EVIDENCE: The registered manager came into post in April 2008 but has already had over 9 years experience at the home as a support worker and then deputy manager. He has NVQ Levels 3 and 4, the Registered Managers Award and Strathleven Road, 94 DS0000022759.V376306.R01.S.doc Version 5.2 Page 23 undertakes periodic training in relevant areas. He is therefore amply qualified and experienced to manage the home. All service users at the home have limited cognitive abilities and only one can verbalise a few simple words. It is not therefore possible to canvass service users’ views on the running of the home and service provision in general but staff try to interpret this using their knowledge of service users’ preferences and needs and by interpreting their behaviours. Currently staff at the home also seek the views of relatives and visitors and feed these back to management via staff and management meetings, and the Registered Provider holds 3-4 monthly Carers Meetings at their head offices. One a year a service user survey is carried out, with staff filling in the survey on behalf of individual service users based on their knowledge and understanding of service users’ needs and behaviours. The Registered Provider also operates an externally verifiable quality monitoring and assurance system for the home, and has a Service Users’ Committee which service users can be supported to attend. Thorough monthly Regulation 26 (registered provider) visits are carried out and reports written with a copy retained at the home. Records seen showed that the following health and safety documentation is in good order: • • • • • • • • • • • Electricity certificate Small electrical appliances Storage of substances hazardous to health (COSHH) Gas safety certificate Arjo bath maintenance Fire detection and equipment Fire drills Fire Risk Assessment Emergency Lighting Employers Liability Insurance Water temperatures (checked and recorded by night staff) Strathleven Road, 94 DS0000022759.V376306.R01.S.doc Version 5.2 Page 24 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 4 3 X 4 4 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 4 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 4 33 3 34 3 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 2 x LIFESTYLES Standard No Score 11 X 12 3 13 4 14 3 15 3 16 4 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 3 x Version 5.2 Page 25 Strathleven Road, 94 DS0000022759.V376306.R01.S.doc Are there any outstanding requirements from the last inspection? No 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 YA17 Regulation 16(2)(i) Requirement The Registered Provider must ensure that a daily record of meals consumed by service users is kept Timescale for action 01/12/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA9 Good Practice Recommendations The Registered Manager should ensure that all risk assessments are reviewed, signed and dated, regularly and that any risk assessments that are no longer needed are signed off. The Registered Manager should try to obtain an advocate for the service users who has no relatives so that his rights are further protected. The Registered Manager should ensure that all Health Action Plans are reviewed and kept up to date until the new 7 keys to citizenship health plans are written. The Registered Manager should reinstate the previous good practice of a list of specimen staff signatures in the front of the medication file. The Registered Provider should consider obtaining industrial washing machines with a sluice facility. DS0000022759.V376306.R01.S.doc Version 5.2 Page 26 2. 3. 4. 5. YA16 YA19 YA20 YA30 Strathleven Road, 94 Strathleven Road, 94 DS0000022759.V376306.R01.S.doc Version 5.2 Page 27 Care Quality Commission National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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